Scribd
Upload
147 views1 page

Provisional Application Form

The application fee is Rs. 550 which includes the application processing. The form requests information such as the candidate's name, date of birth, degree program, registration numbers, examination details, address and a signature. Copies of all marksheets must be enclosed with the application.

Uploaded by

Gopinathan M
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
147 views1 page

Provisional Application Form

The application fee is Rs. 550 which includes the application processing. The form requests information such as the candidate's name, date of birth, degree program, registration numbers, examination details, address and a signature. Copies of all marksheets must be enclosed with the application.

Uploaded by

Gopinathan M
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
You are on page 1/ 1

Fee for applying Provisional &

Application No :
Convocation Certificates Rs.550/-
(includeing application)

nghpahh; gy;fiyf;fofk;> Nryk; - 11.


PERIYAR UNIVERISTY , SALEM -11
APPLICATION FOR PROVISIONAL & CONVOCATION CERTIFICATES
( FOR ALL DEGREE / DIPLOMA EXAMINATIONS
Details of Payment

(To be Cerefully filled in by the Candidate)


FOR OFFICE USE ONLY

Name and Place of the Bank PROVISIONAL CERTIFICATE DEGREE CERTIFICATE


Folio No : Processed by Folio No : Processed by
....................................................
(D.D should be enclosed)
CertificateNo : Read by CertificateNo : CertificateNo :
Amount Rs...................................

D.D. No........................................
Date of Desp : Section In-Chanrge Date of Desp : Date of Desp :
Date of Payment ..........................

NOTE: 1. Candidate should read the Innstructions (Printed backside) very carefully before filling the columns.

2. Incomplete application will not be accepted and no communication will be sent in this regard.

1. Name as registered in the University Records in


English (In Block letters)

2. Name as registered in the University Records in Tamil

3. Expansion of Initials ( ENGLISH )

( TAMIL )

4. Date of Birth

5. Sex
Male / Female

6. Name of the Degree


(eg. B.A., B.Sc., )

7. Branch / Optional Subjects selected


(eg. Economics )

8. State whether the candidate underwent


Semester / Non - Semester
Semester ot Non-Semester Pattern

9. Last Appearance Register Number

10. Last Appearance Month & Year

11. Last Appearance Examination Centre and


Centre Code

12. College / Study Centre


Name & Code

13. a) Whether already applied for Convocation


Yes / No
and Provisional Certificate

b) If Yes : Details

14. Address of the Cendidate


(In Bloack Letters)

Candidates should enclose the attested copies of all marksheets . (Consolidate statement of marks issued by the the college
will not be accepted )

Place : ................................

Date : ................................ Signature of the Candidate

You might also like