TEZPUR UNIVERSITY
APPLICATION FORM FOR MIGRATION CERTIFICATE
1. Name in full (in block letters) ……………………………………………………………………...……….…………..
2. Father's name (in block letters) ………………………………………………………………………….……………..
3. Tezpur University Registration No. …………………………… of ………………………….……….………………
4. Educational Qualification:
Examination Name of Board/University Examination Roll
No Year of Passing Division/Class/
Grade
Degree/Diploma
Master Degree
Others
5. Name of the Deptt./Centre where studied last ………………………………………………………………………
6. Course ..………………………… Class ……..………………………. Roll No ...……………………….
7. Reason of obtaining the Migration Certificate …………………………………………….………………….………
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8. Amount Paid Challan No. & Date Crossed Bank Draft No. & Date
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9. I declare that I have not been debarred from appearing in any examination during the period of my study in Tezpur University.
10. I surrender my Registration Certificate bearing No. ……………………….…….. of …….…………….……………….
Date : Signature of the applicant
RECOMMENDATION OF THE HEAD OF THE DEPTT./CENTRE
The particulars stated above have been checked, verified and found correct. Migration Certificate may be issued.
Memo No. …..……………. Date …………………….. Signature of the Head with Seal
RECOMMENDATION OF THE DEAN, STUDENTS’ WELFARE
The applicant has not been punished for committing or abetting an act of ragging. Migration certificate may be issued.
Signature of Dean, Students’ Welfare
OFFICE ORDER
Migration Certificate may/ may not be issued.
Controller of Examinations D.R. (Academic)/ A.R.(Academic) Dealing Asst.
Note for Applicant
1. An applicant for a Migration Certificate who is studying any course of this University should pay a MIGRATION FEE of Rs.100/and submit this application through the Head of the Deptt./Centre under this University in which he/she is pursuing or pursued his/her studies last or through which he/she appeared at the examination.
2. Migration Certificate is issued only to a registered student of this University. Registration Certificate issued by the University should be surrendered for the purpose.
3. No action will taken unless the prescribed fee is received in this office.
4. Money Orders are not accepted. Fees should be sent by Bank Draft payable to the Tezpur University at the State Bank of India, Tezpur Branch, Tezpur or by cash at the University Cash Counter and Duplicate copy of Challan should be enclosed.
5. Attested photocopy of certificate/transcript/grade card of the last examination issued by the university should be enclosed.