Serial No.

Appliation Fee : Rs. 10/-

BANGALORE
Application for the issue of : (Please mention the document required) 1. Name (IN BLOCK LETTERS) (As Registered for University Exams) 2. Residential / Postal Address

UNIVERSITY
For Office Use only ............................................................................. C.W. Suptd. A.R.

......................................................................... ......................................................................... Pin Code :

3. Name of the College/Department 4. a. Name of the Examination /Course/Branch b. Details of Reg. No(s) with year & month of Passing Sl. Register Number I/II/III Year/Semester 1. 2. 3. 4. 5. 6. 5. Indicate the Documents Required 6. Reason(s) for application for the above document(s) 7. Indicate the Change of Branch or College, if any, enclose the copy of permission letter from the Registrar, BUB

Month & Year Exam

Subject / Paper passed

8. Details of Fee paid : Amount..........................(Rupees....................... ...................................................................only) Challan No..........................& Date.................... D.D.No...............................& Date.................... Name of the Bank.............................................. Place ..................................................................

9. Any other information I hereby declare that the information furnished above are true and correct to best of my belief.

Place : Date :

Signature of the Applicant

CERTIFICATE 1. Certified that the information furnished above are correct as per the records of the College. 2. Certified that the candidate had not rejected his/her results of any year/semester and not involved in any examination Mal-practice. Recommended for the issue of the document(s) applied.

Place : Date :

Signature of the Chairperson/ Chairman/Director/Co-ordinator/Principal with seal

NOTE : INCOMPLETE APPLICATIONS WILL NOT BE ACCEPTED

Fee

Name correction in the Xerox Copy of the PUC marks card & a letter from the Rs. 50 + 25 per Marks Card Principal of the College testifying the correct name of year per marks the candidate card thereafter Correction of Marks Card Nature of Correction to be effected in the Marks Card Rs. 50 + 25 per must be clearly indicated and xerox copy of Marks year per marks Card(s) showing wrong Entry shall be enclosed card thereafter A complete set of xerox copies of Marks Card of all successful attempts of all the years of the course including Marks Cards which are having withheld remarks to be enclosed Rs. 100/- per marks card within a month Rs.75 per marks card after a month.

2.

3.

Withheld/removal in the marks card

4.

Duplicate Marks Card

An affidavit on Rs.20/- stamp paper giving details Rs.150/-per Marks such as year, Reg No./Year of passing course/branch, Card plus Rs.50/college and how the original marks card was lost. per year thereafter. One set of xerox copies of all the marks cards of the Rs.300/course/years without withheld remarks shall be enclosed in case withheld, if any can be got it removed simultaneously by paying additional fee as indicated at Sl. No. 3 or get it removed seperately before applying for consolidated Marks Card.

5.

Consolidated Marks Card (Final year only)

6.

Duplicate/Triplicate An affidavit on Rs.20/- stamp paper giving details Rs. 500 + 100 per consolidated marks such as year, Reg. No. month/year of passing year thereafter card course/branch, college and how the original marks card was lost. Verification of benefit Enclose the xerox copy of the Marks Card. of gracing rules Diploma Certificate Rs. 200/(Not refundable)

7.

8.

Diploma Certificate will be issued after 30 days Rs. 100/from the date of announcement of results of the candidate. A complete set of xerox copies of marks cards for having passed all the subjects prescribed shall be enclosed.
An affidavit on a stamp paper of Rs.20/- giving details Rs. 300 + 50 per such as Reg. No./Month/Year of passing Diploma year thereafter Course. A complete set of xerox copies of marks card to be Rs.100/enclosed. per Certificate.

9.

Duplicate Diploma Certificate

10.

Rank Certificate

Sl. No. 11.

Name of the Document Genuiness of Marks Card / Degree Certificate Provisional Degree/ Diploma Certificate Counter Signature

Information/Enclosures to be furnished by the Candidate

Fee

Verification of genuiness of Marks Cards/ Degree Rs. 150/- per set. Certificate per set.

12.

Provisional pass certificate issued by the college after/ Rs. 200/30 days from the date of announcement of results to Certificate. the candidates who have no opportunity to receive the degree certificate. A complete set of xerox copies of marks card for having passed all the subjects prescribed for the various examinations of a degree shall be enclosed. 'Withheld' results if any, must be got released before applying for counter signature on the provisional Certificate (the candidate shall enclose xerox copies for having completed internship in case of candidates seeking counter signature on the provisional certificate for M.B.B.S./B.D.S/B.A.M.S/ BUMS/BHMS & 200 Hrs training certificate for B.Pharma students.)

per

13.

Duplicate Degree Certificate

An affidavit on a stamp paper of Rs.20/- and xerox Rs. 500/- within a copies of all the marks card for having passed in all year plus Rs. 50/the subjects and a News paper Notification issued by per year thereafter. the Registrar (Eva), BUB on behalf of the candidate shall be enclosed (cost of the paper notification shall be borne by the candidate). Enclose the required Transcript's xerox copies of the Rs. 150/- per set. marks cards/Degree Certificate, etc. No Due Certificate from the Institute last attended to Rs. 200/- within a be enclosed year plus Rs. 25/per year thereafter. An affidavit on Rs. 20/- stamp paper giving details Rs. 500 + 50 per how the migration certificate was lost and the institute year thereafter last attended / degree / course / branch passed / completed. Enclose original certificate which required correction Rs. 100 + 50 per indicating the nature of correction. year thereafter.

14.

Official Transcript

15.

Migration Certificate

16.

Duplicate Migration Certificate

17.

Any other correction of certificates

1503-BUP-2,00,000-July 2006