Format No.: QSP/7.5.1/01.

F12
Issue No.02 Dated: April 16, 2014

AUTHORIZATION LETTER

To : Controller of Examination
University of Petroleum & Energy Studies
Dehradun

Authority Letter to Collect the __________________________________________

for Program__________________ Batch _____________ in respect of Enroll.
No._____________ SAP ID_____________ Name _______________________

I authorize Mr./Ms./Mrs.____________________________________________,
Resident of _____________________________________________________________
Telephone No._____________________ whose three specimen signature are appended
below, is hereby authorized to collect the Degree Certificate on my behalf due to my
inability to come personally to collect the same.

_______________ _______________ _______________

Specimen Signature Specimen Signature Specimen Signature

Signature of the Student : _________________________

Name of the Student : _________________________
SAP ID of the Student : _________________________
Enrolment of the Student : _________________________
Program & Batch : _________________________
Telephone No. : _________________________
Date : _________________________