UNIVERSITY OF DELHI
APPLICATION VERIFIED
Cashier Please Accept Rs………….……
APPLICATION FOR ISSUE OF DUPLICATE STATEMENT OF MARKS

Note: 1. Payment is to be made between 9.30 a.m. to 3.00 p.m.
1. Name of Candidate (In Block Letters) ______________________________________________
2. Father’s Name : _____________________________________________
3. Mother’s Name :______________________________________________
4. Examination appeared (Course) : ____________________ Part: __________ Sem. _______
Roll No._______________________ Subjects:____________________________
5. Annual / Semester /Supplementary: ___________________Year Appeared _____________
6. Marks Obtained & Maximum Marks__________________ Result: Passed/Failed _________
7. Postal Address (in Block Letters) _________________________________________________
__________________________________________________________________________
Signature of Applicant____________________
PHONE/MOBILE No.______________________ (with Date)
The above particulars given by the applicant are verified and found correct
Signature of Principal
(Rubber stamp of the College/Institution)
Dated:………………
1. The statement of marks is issued for all the paper/s subject/s of particular Roll No. under which the candidate has taken the Examination.
2. The application form for issue of statement of marks required for different Roll No. for each of the year of Examination may be filled in separately.
3. The fee charge for issue of detailed statement of marks @Rs.500/- up to 6 years and fee for the statement of marks which are more than 6 years old are chargeable @ Rs.1000/- per statement of marks.
4. The statement of marks will be sent to the applicant by post only when the applicant will enclose a self address registered envelope affixing postage stamp.
Read carefully the instructions given below before filling the application form