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Date . . amounl
FOR OFFICE USB ONLY
Fee if paid by D.D. (Date) Degree written by

Demand Draft Nos. Degree issued by .. .

lbtal amount Rs. .

Date
Fee Checked by
Postage Receipt No. . . if paid in cash
Signature of the Clerk
Date. Rs. ..
DR. BABASAHEB AM EDKAR MARATHWADA UNIVERSITY
ANNUAL CONVOC TION FOR CONFERRING DEGREE
N.B. :- All entries must be correctly made in applicant's own Hand writing. Application with incorrect and
incomplete entries will be re.iected.
To,
The Registrar, Dr. Babasaheb Ambedkar M hwada Un iversity, Aurangabad. (M. S.)
Sir,
I request admission in Person/Absenti totheDegree.... .asmyFirst/Second/
Third Degree of this University at the con ion to be held in the month
Full particulars about the examination passed, etc. are given below :-
I Narne in full in CAPITAL letters Applicant's Name / Father's / Husband's Name Surname
Male / Female
(As per Examination Form)

2 Name in full Devnagri Script (Marathi)

3 Whether Regular or External? REGULAR / EXTERNAL

4 Narne of the College if regular OR Na
External Centre
Please the Caste if you ong to Sub-Caste
backward classes.
6 Name of the Degree Examination Division
in words (
Month and Year o
7 Seat No Examination passed
Oct.-Nov I AprilMay 20

8 Special or optional subjects offered at t

Degree Examination.
or Methods of B.Ed. or B.P.Ed.
(Only of M.B.B.S./B.A.M.S./B.H.M.S I have cornpleted the Internship/Industrial Training
B. Pharm. Degree holders) infi Coursefrom. ...to
regarding completion of Internship / at
Training. From Dr. Babasaheb Certified
Marathwada Un i versitv.

Signature of Dean/Principal Signature of the

with stamp applicanl
l0 Only for Second Degree holders, ( I have obtained First Desree i.e. bearing
Information regarding First Degree o ined by
the candidate from Dr. Babasaheb A bedkar SeatNo. .... Passingyear
Marathwada University or any other U versity
(Attested Copy of latest marks and from. ..... Universityconferred.
Degree Certificate be subrnitted in se First
Degree is obtained.)
10(a) Only for B.E. & B.E. (Arch.) Studen Please
submit the marks memo of T.E. & B Passed
l0(b) Please submit the Marks Memo I yea
to final Year of the all Course. AnnualConvocation
 (2)
I I (a) Correspondance Address: (with Pin ode) Your b flirhfully,

Signature

Date :

(b) (Devnagari Script) (Marathi) Permanent Address : (with Pin Code) .

12 Mobile No. (for quick reply)

Importanl Note :- Tlte Candidate sltould tlteiir ldentity proof while Collecting tlte Degree CertiJicote.

IDENTITY CERTIFICATE
be in
filled and completed while submitting the form)

PHOTO hereby certify that the marginal photograph of

Shri/Kum i/Smt.. ....whoisapplying
....of Degree/Diploma/Certificate

has signed in my presence,

(Latest Passport size photograph

with Signature and Stamp
ofAttesting Officer)
Signature of the atlesting
Sign ature o/' the appl icant Officer/Teacher/Member with designat ion Stomp
(Stamp is essential)

CONTROL HEET FOR (Office use only)

NAME OF THE CANDIDATE
EXAMINATION PASSED March-Apri SEAT NO. :

FORM PROCESSED BY Signature

Date
RESULT / DIVISION / REMARKS Signature
Date
REMARKS BY I/C Signature
Date
DEGREE WRITTEN BY Signature
Date
DEGREE CHE,CKED BY Signature
Date

Date of Convocation the Concerned

RECEIPT
Received Degree / Diploma / Certificate
From the Registrar, Dr. Babasaheb Ambed r Marathwada Universiry Aurangabad. (M.S.)

Receiver s Signature
Date : with Mobile No.