SAMBALPUR UNIVERSITY
JYOTI VIHAR – 768019
FORM OF APPLICATION FOR ISSUE OF MIGRATION CERTIFICATE
[To be filled by the student concerned]
From: _____________________________________________________
_____________________________________________________
_____________________________________________________
Name in full with complete address
To,
The Registrar,
Sambalpur University
Jyoti Vihar, Burla
Through the Principal, ______________________________College only for Regular student
Sir,
I would request you kindly to issue a Migration Certificate in my favour, as I intend to join the
__________________________________________University for my further studies. I passed/failed at
the _________________________________ Examination of the Sambalpur University held in the month
of ____________________ with Roll No.___________________________ from the College
__________________________________________________________ or I am at present reading in
________________________ Class in ______________________________ College, P.G. Department.
I passed/failed at the ________________________________________ Examination of the
Sambalpur University held in the month of _________________________________ with Roll No.
_____________________ a Non Collegiate Candidate.
I have paid a fee of Rs. 100/- / Rs. 130/- (Rupees One hundred & one hundred thirty) only in the
shape of B.D. University Cash Receipt No. ________________________________________ Dated
____________________.
In the circumstances, I request that the Migration Certificate prayed for may kindly be issued to
me at your earliest convenience.
At the first instance, I registered my name in this University as a regular student through
__________________________________________________________College _____________________
_______________________________________ or _______________________ Enclosed Registration
Card in Original.
Attested I beg to remain Sir
Signature of the Gazetted Officer
(with Office Seal) Yours faithfully,
(For Non-Collegiate candidates only)
Signature in full
N.B.: Please strike out the words not required. Date ________________
SAMBALPUR UNIVERSITY
(Information required for issue of Migration Certificate)
(To be filled by the institution recommending the application)
1. Name of the College ____________________________________________________________
(In Capital Letters)
2. Name of student ______________________________________________________________
3. Examination passed with year and Roll No. or if he/she is still a student of the institution state the
class in which he/she is reading __________________________________________
4. Whether the fee of Rs. 100/-has been paid to the University direct or credited to the University
account in State Bank of India, Jyoti Vihar or UCO Bank, A. Katapali (Receipt should be attached)
_______________________________________________________________________________
5. Date of birth as in the College Admission Register _______________________________________
_______________________________________________________________________________
6. Date of first Admission to college under the University after passing the Matriculation, H.S.C. or
any other Examination _______________________________________________________
7. Registered Number as a student of University.
8. Date of leaving the College ______________________________________________________
9. Conduct and character of the student during his/her College career
____________________________________________________________________________
10. Opinion of the Principal as to the University’s granting the application a Migration Certificate
____________________________________________________________________________
11. Degree or course the student wants to take in the University he/she wants to join
_________________________________
Memo No. ____________________________, Dated _______________________
Forwarded to the Registrar, Sambalpur University, Jyoti Vihar, and Burla together the application
of issue of Migration Certificate _________________________________________________ in
original for necessary action.
PRINCIPAL
College
(with Official Seal)
N.B.
1. Applicants are advised to go through the instruction before submitting it to the principal, H.O.D.,
Gazetted Officer (In case of non-collegiate candidates only).
2. Money Order, Postal Order will not be accepted, the fees must be remitted in shape of Bank
Draft credited to UCO bank, A. Katapali, S.B.I., Jyoti Vihar or cash in the University cash counter.
The B.D. Cash receipt must be attached to the application form.
3. Application, incomplete in any manner will not be attended to and no correspondence will be
initiated in the matter.
INSTRUCTION FOR ISSUE OF MIGRATION CERTIFICATE
1. (a) Regular student intending to obtain a Migration Certificate from this University should
apply for the same through the Head of the Institution they last studied under the University
otherwise the certificate can not be issued to them.
(b) Non collegiate students who not attended the college under the University be registered
the names as students of this University, should submit their application in this form for issue of
Migration Certificate direct to the University with attestation by a Gazetted Officer.
2. The prescribed fee of Rs.100/- only is to be remitted the Comptroller of Finance, Sambalpur
University to be draw in State Bank of India, Jyoti Vihar / UCO Bank, A. Katapali / University Cash
Receipt / Bank Challan.
3. The requisite fee as stated above must be paid in advance.
4. Student intending to obtain duplicate Migration Certificate, in case the original one is lost or
destroyed should apply on payment of usual fees in the prescribed application form along with
the Court Affidavit.
5. Any student who does not join another University after obtaining Migration Certificate from this
University and if he/she joins this University again should surrender the Migration Certificate in
case he/she joins alongwith usual registration and recognisation fees.
6. The registration receipt in original must be surrendered alongwith this application for issue of
Migration Certificate. In case Migration Certificate is lost or destroyed he/she should apply
alongwith Court Affidavit on payment of usual fees of Rs. 150/- only.
7. For any other information not provided for in the above items a reference may be made to the
Registrar in writing.
8. Any student, who wants to receive the Migration Certificate in person, should show his/her
proper identification.
9. Any student, who wants to obtain the Migration Certificate by Post may remit a sum of Rs. 30/-
extra towards postal charges over and above the prescribed fee of Rs. 100/- only.
10. Students of MBBS, M.D., M.S., BAMS, BHMS, B. Pharma applying for Migration Certificate should
submit a Xerox copy of Provisional / Original Certificate.
REGISTRAR
