For downloaded applications, kindly remit Rs.50/- (Fifty only) through "Payment Gateway for students &
others" provided in the Online Remittance System in the University website.
Application No.:
(To be Filled by Office)
Application for obtaining Provisional / Extract Certificate
( For Degree / Diploma Examinations )
FOR OFFICE USE ONLY
For D.D. Endorsement
DETAILS OF PAYMENT
(To be filled in by the candidate)
Name and place of the Bank
D.D. Should be enclosed.
………………………………………….……………
Demand Draft No.: ………………………………..
Date of Payment : ………………………………..
Amount Rs.: ………………………………………..
Date:
Register P No:
Sl No:
Initial of the Asst.
Candidates should read the instructions very carefully before filling in the columns. Any column left
blank will cause delay in issuing of certificate.
1. Name as registered in the University Records
(In Block Letters)
}
} …………………………………………..
2. Sex
: Male / Female
3. Date of Birth
: …………………………………………...
4. Name of the Degree course Passed
: ………………………………………..…
5. Last Appearance Register Number
: …………………………………………….
6. Month & Year of passing the Final Examination
: …………………………………………….
7. College in which last studied
: …………………………………………….
8. Branch /Optional Subject Studied
: …………………………………………….
9. If applied for 2nd Provisional Certificate the period
Of C.R.I. to be mentioned here
} CRI From……………. To ……………..
} At …………………………………………
10.Whether applied for convocation and received
the degree or not (in person or in Absentia) If received,
state the date, month and year of convocation.
}
} …………………………………………….
}
10.
Certificate for which applied for kindly tick[  ]
The column applicable
12. Address of the Candidate
(In Block Letters)
}
}
1. Provnl Cert
First.
Second
2. Extract of Convo
} …………………………………………….
} …………………………………………….
} …………………………………………….
Date:
Signature of the Candidate
Endorsement of the Institution
Recommended towards issue of (Strike out whichever is not applicable) First/Second Provincial/ Extract of
convocation certificate as the candidate has passed / fulfill all the prescribed conditions as per the regulations of
this University to receive the Certificate.
Seal:
Date
Signature of the Principal/ Dean
i) Admission register P.No,.:
iii) Certificate Printed Machine No.:
iv) Signature:
Prepared by
Read by
FOR OFFICE USE ONLY
ii)Certificate Issued Folio No.:
Examined by :
CONTROLLER OF EXAMINATIONS.
DETAILS OF PASSING THE DEGREE / DIPLOMA EXAMINATION FOR WHICH THE CANDIDATE
HAS APPLIED FOR THE PROVISIONAL CERTIFICATE / CONVOCATION EXTRACT
This column should be filled in compulsorily by the candidate
Name of the Subject
Reg.No.
With Code
Month & Year of
Name of the College /
Marks
Passing
Centre Code
Obtained
Place : ………………………….
Date
: ………………………….
Signature of the Candidate
INSTRUCTIONS
1. After conferment of a degree at a convocation. Provisional certificate will not be issued. But
only an EXTRACT from the convocation report will be issued based on the affidavit / Police
NOC produced by the candidate.
The fee should be paid through "Payment Gateway for students & others" provided in the
Online Remittance System in the University website. Postal orders and Money orders will
NOT be accepted.
2. A self addressed sufficiently stamped Registered cover should be enclosed for sending the
certificate by REGISTERED POST.
3. NOC of this University should be enclosed at the time of applying for IInd PPC for the CRI
transferred candidate of one recognised institution to another recognised institution.
4. A Xerox copy of H.S.C. mark sheet or equivalent certificate should be enclosed.