Requisition Application (INCOME TAX CERTIFICATE)

Date of Request _________________________________

Student Name _____________________________ Registration No. ______________________________

Father Name :______________________________Mother Name : _____________________________

Contact No _________________________________

Scholarship availing from LPU (if any), please tick : YES / NO

Signature of Student /Parent/ Guardian

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Certificate No :-…………….

Signature of dealing official Receiver’s Signature

(Student/Parent/ Guardian)