Serial No............................................. Case No............................................

PANJAB UNIVERSITY (for office use )

Fee Code No. R00 40 Application for Duplicate Certificate
(See Instructions overleaf)
NOTE : No person is entitled to apply on behalf of another person or to receive his own or another person’s certificate personally from the office.

A. Particulars of the applicant : B. Fees Paid : Rs...............................................

Name (in Capitals) : Man/Woman/Transgender (Please tick) Rupees........................................................................

ccccccccccccccccccccc Bank Draft...............................................................

Father’s Name :
University Receipt No...........................................
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Mother’s name :

ccccccccccccccccccccc Dated.........................................................................

Date of Birth...........................................................Regd. No.............................................

C. Nature of the certificate required : Duplicate Certificate/Degree/Detailed Marks/Provisional/Merit Subject Certificate (Please Tick).

D. Reason for applying...........................................................................................................................................................................................................................................

E. Examination.........................................................................................Roll No....................................................................Session & Year....................................................

( )
Hons, if any.......................................................................Environment Edu. Sub. if Passed mention R. No., Class, Year .........................................................................
attach Photocopy

Marks obtained................................................Division.........................................Result of Re-evaluation, if any...........................................................

Subjects offered : 1.....................................2.....................................3.....................................4.....................................5......................................6......................................

School/College....................................................................................................................................................................................................................................................

District (for private candidate).......................................................................................................................................................................................................................

Position in order of merit (if applied for merit certificate)............................................................................................................................................................................

F.

Dated................................................................. Signature of the applicant

G. Attestation
I certify that the applicant...........................................................................................................................................son/daughter of
Shri......................................................................................................................is the same person who passed..........................................................
examination under the particulars mentioned above and that he/she is not in any way related to me.

Dated.........................................................

Name & Address of the attesting authority Full Signature of attesting authority
Official stamp
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Attesting authorities : A Fellow of Panjab University, Gazetted Officer, First Class Magistrate, Principal of Affiliated College, Headmaster of the
Govt. School, Officers of Panjab University, whose Grades are equivalent to or higher than the Grades of Assistant Registrar.

H. (for office use)

Particulars checked and found correct. The case is in order. Certificate be issued.

Dealing Official/Assistant Superintendent

(To be filled in by the applicant)

I. Name and address for correspondence Name and address for despatch of certificate

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Mobile No................................................................................ Mobile No................................................................................

Price : Rs. 170/- P.T.O.