Free of Cost
NTR UNIVERSITY OF HEALTH SCIENCES ANDHRA PRADESH
VIJAYA WADA-520008 IN ADVANCE
POST CONVOCATION

APPLICATION FOR ISSUE OF PERMANENT DEGREE CERTIFICATE
FOR ALL PG COURSES IN ADVANCE / POST CONVOCATION
(This is tho prescribed Application Form for obtaining Permanent Degree Certificate TN ADVANCE of
the Annual Convocati.ons, to be f)Jled up and !.o be submitted to this University through the concerned Principal, by all those candidates who have passed their UG Degree I PG Degree! PG Diploma I Super Specialty Degree Examinations between tho Lust and FortbnmJJug Aon.mtl Convocation only)
1) Full Name of the Candidate:
2) Surname of the Candidate:
3) Name of Father! Mother of the Candidate:
4) a) Degree Certificate applied for ---·---
b) Month & Year of passing -------------
c) Registered No. / Hall Ticket No: ____ .
d) College where studied and passed: ____ _
5) Details of fee paid:
r -----
Please affix here
your latest
pussport size
photograph
I
····----1
I
duly attested
by the Principal.
(Colour or BJack &
L_ White)
-----··----·---------
a) Amount: Rs. _____ b) DD I Pay Order/NTR lJHS Chullan No:
Dated:
c) Name of the Bank:---------··- d) Place ofthe Bank: ··--·--·---
6) Details ofintemship:
a) Date From: To:
b) Hospital where Internship was done: --
FOR THE USE 01< NTR UHS EXAMINATIONS WING
1) TR Page No. 2) Degree Certificate Sl.No.
3) Sl.No. & Page Noofthe
Degree Issue Register (IN ADVANCE OF)
Submitted:
All the details have been verified. DD I PO has been sent to the Finance
Wing. Hence, the Permanent Degree Certificate may be issued.
--------··-·-··--·----------------------
7) Details of Registration done with the Stale MC! I DCJ I NCl:
a) Registration No:. _______ __ Temporary I Pennanent:
b) Date of Registration : _______ c) Place of Registration:
8) Full Postal Permanent I Temporary address
(with PIN Code, Telephone No., Cell Phone No.):
Station: ________ _
Date (Signature of the Applicant)
,-----------------------
. FOR THE USE OF PRJNCIP AVS OFll'ICEONLY
C01tified that rhe details fumished above by Dr. ___ ·------
are verified from the relevant records and are found correct. The applicant has no dues to this
College, Hence, there is no objection for issue of UG Degree I PG Degree I PO Diploma I Super
Specialty Pennanent Degree Certificate to him I her.
Station: ---------
Date (Signature of the Principal v.th offtce seal)
INSTRUCTIONS I GUlpELJNES TO THE CANDIDATES WHO ARE APPLYING FOR
ISSUE OFPERMA_NENT UG I PG ISS DEGREE CERTIFICATE
"IN ADVANCE" OF CONVOCATION.
I) Use only Capitol Letters.
2) All applications must be routed through the Principal of the Coi!ege whe:·e the applicant has
studied and pa.,sed the UO Degree I PO Degree I PG Diploma I Supe1· Specialty Degree
Examination.
3) Co!um" No.1& 2 ofthe appliwtion form: l<'ull Name & Surname ofthe cll\udidgte:
a) It should be written a• spelt in the Intermed,ate or liN EquiYalent Cer!l!ien!e (by those
who !ll'e applying for UO Degree Permanent Certificates only).
h) It should be written strictly as spolt in the UG Degree Cet!ificnte (by those who are
applying for PG Degree I PO Diploma! Super Specialty Degree Pem>anent Certificates
only).
c) In case of those who want to obtain the UO Degree I PG Degree I PO Diploma I Super
Specialty Degree Certificates ll.'l per the changed Name I changed Surname, the Full
changed Name must be written as a pelt in the A1' Gazette I Proceeding• of the NTR
Vnivendty of Health Sciences I Proceedings of the Director of Medical Educot!on,
Andhrt! l"rn.desh I Proceedings of tile Direc!o• of Health, Andhra Pradesh OR ""Y
other Educational Authority.
4) Cohn!!!! No.3 of !be !II)!!U£1\timn form : Nsme of the Father I Mother : lt should be filled up
only by those who are applying for issue of the Super Specialty. Pennnnent Degree Certificate
only.
5) Column No. 4 (a) of the application fonntj Permanent Degree Certificate Hpplied for;
Please specifY whether applying for issue of Permanent MBBS I BDS I BHMS I BAMS I BNYS i
BUMS I B.Sc.(N) I BPT I B.Sc. (ML T) Degree Certificate or whether applying for issue of
permanent MD I MS / MDS I MD (Ay) I MD (Homoeo) I M.So. (Applied Nutrition) I M.Sc.
(Nursing) I DM I M.Ch. Degree Certificate. Also, please spedfY within brsckets the concerned
speciality of the Faculty, without fail.
8) Column'No.8 of the application form: l'ermOJ!ent Address: This is required by NTR UHS to
get certain doubts etc. if any, cleared from the applicant before' issuing or after issuing the
Permanent Degree Certificates.
9) Two address Slips: Two address slips given at the end of page No.2 of this application form are
to be filled up by the candidate (all in capital letters only), giving the Pin Code, ·Telephone No.,
Cell Phone No., for use by NTR UHS Examination Wing, for pasting in the Degree Dispatch
Register and on COtirier SerVice cover)
1 0) Passport Size Photographs:
a) One Photogrph should be affixed on the Application E,onn,duly attested by the Principal
of the college where the applicant has studied and passed the course I examination.
b) One extra Photograph ofthe same should be kept in an envelope and is to be enclosed to
the Application at the end of all the enclosures.
ENCLOSURES:
The following documents are to be enclosed to the Application form seciirely tagged, in the order
specified.
A) By those wbo are up plying for isone of Permanent UG Degree ·Certificate• only:-
1) Attested copy of Intermediate or Equivalent Certificate.
2) Attested copy of Internship Certificate 'issued by the Principal of the concerned Medical
College. .
. 3) Attested copy ofUG Degree Provisional Certificate.
4) Attested copy of Temporary I PennmJent Registration Certificate as proof of having
registered themselves with MCI I DC! INC!.
5) Attested copies of Individual Marks Memos of j·"'·to Final year ofUG Degree Exams
(only if the Official Transcript is not yet been issued byNTRUHS).
6) Attested copy of G.O. on transfer of candidate from one college to another college during
the Internship Period.
B) By those who are applying for issue of Permanent PG Degree I PG Diploma I Suocr
Specialty Degree Certificates only:-
1) Attested copy of MBBS Permanent Degree Certificate.
2) Attested copy of PG Degree Provisional Certificate.
3) Attested copy of PG Diploma Certificate.
4) Attested copy of Super Specialty Provisional Certificate.
C) Common to all Applicants:
1) Attested copy of AP Gazette I Proceedings of NTR University of Health Sciences I
Prom;edings of Director of Medical Education, Andhra Pradesh I Proceedings of Director
of Health, Andhra Pradesh or any other Educational authority, by tose who want to
obtain their Permanent Degree Certificate as per the changed Name I changed Surname.
2) Envelope containing one Passport size photograph (should be kept at the last of all the
enclosures).
3) DD I F:y Order INTEUHS Challan (should be kept on top of the application form).
4) There iu no need to enclose a self addressed envelope either with stamps or without
stamps.
--------------------··--·-------------
NOTE: (1) This ApplicationFonn should not be used for·obtaining the pimmmentUG I PG I
Diploma I Super Speciality Degree Certificates "IN PERSON" or "IN ABSENTIA" of the NTR UHS Ammal Convocati{)IL .Separte prescribed:Application Forms will be supplied to all the Principals I Directors·for this purpose, i.e,, Pink Cololir for obtaining IN PERSON (by those who can take part in !he Convocation ceremony in Vijayawada) and White colourTor obtaining IN ABSENTIA (by those who crumot take part in the Convocation ceremony) to j:iut on a ale forRs.251- or mote for each application form to be purchased by eligible candidates as and when the date j'or .the NTRUHS Annual Convocation is finaliZed and the sllllle· is announced tbroligh aU the leading News Dailies. ·········
To:
(2) The following Two Address. slips are to be filled up by the llpplicantto which his I her
permanent Degree Certificate is to be dispatched.
Pin Code : --c----Telephone No .. ----,. Cll Phone No.-------
To:
Pin Code: _____ Telephone No.------- Cell Phone No.