` 10.00
MZU / Ex / XIV
Sl. No. …………
MIZORAM
UNIVERSITY
AIZAWL
Application form for Degree Certificate (Original* / Duplicate*)
1. Name of the Degree applied for
: ……...…………………………………………………………….
2. Class / Division / Grade
: ……...…………………………………………………………….
(Mention Honours or General in case of U.G Courses)
3. Name of the Candidate (in block letters): ……...……………………………………………….….…….…
4. Registration No. & Year
: ……..………………………………………………….…….........
5. Father’s Name
: ……..…………………………………………….…………….....
6. Roll No.
: ………………………….......... Year of Passing ………..……..
7. Name of the College / Department
: ………………………..……………………………………….….
8. Complete Postal Address
: ………………………..…………………………………………..
……..……………………………………………………………..
Phone / Mobile No.
: ………………………..…………………………………………..
9. Receipt No. & date of payment of fees : ………………………..………………………………….……….
Countersigned by
:
……………………………………
Principal or Head of the Institution
……………………………
Signature of the Applicant
Station : …………………………………..
Date
: …………………………………..
Note
: The prescribed fee of the Original Certificate and Duplicate Certificate is ` 500/- . Payment
should be made by University Challan deposited to the Finance Department, Mizoram
University or Crossed Bank Draft of SBI / UBI only payable to the Mizoram University, Aizawl.
N.B :- 1. The Candidate should submit an attested copy of last passed Marksheet and Xerox Copy of
Registration Card along with the application form.
2. The Certificate will be issued after 10 (Ten) days from the date of submission of application.
3. *Strike off which is not applicable.