Scribd
Upload
39 views

Duplicate Diploma Form

1) The document is an application form for a duplicate diploma certificate from Rajiv Gandhi Proudyogiki Vishwavidyalaya in Bhopal for a student whose original certificate was lost or destroyed. 2) The application requires information such as the applicant's name, roll number, course details, exam results, and reason for requesting a duplicate, along with enclosures including a fee payment and affidavit. 3) The application must be endorsed by the principal of the applicant's institution, who must verify the applicant's identity and information and attest a photo before forwarding the application to the university secretary.

Uploaded by

Mamma's Corner
Copyright
© © All Rights Reserved
Available Formats
Download as PDF, TXT or read online on Scribd
39 views

Duplicate Diploma Form

1) The document is an application form for a duplicate diploma certificate from Rajiv Gandhi Proudyogiki Vishwavidyalaya in Bhopal for a student whose original certificate was lost or destroyed. 2) The application requires information such as the applicant's name, roll number, course details, exam results, and reason for requesting a duplicate, along with enclosures including a fee payment and affidavit. 3) The application must be endorsed by the principal of the applicant's institution, who must verify the applicant's identity and information and attest a photo before forwarding the application to the university secretary.

Uploaded by

Mamma's Corner
Copyright
© © All Rights Reserved
Available Formats
Download as PDF, TXT or read online on Scribd
You are on page 1/ 2

RAJIV GANDHI PROUDYOGIKI VISHWAVIDYALAYA, BHOPAL

A/4 OFFICE COMPLEX GAUTAM NAGAR, BHOPAL, 462023[M.P.]

APPLICATION FOR DUPLICATE DIPLOMA


Note :

1. This application form should be filled by the candidate itself in capital letters.
2. Incomplete application or applications without requisite enclosers (as below) shall not be considered.
3. Fees once paid are not refundable.

Passport size photo


4. This application should be endorsed by the Principal, overleaf.

attested by the
Principal
To,
The Secretary,
Rajiv Gandhi Proudyogiki Vishwavidyalaya
Bhopal

The original DIPLOMA CERTIFICATE issued to me by the FORMER M.P. BOARD OF TECHNICAL
EDUCATION, BHOPAL / RAJIV GANDHI PROUDYOGIKI VISHWAVIDYALAYA BHOPAL has been lost or
has been destroyed and I am in need of a DUPLICATE COPY of the same.
It is, therefore, requested that a DUPLICATE COPY of the DIPLOMA CERTIFICATE may kindly be issued
to me.
The prescribed fee of Rs. 200=00 (Two Hundred Rupees only) has been paid vide Bank Draft no--------------------
---------dated ------------------- (bank & branch) ----------------------------.

Detailed Particulars:-

1. Name (in English) ------------------------------------------------------------------------

(in Hindi) ------------------------------------------------------------------------

2. Roll no. of the examination ------------------------------------------------------------------------

3. Branch or course of study ------------------------------------------------------------------------

4. Examination passed with month ------------------------------------------------------------------------


and year of passing

5. Division obtained ------------------------------------------------------------------------

6. Mark obtained & max. marks ------------------------------------------------------------------------

7. Serial no of original diploma certificate ------------------------------------------------------------------------

8. Reasons for the demand of the ------------------------------------------------------------------------


duplicate copy (in short)
Contd. ----2----
///2///

9. Present occupation or employment ------------------------------------------------------------------------


with name & address of employer

Date ----------------------

Certified that the information given by me in this application is true and that I shall personally be held
liable for any action in case the information given by me is found to be false.

Enclosers (Please Tick) Your’s Faithfully,


1. Demand Draft of Rs. 200/- in favour of ‘Secretary’, RGPV,
Bhopal payable at Bhopal.
2. Notorised affidavit on Stamp Paper of Rs 10/-
3. Copy of F.I.R./ Complaint lodged in Police Station. (Signature of candidate)
4. Copy of final year marksheet Address in full :----------------
5. Copy of original diploma (if available) ------------------------------------
------------------------------------
Phone No. ----------------(mobile)-----------------------
Email add.: ------------------------------------------------

OFFICE OF THE PRINCIPAL ---------------------------------------------------------------------------------------------

No. : ---------------------------------- Dated :------------------

Forwarded to THE SECRETARY, RAJIV GANDHI PROUDYOGIKI VISHWAVIDYALAYA


[FORMER M.P. BOARD OF TECHNICAL EDUCATION, BHOPAL] for issue of Duplicate Copy of
Diploma Certificate to the candidate. Certified that the identity of the candidate and the information given in the
application have been verified by me and found to be correct. The photograph of the candidate have been
attested by me. The prescribed affidavit produced by the candidate is also enclosed in original.

The prescribed fee of Rs. 200=00 (Two Hundred Rupees only) has been paid by the candidate at Bank
Draft no. -------------------------- Dated ------------------ at Bank & Branch ---------------------------------- is vide
enclosed here with.

Date : ---------------- Signature : --------------------------------

Principal / Supdt.
Office seal

You might also like