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Shanto-Mariam University Certificate Application

This document contains an application form for students of Shanto-Mariam University of Creative Technology to apply for certificates. The form requests personal information about the student such as name, registration number, program of study, and contact details. It also requests information about the type of certificate being applied for, such as original, transcript, or testimonial. The student must submit photocopies of identity documents like SSC or HSC certificates based on their program. The form collects payment details and requires signatures for clearance from the library, hostel, and accounts department. It provides instructions on filling the form in block letters and attaching passport photos.

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Fazley Rabbi
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1K views1 page

Shanto-Mariam University Certificate Application

This document contains an application form for students of Shanto-Mariam University of Creative Technology to apply for certificates. The form requests personal information about the student such as name, registration number, program of study, and contact details. It also requests information about the type of certificate being applied for, such as original, transcript, or testimonial. The student must submit photocopies of identity documents like SSC or HSC certificates based on their program. The form collects payment details and requires signatures for clearance from the library, hostel, and accounts department. It provides instructions on filling the form in block letters and attaching passport photos.

Uploaded by

Fazley Rabbi
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
  • Application Form for Certificate

Form No.

12

Shanto-Mariam University of Creative Technology


House#01, Road#14, Sector#13, Uttara, Dhaka-1230.
Contact: 88-02-48962714, 48964596, Hotline: 01969904000

APPLICATION FORM FOR CERTIFICATE Attach 4 p.p


size photos
The application form should be written in block / capital letters:
To
The Controller of Examination(s)
Shanto-Mariam University of Creative Technology

Application for Certificates (Please put ( ) tick mark in appropriate Box)


Original, PVC, Transcript, Testimonial, Grade Sheet, Appeared, Others
UNIVERSITY INFORMATION
Name of the Programme: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Student’s Reg. No: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Student’s I.D No: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Batch: . . . . . . . . . . . .
Session: . . . . . . . . . . . . . . . . Date of Publication of Result: . . . . . . . . . . . . . . . . . . . . . . . . . CGPA obtained: . . . . . . . . . . . . . . . . . . . .
PERSONAL INFORMATION
Name of the Student (In Block Capital Letter): . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Father’s Name: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Mother’s Name: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Mailing Address: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Telephone No: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Mobile No: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

To get the certificates from SMUCT you have to enclose the photocopies of following certificates (Please put ( ) tick mark
in appropriate Box) for Hons Programme, SSC,HSC,Dakhil,Alim or A level or equivalent Certificate. For Masters SSC, HSC,
Dakhil, Alim, A level or equivalent Certificate and Graduation Certificates (any discipline)
SSC Certificate, HSC Certificate, B.A/[Link]/[Link] Certificate/[Link]/B.F.A/[Link]/BA(FDT)/BA(AMMT)/BA(GDM)/
BA([Link])/[Link]/BBA/LLB/Others. Dakhil, Alim, Fazil, O’ level, A’ level or ND/HND Certificate.
CERTIFICATE FEE
Amount Paid Tk: . . . . . . . . . . . . . . . . . . . . . . . . Bank Receipt No: . . . . . . . . . . . . . . . . . . . . . . . . . . . Date: . . . . . . . . . . . . . . . . . . . . . .
Name of the bank with branch/SMUCT accounts section . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
I do hereby declare that the above statements made by me are true and correct.

Signature of Student
CLEARANCE PART

Sign. of Librarian Sign. of Hostel Super(if any) Director of Accounts/Authorized officer

Signature of the Authorized officer Delivery Date (Approximate)

STUDENT’S RECEIPT COPY


Serial No: . . . . . . . . . . . . . . . . . . . date: . . . . . . . . . . . . . . . . . . . . . . . . . . .
Name of the student: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ID No: . . . . . . . . . . . . . . . . . . . . . . Attach
Official seal
Student’s Reg. No: . . . . . . . . . . . . . . . . . . . Programme: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . with p.p
size photos
Delivery Date: . . . . . . . . . . . . . . . . .

Signature of the Authorized officer

Shanto-Mariam University of Creative Technology House#01, Road#14, Sector#13, Uttara, Dhaka-1230. Contact: 88-02-48962714, 48

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