APPLICATION FORM FOR _____ CONVOCATION
SB Collect Reference Number. Date: Amount (Rs): Convocation
NO.
Gulbarga University, Kalaburagi
_____ ANNUAL CONVOCATION FOR
CONFERRING DEGREE
To,
The Registrar (Eval.)
Gulbarga University,
Kalaburagi- 585 106
Sir,
I request for admission to the Degree / Diploma at the University Convocation to be held in the month of
_____________. I have not applied for admission to the Degree prior to this application.
Sl.
No. Particulars To be filled in by the candidate
1. Name of the Applicant in Capital Letters as
per Final Year/Sem. Marks Card
2. Name of the Applicant in Kannada as per
Final Year/Sem. Marks Card
3. Sex: Male / Female
4. Mobile No. / Land Line No.
5. Name of the Course/Degree
6. Name of the College/Department
7. Year of Admission to the
College/Department
8. University Register No. as shown in the Register No:.
Eligibility Certificate/Marks Card. Month & Year:
9. Optional Subjects.
10. Year of completion /passing of the course.
11. No. of Xerox copies of Marks Cards enclosed
(The candidates are required to submit all
Marks Cards.- attempt wise)
12. Indicate, whether your name is common in Yes / No
all your Marks Cards. (The applicant should
verify their marks card from First Sem. /
Year to Final Sem./Year)
1
13. Indicate, whether you have obtained the Yes / No
Provisional Passing Certificate from the
University (Enclose the Xerox copy). If no, Class/Grade Obtained:
the application will be summarily rejected.
14. Address to which the Convocation Certificate
is to be sent (Applicable to the applicants for
award of degree certificate IN ABSENTIA).
PIN Code:
15. Indicate, whether you desire to have the IN PERSON/ IN ABSENTIA
Degree/Diploma Certificate IN PERSON/ IN
ABSENTIA.
16. The details of Prescribed Convocation Fees SB Collect Reference Number:
paid through Online. Enclose the original Purpose of Payment:
e-receipt for State Bank Collect Payment. Amount (Rs):
Date:
17. Postal Address of the applicant
PIN Code.
The information given above is accurate and correct to the best of my knowledge and belief. I have not suppressed
any information, and I have provided all the information to the University for the award of Degree Certificate. If
any, information found to be untrue, the University is at liberty to withdraw my Degree.
Place: Signature: _
Date: Name : _
FOR O FFICE USE
Sl.
No. Particulars To be filled in by the official
1. The particulars of applicant: Convocation No. Year
Page No.
2. Name of the Case Worker scrutinized the
application
3. Name of the person who printed Degree
certificate.
4. Indicate, whether they have put their initial Yes / No
on the degree certificate.
5. Date of receipt of the application
6. Date of disposal of the application
Case Worker Office Supdt. Asst. Registrar Dy. Registrar Registrar (Eva.)