CENTRAL UNIVERSITY OF SOUTH BIHAR
Application form for issuance of
Bonafide Certificate / Fee Structure Certificate
Details about the applicant Date of application:.........................
Applied for issuance of (Kindly tick mark ( a ) Bonafide Certificate [ ]
1.
on required certificate) ( b ) Fee Structure Certificate [ ]
2. Name
3. Father's Name
4. Date of Birth [DD/MM/YYYY]
5. Enrolment No.
6. Date of admission
7. Programme and Session
8. Semester
9. Purpose for which certificate is to be issued
10. Address
(a) Copy of Semester Registration
11. Enclosure
(b) Copy of Semester Fee Receipt
12. Signature of the Student with date
Remarks of the HoD : Recommended / Not Recommended Signature of HoD with Date
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For Office Use Only
Diary No........... Date :........................
The details of the student have been verified as per office records and the bonafide
certificate/fee Structure Certificate has been prepared and placed for approval please.
Remarks if any : ..............................................................................................................................
..........................................................................................................................................................
Signature of Dealing Assistant with date
(Name: ......................................................& Designation :......................)
S.O. (Academic)’s remarks:
Deputy Registrar Controller of Examinations
Certificate issued by Ref. No. : CUSB/Acad/..................................... Date :..........................
Original copy of aforesaid issued certificate has been received by me.
Signature of student
