request letter cum document issue form

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/ NATIONAL INSTITUTE OF TECHNOLOGY PATNA

शिऺामंत्राऱय,भारतसरकारकेअधीनएकराष्ट्रियमहत्वकासंस्थान/ An Institute of National Importance under Ministry of Education, Govt. of India अिोकराजऩथ, ऩटना – 800005, बिहार/ ASHOK RAJPATH, PATNA - 800005, BIHAR

(EXAM SECTION)

REQUEST LETTER CUM DOCUMENT ISSUE FORM

To, Associate Dean (Exam)

NIT Patna

I am a bonafide student of NIT Patna and requesting you to kindly provide me the following tick marked (√) document(s). The details are given below:

Grade Card

Provisional Certificate

Transcript No. of additional copies

Check list of photo copy of documents attached:-

A. For Issue of Grade Card

1. Photo ID Proof 2. Final Semester provisional grade card (UG/PG) 3. Semester registration slips (Ph.D.) 4. Authority Letter / Email (if needed) 5. FIR Copy/Affidavit for Duplicate Grade Card (in case of loss) 6. Payment receipt of Rs. 1000/-(for issue of duplicate grade card).

B. For Issue of Provisional Certificate (PC)

1. Photo ID Proof 2. Consolidated Grade card 3. Due Status from department / Library /hostel (as applicable) 4. Authority Letter / Email (if needed) 5. FIR Copy/Affidavit for Duplicate PC (in case of loss) 6. Payment receipt of Rs. 1000/-(for issue of duplicate PC) C. For Issue of Transcript

1. Photo ID Proof 2. Consolidated Grade card 3. Payment receipt of Rs. 500/- for first copy 4. Payment receipt of Rs. 100/- for each additional copy 5. Authority Letter / Email (if needed)

D. Payment receipt of postal charges (if documents to be dispatched):- (i) For India: - Rs.150/- (ii) For Abroad: - Rs. 1500/-

E. Fee Payment link:- www.nitp.ac.in

It is certified that all the documents and information provided are true and correct.

Program: (UG/PG/Ph.D.) Roll No.: --- Name of the student:--- Branch:--- Email Id &Contact Number--- Postal Address (If document to be dispatch)

Signature with Date and time:

(For Office use only)

Handed over the following Documents after verification 1………Certificate No………

2………Certificate No……… Received

3………Certificate No………

(Staff Sign with date) (Student Sign with date)