Format No.: QSP/7.5.1/01.

F12
Issue No.02 Dated: April 16, 2014

AUTHORIZATION LETTER

To : Controller of Examination
University of Petroleum & Energy Studies
Dehradun

Authority Letter to Collect the __________________________________________

for Program__________________ Batch _____________ in respect of Enroll.
No._____________ SAP ID_____________ Name _______________________

I authorize Mr./Ms./Mrs.____________________________________________,
Resident of _____________________________________________________________
Telephone No._____________________ whose three specimen signature are appended
below, is hereby authorized to collect the Degree Certificate on my behalf due to my
inability to come personally to collect the same.

_______________ _______________ _______________

Specimen Signature Specimen Signature Specimen Signature

Signature of the Student : _________________________

Name of the Student : _________________________
SAP ID of the Student : _________________________
Enrolment of the Student : _________________________
Program & Batch : _________________________
Telephone No. : _________________________
Date : _________________________
 Degree/Grade card Issuance Application (Self)

To,
The Controller of Examination,
SRE Department,
UPES, Dehradun.

Dear Sir/Madam,

I, ……………………...........................…. (Student Name) want to collect my Degree

certificate(s) as per details mentioned below.

As I am not carrying my college ID card, kindly allow me to collect my degree

certificate(s). I am providing copy of my Government issued ID proof
(DL/PANCARD/PASSPORT/AADHAR CARD/VOTER ID CARD) for verification purpose.

Student Details :

SAP ID : ……………………………………………………………..
Enrl No:………………………………………………………………
Program Name:………………………………………………….
Year of Passing: ………………………………………………….

Student Name :……………………………………………………

Student Signature :………………………………………………

Mobile Number :…………………………………………………

*Issuance of Degree is subject to verification of Student’s signature as per University Records.

* Student have to attach ID proof along with this Application as per ID proof list mentioned above.

For Office Use Only

Verified By Issued By
(Records Section) (Result Section-ACG)
 INFORMATION FORM FOR DUPLICATE ID CARD

(Kindly fill all the details in Capital Letters only)

Date: ………………..
1. Student’s Name : ………………………..………...…………….
(In English Capital Letters – As per 10th Class Certificate) Recent
Passport Size
Colour
2. Program & Branch : …………………..……….. Semester:………. photograph.

3. Enrollment Number : R

4. SAP ID : ………………………………………………..

5. Duration of the Program : From: …..……......… To: ……………………

6. Father’s/Mother’s Name :…………………….………………………………….

7. Address (Permanent) :...……………………………………………………………...

……….…City/Distt:………...………………… State:

…………………... Pin Code: ……………

Phone No.: ………..…………………...
8. Emergency Contact Number :…………………...………….…………………………….

9. Blood Group :………………………………….…………...………………….

10. Date of Birth …………………………………………………………….

Specimen Signature of the Student: ………………………………

 Format No.: QSP/7.5.1/01.F09
Issue No.02 Dated: April 16, 2014

REQUEST FORM FOR MIGRATION CERTIFICATE

Date: ……………

Name of the Candidate (as per 10th certificate) :………………………………………………………..

Enrollment No. : …………………………………………………………..
SAP ID :…………………………………………………………..
Father’s Name :…………………………………………………………..
Course & Branch :…………………………………………………………..
Course Status : Completed / Discontinued
College of Study :…………………………………………………………..
Period of Study :From:……………..…………To:……………………...
Correspondence Address :…………………………………………………………..
…………………………………………………………..
…………………………………………………………..
…………………………………………………………..
Contact No. …………………………………………………………..
Email ID :…………………………………………………………..

……………………….…
(Student’ Signature)

FOR OFFICE USE ONLY

Verified by : ……………………………….. Issued by ………………………………….

Signature :……………………………....... Signature :………………………………….
Date :……………………………...... Date :………………………………….
 Format No.: QSP/7.5.1/01.F21
Issue No.02 Dated: April 16, 2014

University of Petroleum & Energy Studies, Dehradun

School of Legal

NO DUES CERTIFICATE

SAP ID:________________________

Name of the Student: ______________________________Enrollment No.: _________________

Programme: __________________ Batch: ________Reason for leaving: ___________________

It is to certify that the above said student has no dues towards our department:
S. No. Department/Office Dues (if Head of the Signature (with Remarks
any) Department date)
1. Hostel
2. MI Room
3. SEE Manager
4. Admin. Department
5. Career Services H - CSO / CSO
6. Computer / IT
7. Library
8. Finance
9. Alumni Registration @
Corporate Relations
(only for graduating batch)
10. CIMG

Last Class Attended: Date: __________________________

PEP Attended: Signature of Student: _____________
Industrial Tour Attended: ID card Submitted: Yes or No_______

Programme Coordinator: __________ Submitted at SRE on: _____________

Dean (CoLS):__________________ Received by: ____________________

Signature of Registrar: ____________________

 Format No.: QSP/7.5.1/01.F14
Issue No.02 Dated: April 16, 2014

University of Petroleum & Energy Studies, Dehradun

School of Business

NO DUES CERTIFICATE

SAP ID:________________________

Name of the Student: ______________________________Enrollment No.: _____________

Programme: __________________ Batch: ________Reason for leaving: _____________

It is to certify that the above said student has no dues towards our department:
S. No. Department/Office Dues (if Head of the Signature (with Remarks
any) Department date)
1. Hostel
2. MI Room
3. SEE Manager
4. Admin. Department
5. Career Services H - CSO / CSO
6. Computer / IT
7. Library
8. Finance
9. Alumni Registration @
Corporate Relations
(only for graduating batch)

10. CIMG

Last Class Attended: Date: __________________________

PEP Attended: Signature of Student: _____________
Industrial Tour Attended: ID card Submitted: Yes or No_______

Programme Coordinator: __________ Submitted at SRE on: _____________

Dean (CoMES):__________________ Received by: ____________________

Signature of Registrar: ____________________

 Format No.: QSP/7.5.1/02.F13
Issue No.02 Dated: August 06, 2015

School of Engineering / School of Computer Science / School of Design

NO DUES CERTIFICATE

Name of Student: ________________________Enrollment No.: ___________ SAP ID: _____________

Programme: ______________ Batch: ____________ Reason for Leaving: _________________________

S. Dues Head of the Signature
No. Department / Office (if any) Department (with date) Remarks

1. Physics Lab
2. Chemistry Lab
3. Computer Programming Lab
4. Engineering Workshop Lab
5. Electrical and Electronics Lab
6. Concerned Department’s Lab
7. Hostel
8.
MI Room
9.
SEE - Manager
10.
Administration Department
11. Career Services H - CSO / CSO
12.
Library
13.
IT Department
14.
Finance
Alumni Registration @ Corporate Relations
15. (only for graduating batch)

Details to be filled by Course Coordinator:- Date: ________________

 Last Class Attended: ____________________ Id card Submitted : Yes/No:__________

 PEP Attended/ Not Attended: _____________ Signature of Student :_______________

 Industrial Tour Attended/Not attended: ______ Submitted at SRE on: _______________

Signature of Course Coordinator:_______________ Received by: ______________________

Head of the Department: ________________________

Associate Dean/Dean :__________________________ Signature of Registrar: _______________

 Application for Re-Registration of Year Back Students
Date:……………………….

To,
Students Record and Evaluation Department,
University of Petroleum & Energy Studies.

Subject: Re-Registration of Year Back Student

Dear Sir/Madam,

With reference to subject, this is to bring to your kind notice that I have cleared all my backlogs
pertaining to previous semester/year and I have paid the fees for the current semester.

Request you to kindly Re-Register me for the next academic year/session. Details as under:

Name :……………………………………………………………………………………
Program Name : ……………………………………………………………………………………
SAP ID : ……………………………………………………………………………………
Enrolment Number : ……………………………………………………………………………………
Semester to be Registered In : ……………………………………………………………………………………
Mobile Number : ……………………………………………………………………………………

SRE Results Section: (Allowed/Provisionally Allowed):

Name:
Signature:

Finance Department (For Fee Confirmation)

Name:
Signature:

SRE Records Section

Registered Date:…………………… Registered By:
 UNIVERSITY OF PETROLEUM & ENERGY STUDIES
Dehradun
APPLICATION FORM FOR RE-EVALUATION OF ANSWER SCRIPT

SAP No 5 0 0 0 Date of Submission:

Enrolment No : R Programme : ___________

Name : ______________________________ Semester : ___________

Name of Examination : End Semester/ Supplementary _____________________________________

Date/Month/Year of examination to be re-evaluated: ____________________________________

Mobile No:__________________________________ Emergency Contact No:_____________________

S. No. Subject Code Subject Name Grade obtained in the

Subject
1
2
3
4
5

Re-evaluation Fee Rs. 250/- per subject

(Enclose copy of the fee-receipt & Grade card )

UNDERTAKING
I hereby state that this application for re-checking of answer script is submitted within a period of 15 days
from the date of declaration of result. I also understand that re-checking imply only to ascertain, whether
the marks awarded to various answers have been correctly added and the examiner has evaluated answer to
all the questions written by the Examinee.

______________________
Student’s Signature Date:______________

FOR OFFICE USE ONLY

Result Declared on (Date): _________

S. Course Subject Name Change in Marks / Grade Deviation Revised Mark /Grade
No. Code (Yes/No) (Yes/No)
1
2
3
4
5

Checked by Verified by Controller of Examination

Date: ___________