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Application Form for obtaining the Original Degree in Convocation/ABSENTIA for UG/PG/PG Diploma/M.Phil/Ph.D. Programmes

PLEASE ENTER YOUR REGD. NO AND PRESS ENTER KEY
Autonomous Type:
Hallticket No.:
Category:
Category of Application:
Mode of receipt of certificate:
Name of the Candidate:
(In capital strictly as per the SSC records)
Father Name:
(In capital strictly as per the SSC records)
Name of the Programme:
Month & Year of Passing:
Class/Division obtained:
Medium:
Gender:
Address to which OD to be posted:
(In Capital Letters)
 
 
Phone No. with STD Code:
Mobile No.:
Aadhar Card No.:
FEE DETAILS:
SBI Collect Reference Number:
Mode of Payment:
Amount:
Date of Payment:
(Please enclose attested copies of the Marks memos/Grade Cards/Consolidated Statement of Marks/ Consolidated Statement of Grades & Provisional Certificate)
Attachment
(Note: Attachment File size limit: 150 KB)
Photo


(Note: Photo File size limit: 50 KB)



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