PARUL UNIVERSITY

To,

The University Office, APPLICATION FORM FOR OBTAINING THE CERTIFICATE Application No. ______________

 Name of Student : _____________________________________________________________________ Enrollment Number :_______________________

 Name of Institute : ____________________________________________________________________________________ Shift : 1st / 2nd
 Name of Degree : __________________________________________ Specialization : __________________________________________________________
 In case of pass out students Last Exam Appeared Details : 1. Name of Exam : ________________________________________

2. Exam Seat No. : __________________________ 3. Passing Month/Year : _____________________________

 Are you an External Agency to demand documents verification? Yes Then give your Complete contact detail in
Table No.1 (A) In Presentia (Yes / No.): _________________ (B) In Absentia (Yes / No.): _______________
 To receive document in presentia : 07 days from the date of application

To receive document by post (Postal Address): [Extra Rs.100/- for packaging, handling, postal/Courier charges]
Give complete contact detail in table no.1

(Capital Letters)

PIN:
Contact No. : (M) (R)

Email. ID. :

 Mode of Payment made :

1. CASH _____________ [Receipt Number: _____________________________]
2. D.D __________ [In favor of Parul University]
(A). Demand Draft No. : ______________________ (C). Date : __________________________
(B). Name of Bank : ______________________ (D). Amount : __________________________
3. Online Transfer/Debit Card: To Account Number: 2099586062, IFSC Code: CBIN0284063, Central Bank of India,
Limda. (A). Receipt Number: ______________________ (B). Amount (Rs.): __________________________
 ‘√’ tick marks the documents in the table below.
Type of Documents Attach supporting documents

Transcript, D.D/ Receipt of Online or Cash

Document Verification of Grade Card/Marks Card
Payment
Document Verification of Degree certificate, Migration Certificate,

Document Verification of Provisional Certificate, Progress Report

Document Verification of Teaching Scheme, Rank Certificate
Correction in Grade Card / Marks Card Gold Medal Certificate
Document Verification of Detail Syllabus, Language Certificate,

Duplicate Transcript , Duplicate Migration Certificate A copy of challan for having

registered a complaint of loss
Duplicate Grade Card/ Marks Card, Duplicate Degree certificate
with the police.
Necessary Documents, on
Other Certificate ( Please Specify) __________________________________________________
demand.

Date : ________________ Signature of Applicant

 FOR UNIVERSITY OFFICE USE ONLY

_____________________________ _______________________________

Application Checked by Office Record Verified By

Approved/ Not Approved

__________________________________________ _________________________________ _______________________

Recommendation of CoE. / Registrar Asst. Registrar- Exam Registrar

Certificate Issued on: _____/_____/__________ Signature of Student: _______________

Issue Details:

Receiver’s Name & Signature:

Dated: