Application Form for Verification of Marksheet / Degree Certificate(Photocopies / Original) / Transcript

PART-I DETAILS OF APPLICANT

Name of Applicant (Full Name of person who is applying, in case where the applicant is Institution / Company write the fullname of Institution / Company)

PART-II DETAILS OF CANDIDATE WHOSE DOCUMENTS ARE TO BE VERIFIED

Voter’s Identity Card

Passport (all pages)

Driving License (all pages)

PAN Card (Both Side)

1.

2.

3.

4.

Sr. No. Type of Document Put a Tick mark In this space

Name of Candidate:

Postal Address:

E-mail ID

Mobile Number

PIN

Website

Fax Numbers

Registration Number

Detail of Registration (in Case Applicant is Institution / Company):

Name of the Act under which Institution / Company is Registered

Name of the Authority with which Company / Institution is Registered

Attested copy of any one of the following Photo Identity Proof of the person whose Documents are to be verified (Pleasetick approciate box) (Applications Received without Photo Identity Proof will not be processed / will be cancelled)

Paste recent Passport SizeColored Photograph

1. Do not use digital orComputerized Picture.

2. Do not Pin or Staplethe photograph

3. Do not Sign onPhotograph

Signature of Candidate

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First Name Last Name

Telephone Numbers with STD Code

Postal Address:

E-mail ID

Mobile Number

PIN

Website

Fax NumbersTelephone Numbers with STD Code

First Name Last Name

PART-III DETAILS OF DOCUMENTS TO BE VERIFIED

Detail of DD :-

Name of the Bank DD No. Date Amount

Signature of the Candidate Date

GUIDELINES :-

1.

2.

3.

Fill up the prescribed application form in capital letters.

Enclose self attested copy of documents that candidate required to be verified. Submit the verification fee Rs.1000/- in the form of Demand Draft drawn in favour of Kalinga University, Payable at Raipur only.

Marksheets Degree Certificates Transcripts

Name of Degree Year of Degree awarded Year of PassingName of ExamYear of PassingName of Exam

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