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Provisinal Certificate

This document is an application for obtaining a provisional certificate or changing a name from the University of Madras Institute of Distance Education. It provides instructions for applicants, including a fee of Rs. 125 for a provisional certificate or Rs. 1,025 for changing a name. Applicants must fill in personal details like name, enrollment number, exam details, address and mobile number. Required documents like mark statements and course completion certificates should be enclosed along with the application and prescribed fee.

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Wajid K
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255 views2 pages

Provisinal Certificate

This document is an application for obtaining a provisional certificate or changing a name from the University of Madras Institute of Distance Education. It provides instructions for applicants, including a fee of Rs. 125 for a provisional certificate or Rs. 1,025 for changing a name. Applicants must fill in personal details like name, enrollment number, exam details, address and mobile number. Required documents like mark statements and course completion certificates should be enclosed along with the application and prescribed fee.

Uploaded by

Wajid K
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
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Cost of Application Rs.

25/- should be remitted


along with the fee for the issue of certificate

UNIVERSITY OF MADRAS
INSTITUTE OF DISTANCE EDUCATION
IDE Buildings, Chepauk, Chennai – 600005
APPLICATION FOR OBTAINING PROVISIONAL CERTIFICATE / CHANGE OF NAME
(Note : Candidate should read the instructions carefully before filling the columns. Any column left blank will cause delay in issuing the Certificate)
FEE REMITTANCE PARTICULARS (FOR OFFICE USE ONLY) Enclose the Reference copy (FOR ENDORSEMENT)

Name of the Bank


Place of the Bank
D.D. No. & Date /
Bank Ref. No.
Paid Amount Rs. Date: Bank Code :
Degree for which application is now made Subject Enrolment No. Month Year of Passing

NAME OF THE DEGREE & SUBJECT


(Note : Candidate should read the instructions carefully before filling the columns. Any column left blank will cause delay in issuing the Certificate)
Name of the Candidate (in English)
(in BLOCK LETTERS)
as enrolled in the University Records (in Tamil)
Date of Birth (DD/MM/YYYY) Gender (M/F/T)
Name of Father (in Tamil)
Name of Mother (in English)
Name of Examination Passed Enrolment No.
Branch / Optional
Month & Year of Passing
Subject selected
Examination Centre
Semester or Re-Structured Pattern
(Final appearance)
If the candidate has applied for Convocation Degree state the Whether the candidate has enclosed the T.C./Course
month & year of Convocation in which applied Completion Certificate
Whether the candidate has paid all the Fees due to the IDE YES / NO YES / NO
Name :
Residential Address
Address :
to which the Degree has to be sent
:
:
ENROLMENT NUMBER Mobile
PIN
No.
Email ID

Place :
Date : Signature of the Candidate
Note: 1. Candidates who has obtained EXEMPTION ORDER from appearing in any subject(s) should encl. the photocopy of the same together with Three year / Two year mark statements.
2. Candidate should enclose a copy of the Course Completion Certificate/T.C. issued by the Director, IDE for issuance of Provisional Certificate.
To be filled by the Candidate To be filled by the Office
NAME OF THE CANDIDATE Class obtained in UG Course :
NAME OF THE DEGREE Part-I – Language :
ENROLMENT NUMBER Part-II – English :
MONTH & YEAR OF PASSING Part-III – Core Course:
Class obtained in Optional Subject
PG/Diploma : selected
WAM :

Prepare by Read by Examined by Assistant Registrar


-------------------------------------------------------------------------------------------------- CUT HERE ------------------------------------------------------------------------------------------------------
INCOMPLETE ADDRESS WILL CAUSE DELAY

NAME : __________________________________________________________________________
ENROLMENT NUMBER: __________________________________________________________________________
ADDRESS : __________________________________________________________________________
: ____________________________________________________________________
Mobile No. PIN
Cost of Application Rs.25/- should be remitted
along with the fee for the issue of certificate

DETAILS OF THE DEGREE EXAMINATION FOR WHICH THE CANDIDATE HAS APPLIED FOR PROVISIONAL CERTIFIACTE

Name of the Subject En. No./ Month & Examination Marks


Reg. No. Year of Centre Obtained
Passing

Place :
Date :
Signature of the Candidate
N.B. : PHTOCOPY OF ALL THE STATEMENT OF MARKS AND COURSE COMPLETION CERTIFICATE OBTAINED BY THE CANDIDATE
ARE TO BE ENCLOSED FOR ISSUING PROVISIONAL CERTIFICATE.

INSTRUCTION TO CANDIDATES
PRESCRIBED FEE :

1. Fee for Provisional Certificate : Rs.125/- (Rs.100/- for Provisional Certificate and Rs.25/- towards cost of Application for all the Examinations of
this University under various faculties).
2. Fee for Change of Name : Rs.1,025/- (fee for Rs.1,000/- for Change of Name and Rs.25/- towards cost of application) Original Copies of
i) Gazette ii) Statement of marks iii) Provisional Certificate iv) Degree Certificate v) Photo Copy of the Course Completion Certificate /T.C. should
compulsorily be enclosed.
3. Fee should be remitted in the form of Indian Bank Challan/ A/c Payee Demand Draft drawn in favour of “The Director, Institute of Distance
Education, University of Madras, Chennai - 600005” from any Nationalized Bank payable at Chennai.
4. If the particulars provided above are found defective/incomplete and their application will not be accepted and the amount thus paid will not be
refunded at any circumstances.

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