"Jnana Sangama'", Belagavi-590 018 Application form for the issue of Degree Certificate VTU Convocation 20 __ Degree Certificate @ VISVESVARAYA TECHNOLOGICAL UNIVERSITY PONISIO BE NOTED. Online Receipi of fees paid By Post | By Hand] Token Ni ‘DDS are not accepted Fee paid once cannot be refunded Name of Stee . Ths Marks Cards) USN Gaasyhessstgan™! | nop] BEL] Beeen[] BArA|_] Mite] MAL | MCAT] MAren]_] MSe]_] PHD ‘etal of Fee: Chomse Caegory "FFees to be pad by stadenl™> Examination (Chowne one of ihe blow ostons TJ] ware Deeree Create Fess 2800 + £100 penalty per each year For Indians AO + (100% No. oF years) | Attonomous UGIPG Degree Certificate Fees €1000-+ € 100 penalty per eash year Fr Indians 1000 (100% No. oF years) | Mise researey/Ph.D Depree Cerificate Fees € 2000 £100 penalty per each yer For Indians 2000 + (100% No.of years) Tl] UGirG Degree Cerificate Fees USD 200+ USD 50 penalty per each year For Foreign nationals USD.200 (USD 50x No. Ta se (eseareny Ph Degree Cerificate Fees USD S00-> USD 50 penalty per cach year For Foreign nationals | USD.S09= (USD 30x Ne. Fes paid Rs at Ret No Date Details of Examinations passed To enconures ae De ot] Fist ater Toad Sem a : Aix 2 your photo a 3 © = 7 0 ‘To be attested by PrincipaHOD Gazetted officer** Year of passing Date : Candidate Signature : - For Office Use Only Case Worker : Special Officer Registrar : Eval.) Postal Address to which Degree Certificate (DC) isto be sent should be filled in duplicate IN CAPITAL LETTERS Name : USN Address: PIN Mobile No, Postal Address to which Degree Certificate (DC) is to be sent should be filed in duplicate IN CAPITAL LETTERS. Name USN ‘Address PIN Mobile No.DECLARATION TO BE SIGNED BY THE CANDIDATE | Thereby solemnly declare and promise that, if admitted to the... (Name ofhe Degree), degree for which Ihave been recommended, I shall, in my daily ife and conversation, conduct ‘myself, as befits a memberal this university, that I shall, to the utmost of my capacity and opportunity, support the cause of morality and sound learning and that, as far as in me lies, I shall uphold and advance the social order and the well- being of my fellowmen. I shall faithfully and carefully fulfill the duties of the profession to which I may be admitted by virtue of my degree, that I shall, on all occasions maintain its purity and reputation and I shall never deviate from the straight path of that honourable exercise by making my knowledge subservient to unworthy ends. Date:.. Place: Signatre ofhe candidate Certified that the above candidate is /**wasa bonafide student, (Name of the College) ... during Signature of the Principal/HOD** Gazetted officer with Date and Seal. NOTE: 1. Convocation Application shall be held along with the final semester examination Application, No. enclosures are required along with the application form. THE CANDIDATE SHALL INTIMATE THE CHANGE IN MAILING ADDRESS WITHOUT FAIL, BEFORE THE DATE OF CONVOCATION 3. For such candidates who fail in the final examination or who remain with arrear subjects, the convocation fee will beadjusted with effect to that. 4, Theexact date of convocation will be notified by the University from time totime, 5. Doctorates, Gold Medalists / First Rank Holders and the Prize Winners will receive degree certificates in person at the convocation. Alll others will be given the Degree in Absentia and the Degree Certificate will be dispatched by speed post to the address mentioned. 6. Candidates applying for convocation during subsequent year of graduation may apply directly to the office of the Registrar (Evaluation), VTU, Belagavi - 590 018 Such applications shall be attested by the HOD/Gazetted Officers and Convocation fee shall be paid through online payment option - http:/vtu.ac.in/online-fee-payment. The principals are requested to send all the duly filled convocation applications along with details of fee paid (paid through online) directly to the office of the Registrar (Evaluation) before May 31, every year. ** FOR THOSE FILING APPLICATION DURING SUBSEQUENT YEARS OF COMPLETION OF GRADUATION. Send the filled and signed application form and online receipt of fees paid to the following address : Registrar /Evaluation), Viwvesvaraya Technological University, Jnana Sangama, Belagavi - 590018