Website. Form verification by Exam Section (Grade card no, months, year, semester etc.) Final Verification by the Deputy Registrar

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1 Information for obtaining Duplicate Grade Card/Name correction Grade Card Candidate should follow below flow to get Duplicate Grade card /name correction in Grade card Fill up the Prescribe form for obtaining Duplicate Grade card/name correction in grade card etc. Form available at Exam Section OR Download from University Website Form verification by Exam Section (Grade card no, months, year, semester etc.) Final Verification by the Deputy Registrar Entry of payment in E-governance system Payment of the prescribed fee in Account Section Completed form to be Submitted to Exam Section Collect the copy of duplicate Grade card / name correction (within week) NOTE: 1) For Name correction student should submit their Leaving Certificate & 10th Std. Mark -sheet along with the form.

2 INSTRUCTIONS 1. Application should be made by the candidate in the prescribed format and should be submitted at CHAROTAR UNIVERSITY OF SCIENCE AND TECHNOLOGY, CHARUSAT CAMPUS, CHANGA The following documents should be enclosed along with the application form. (a) An affidavit duly signed and notarized by a First Class Magistrate detailing the circumstances under which the original Degree Certificate was lost/destroyed. (As per the format attached herewith) (b) Photocopy of the Grade Card / Degree Certificate for which duplicate certificate is required (if available) 3. The fee for the issue of various certificate is as follows: (a) For Duplicate Grade Card /- per Grade Card (b) For Duplicate Degree Certificate /- 4. The fee should be paid either in the form of Demand Draft in favour of the Charotar University of Science and Technology OR in cash at CHARUSAT UNIVERSITY office. 5. Fee once paid will not be refunded nor adjusted for any other certificate under any circumstances.

3 FORMAT OF AFFIDAVIT TO BE EXECUTED ON NON-JUDICIAL STAMP PAPER OF THE VALUE OF. 100/- BEFORE A FIRST CLASS MEGISTRATE FOR ISSUE OF DUPLICATE DEGREE CERTIFICATE 1). I Son/Daughter of aged years, an old student / student of Degree of college with Enrollment/ Examination number and residing at do hereby solemnly and sincerely state as follows. 2). I state that I have lost my Degree Certificate (ID No. ) given in the year and if I do manage to recover or the original Degree Certificate, I shall return the Duplicate Degree Certificate to the concerned authorities at CHARUSAT. 3). My Degree/Diploma certificate issued at the Convocation held on 4). I this for the purpose of receiving duplicate Degree Certificate. 5). The facts stated are true and correct to the best of my knowledge and if found false by the University, I shall abide by the decision of the University. 6). I also undertake that if my original Degree Certificate which has been lost, if put to any unfair use by the person who may lay hands on it, I shall stand for the damages which may accrue from such use. 7). The above mentioned facts are true and correct to the best of my knowledge, information and belief. Place : Date : Signature of the Deponent Solemnly at (place) this day of 20

4 CHAROTAR UNIVERSITY OF SCIENCE AND TECHNOLOGY CHARUSAT CAMPUS, CHANGA APPLICATION FORM FOR OBTAINING DUPLICATE : 5 GRADE CARD 5 DEGREE CERTIFICATE A). General Information Date : / / 1. Student ID : 2. Full Name : 3. Address : : : 4. City/ Village : Pin code : 5. Contact No : (Res.) (Mob): 6. B). Academic Information I). For Duplicate Grade Card Semester Month / Year Exam Type (Regular/ Backlog) ii). For Duplicate Degree Certificate Degree Month / Year of Passing Convocation Year /Degree Conferred Year C). Reason for seeking the Duplicate Grade Card / Degree Certificate : D). Declaration : I solemnly declare that the particular given above are correct to the best of my knowledge Office Use Only Signature of Student a). Application Checked by : b). Office Record Verified By : 5 Approved / 5 Not Approved Dy. Registrar Certificate Issued on : Registrar Received Sign. of Student :

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