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Collection of Certificate Form

The document is a certificate clearance form from Karatina University's Examinations Office. It contains sections for the Finance Department and Examinations Section to verify if a student owes any fees or dues and is cleared to collect their certificate. The form also collects details of the student like their name, registration number, contact information, certificate details, and signature.

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62 views

Collection of Certificate Form

The document is a certificate clearance form from Karatina University's Examinations Office. It contains sections for the Finance Department and Examinations Section to verify if a student owes any fees or dues and is cleared to collect their certificate. The form also collects details of the student like their name, registration number, contact information, certificate details, and signature.

Uploaded by

Nathan
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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KarU/EXM/F/005

KARATINA UNIVERSITY
EXAMINATIONS OFFICE
Collection of Certificate

NAME OF STUDENT:……………………………………………………. REG.NO.:……………………

DATE: ……………………………………………………………………

Please certify whether the student named above owes/does not owe the University and is therefore cleared/not
cleared to collect his/her certificate.

1. FINANCE DEPARTMENT

(A) Fees cleared/not cleared (attach current fees statement)……………………………………..........

SIGNATURE: …………………………………………… DATE: ………………………………….

(B) Graduation and Convocation fees (attach receipt)


Cleared/not cleared

SIGNATURE: …………………………………… DATE: ……………………………

2. EXAMINATIONS SECTION:

SIGNATURE: ………………………….. DATE: …………………………..

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Name of Graduand: …………………………………………………………………………………..

Registration Number: ………………………………………………………………………….

Telephone and Email…………………………………………………………………………………..

Contact Address: ………………………………………………………………………………….

Current Occupation: ………………………………………………………………………………..

Certificate: ,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
(e.g. BSc.,BA, Dip (ECE) etc

Classification: ………………………………………………………………………………......
(e.g. 1st Class, Distinction, Credit etc)

Awarded on: ……………………………………………………………………………..........

Signature: ………………………………………………………………………………….

National I/D Card No./Passport No.: …………………………………………………………………..

Date: …………………………………………………………………………………………………..

………………………………………
Assistant Registrar

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