OSMANIA UNIVERISTY

Hyderabad 7, (A. P.)

Application Form For Obtaining The Degree Certificate (In Place of Lost Original Certificate)
Name Ht.No. Fathers Name Name of the College Applied For Exam Passed/Appeared Year of Pass/Appeared (Check List for the Counter Use) : _____________________________ : _____________________________ AFFIX ONE PASSPORT SIZE PHOTO

:_____________________________ ::_____________________________ :______________________________ : _____________________________ : _____________________________

D. D. No:_________________

D. D .Date:_________________ Amount:_________

Signature of the Candidate

Collection : Person/Post Signature of the Candidate __________________________________(For Office Use At Counters) __________________ Receipt No : Receipt Date: ____________________ ____________________ Due Date: _______________

I Solemenly and sincerely swear on oathe that my _____________________________________ Certificate is lost/ is not in a proper Condition (The Certificate is enclosed) and pray that a duplicate copy of the Certificate may be issued to me. Date: _________________________ Name of the Candidate (BLOCK LETTERS) Fathers Name (BLOCK LETTERS) Address to which the Duplicate Certificate should be sent (in case it is to be sent by Registered Post) Particulars of the Examination Passed Signature of the Applicant.

Examination Passed

Roll No.

Year

Division

Subjects

D.D. No. through which the fee of Rs. 1000/- is paid

D.D. No.

Date

Date:_________________________

Signature of the Applicant

1. Attach an extra Photograph to the Application Form while submitting. 2. As the Original Certificate cannot be issued, a Duplicate copy of the Certificate may be issued to the Candidates on submitting this form to the Controller of Examination, Osmania University duly filled in and the Identify Certificate given below duly certified together with the prescribed fee of Rs. 1000/-. 3. Candidate is instructed to be very careful about the entries to be made in the under mentioned columns. All the entries should be in Candidates own hand writing and candidate with be held personally responsible for any incorrect entry that he/she makes. 4. The name of the Candidate and that of his/her father given here under should correspond to those mentioned in the Examination Form. 5. D.D. amount Rs.1000/- drawn in favour of Controller of Examinations, Osmania University (From Nationalized Banks Only). 6. Non Judiciary stamp paper worth of Rs. 10/- duly signed by Notary (Affidavit). 7. Xerox copies of Certificates/Memorandum of marks. 8. The requisite fee will have to be paid through Demand Draft within one month from the date of its issue along with Application Form. 9. Alternatively Attestation may be done by the Candidate (Self Attestation). If the information furnished is found to be wrong, the Candidate will be fined Rs. 100/- and necessary Criminal Action will be initiated according to the Rules. 10. Application along with prescribed fees and other documents should be submit to the Controller of Examinations, Osmania University, Hyderabad 500 007.

Received from the Controller of Examinations, Osmania University, the ___________________ Degree Certificate.

Date:__________________________

Signature of the Candidate