SHIVAJI UNIVERSITY, KOLHAPUR

Application for Conferring Degrees,Diplomas and Certificates

1. Application Form No.
TC140654
2. Student Type Regular Student
3. Mode of dispatch Through College
4. Faculty ENGINEERING & TECHNOLOGY
5. Name of the Course Bachelor of Engineering
6. Branch/Spl. : Civil
7. College Name Adarsh Institute of Tech. & 8. Final Year Exam Seat No. 29226
Research Center
9. University PRN Number : 1412695094 10. PRN Number
11. Student's full Name : DAMAKALE MAHAVIR DILIP 12. Mother's Name VANDANA
13. Sex : Male
14. Address : Mandle vasti hanmantnagar AT POST VITATAL-KHANAPUR
City:VITA:415311 , Dist:Sangli(Maharashtra)
15. BankDetails. : IDBI Bank/DAMAKALE VANDANA DILIP/0640104000121668/0640104000121668
16. Mobile No. : Mobile No :7066004511 MailID : mahavirdamakale1995@gmail.com
17. Month & Year of Passing : MAY -2019 18. Class Obtained A: EXCELLENT
19. Subject 1(if applicable) :
20. Subject 2(if applicable) :
22. Paid Fees Details : Online Payment TRN No. - 101920102160056383 Amount Rs. - 250 Dated -
9/22/2019 9:28:35 AM
DECLARATION
I declare that this information submitted by me is true to the best of my knowledge and I have read and understood the rules for
convocation. I am also aware that the information submitted by me shall be verified with the current records available with the
SHIVAJI UNIVERSITY and on verification the conferring Degree/Diploma / Certificate shall be allocated to me.
Last date for submission of final printout in university office : 30/11/2019
Place : Date : Signature of the Student
DAMAKALE MAHAVIR DILIP
Important instructions to the applicant
1 . Document Required :-
I. Attested copy of Final Year Marklistand receipt of successful payment is compulsory with this form.
II. Students who have passed under improvement scheme should submit their earlier Original Degree Certificate.

III. In case of non availabilityof photo in system the student may upload his/her photo and this photo must be certified
by the respective college. (The Annexure ‘P’ is compulsory in such case)It is available with the form itself.
2 . Submission of Form:-
I. The complete filled application with successful payment receipt should sent to University office on following address

The Director, Board of Examinations And Evaluation, Shivaji University, Kolhapur 416004
OR may submit in person at Convocation section Room No 110 Exam bldg. No 01Shivaji University, Kolhapur
3. Mode of Payment :-
I. Only through Payment Gateway
(Please wait for while as the fee process is going on, do not click again and again for payment)
In case of failure in payment pl. wait for 1 hour, check the receipt & then only retry for payment.
4. Rules and Regulations :-
I. Please ensure the bank details /faculty/course /subject/ class details while submitting the form. In case of any
discrepancy please submit student grievance form available online in this module.
(Click to grievance form )
II. Forms with incomplete incorrect, insufficient information and without fee will not be accepted No correspondence will
be made in that regard.
III. Student who have passed under the following scheme will not be issued degree certificate.
(i) RBE. , (ii) R.B.Sc.-10 , (iii) OBCS.iii (A), (iv) RB.A. 11 (i) , (v) For IMP-I Class , (vi)
R.B.com-12, (vii) Form DIDD.
IV. Degree certificate will be conferred for the courses enlisted in statute No. 548.
V. Each Application will be entered with separate User Name.
VI. For any problem pl. report your grievance by online method OR contact on 02312609113 during office hours.