TEZPUR UNIVERSITY
Please deposit a sum of
Rs………..in Finance for
……….nos.of transcripts.
Application form for Dummy Transcript
Signature
Name of the applicant :
Roll No. / Enrolment No. :
Name of the programme completed from T.U. :
CGPA of the final semester end examination :
Year of completion of the programme :
No. of transcript(s) required :
Purpose for applying the Dummy Transcript(s) :
Names of the Organisations/ Institutions/Universities where the transcript(s) will be sent :
Whether Organisation/ Institution/University sought for the transcript(s) :
(Copy of the letter should be enclosed)
Mailing address (in case the transcripts are desired to be sent by post):
Signature of the applicant
Issue of ………..number of transcript(s) is allowed/not allowed
Asstt. Registrar(Acad)
Controller of Examinations
Received an amount of Rs……………………. (Rupees………………………………………………………)
Vide receipt No. …………………………………… dated………………..
Junior Accountant
………….number of Transcript(s) prepared,
verified and forwarded for your signature.
Dealing Asstt.
Asstt. Registrar(Acad)
Transcript(s) signed
Controller of Examinations
* Rs.50/- (Rupees fifty) only per transcript.
# A copy of original Transcript, duly attested should be enclosed.
# A separate application in plain paper justifying the requirement should be enclosed alongwith this form if
the requirement is more than 05(five).