20100925162939 Inter University Migration

Fee Code R0040 Website: http://forms.puchd.ac.in Panjab University, Chandigarh Application for Inter-University Migration/copy of entries from the Register of Students (To be filled in by the applicant in his/her own hand) Case No._____________________ (For Office Use) A. Fee Remitted Rs.___________________________ Bank Draft/University Receipt No._______________ Date __________________ B. Name: (In capitals) Father’s Name: (In capitals) Mother’s Name: (In capitals) Registration No. Institution where studying presently ________________________________________________ Class ________________ University to which Migration is sought __________________________ _______________________Reasons for Migration ______________________________________ ______________________________________________________________________________ C. Last examination of this University in which appeared/passed: Examination _____________ Year/Session__________ Roll No. __________ Result__________ Institution/District (For Private Candidate ___________________________________________ ______________________________________________________________________________ D. I solemnly declare that: (i) All the particulars given by me are correct; (ii) I have passed Matriculation/Higher Seconday Examination of Panjab University but I did not join any College affiliated to this University. (For applicants who are not registered students). Address ___________________________________ ___________________________________ ___________________________________ _____________________________ Signature of Applicant CERTIFICATE NO. 1 (For applicant who are/were on rolls of affiliated College/Departments of Correspondence Studies and leaving the course without completing) I have no objection to the issue of University Migration Certificate to the Applicant Signature of Principal/Chariman Dept. of Correspondence Studies Dated: ____________ Official Stamp ATTESTATION (Regular Student /Private Candidates) AFFIDAVIT For duplicate Migration Certificate please attach an affidavit duly attested by Ist Class Migistrate stating therein :That the Migration certificate earlier issued to me has been lost and has not been used by me to seek admission anywhere. Last Exam:____________ I certify that the applicant __________________________ son/daughter of Shri _______________ ___________________ is the Same person who signed in my presence under the particulars on the enclosed form. Name, designation and address of the attesting authority ______________________________ ______________________________ ______________________________ 1 of 2 Signature of attesting authority Dated ______________________ ____________________________ Offical Stamp Website: http://forms.puchd.ac.in Attesting Authorities: (i) College/University Teaching Deptt. Candidates. (ii) Private Candidate : Principal of the College/Chairman of the Deptt. Concerned. A Gazetted officer, Principal of an affiliated College, Chairman of the University, Teaching Deptt, a fellow of University. University Officer not below rank of Asstt. Registr!r : FOR OFFICE USE Particulars verfied vide Gazette/According to Register of students Allowed /Not Allowed Asstt. Address Suptd. (To be filled by the Candidate) ORDERS A.R. (R & S) Name(In Capitals):_________________________ Address: _________________________________ ________________________________________ Address (For despatch of Certificate) Name(In Capitals):_______________________ Address: ______________________________ _____________________________________ 2 of 2