GITAM UNIVERSITY

(Declared as deemed to be University u/s 3 of UGC Act 1956)

Gandhi Nagar Campus, Rushikonda, Visakhapatnam – 530 045, A.P. INDIA

APPLICATION FOR ISSUE OF MIGRATION CERTIFICATE

1. Name of the Candidate

(in CAPITAL LETTERS)
2. Father/Mother’s Name
B.Tech/M.Tech/M.Sc/MBA/OTHERS(Please specify)
3. Programme

4. Branch

5. Institution
6. PARTICULARS OF LAST EXAMINATION APPEARED
Register No.
Month and Year SEMESTER/TRIMESTER

7. Postal Address

8. Permanent Address

9. Phone No. Mobile: Land Line:

10. E mail Id

Date: Signature of the Candidate

Particulars of Fee Paid : (Payment should be made either through Challan to GITAM University
Account No.35017, Union Bank of India, GITAM Campus Branch,
Visakhapatnam-530 045 OR through DD in favour of The Registrar,
GITAM University, Visakhapatnam-530 045)

Name of the Bank:

Challan/ DD No. Date of Payment:

Amount: Rs. (in words: )

(Original challan/DD should be submitted alongwith this application)

Received the documents as per the application above

Date: Signature of the Candidate

Note: A copy of SSC or equivalent and TC should be enclosed to the application