H.T.No. COLLEGE CODE
APPLICATION FOR PROVISIONAL CERTIFICATE
NAME OF THE CANDIDATE
*(IN BLOCK LETTERS AS PER S.S.C.)
FATHER’S NAME (IN BLOCK LETTERS)
GENDER (Male/Female)
Degree / Diploma COURSE AND BRANCH
Branch
MONTH & YEAR OF PASSING EXAM
(To be filled by the candidates, who completed the Course)
PERMANENT ADDRESS
Pin code FEE PARTICULARS: (Rs.200/-)
Bank: ______________________ D.D.No. ____________________ Date: ______________
NOTE:
1. Demand Draft for Rs. 200/- should be drawn in favour of the REGISTRAR, J.N.T. UNIVERSITY HYDERABAD, Payable at Hyderabad.
2. Xerox Copy of SSC Certificate should be enclosed. *
Date: SIGNATURE OF THE CANDIDATE
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For College Office Use Only
Certificate of Identification
I certify that Mr. / Mrs. / Miss.__________________________________________________
S/o / D/o of ________________________________________________is a Bonafied Student of (College Name): __________________________________________________________
College Code: __________ during ___________ to _________ with H.T.No._____________
Date: Signature of the Principal
With Office Seal
