JODHPUR NATIONAL UNIVERSITY

Jhanwar Road, Narnadi,JODHPUR DEGREE/DIPLOMA CERTIFICATE FORM

(Tick appropriate)

To, The Registrar, Jodhpur National University, Jodhpur

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Sir, I request for admission to the ------------------------------------ Degree/Diploma at the First Convocation 2012. I am remitting Rs. ------------- as convocation fee vide D.D. No. ----------------- Dt. --------------- drawn on ----------------------------------------------My particulars are as follows: 1) Name in Full (IN CAPITAL LETTERS) In English --------------------------------------------------------------------------------In Devnagri Script (Hindi)----------------------------------------------------------------Candidates Father/Husbands Name In English --------------------------------------------------------------------------------In Devnagri Script (Hindi)----------------------------------------------------------------2) Residential Address(with pin code) ------------------------------------------------------------------------------------------------------------------------------------------------Phone------ --------------------------------- Mobile -------- ----------------------------Email:---------------------------------------------------------------------------------3) Name & year of the Exam. Passed----------------- ------------------------------------4) Optional Subject Studied ----------------------------------------------------------------(Specialisation at masters level/Topic of Ph.D)

5) Enrollment No.---------------------------- Examination Roll No. --------------I have read & understood the instructions enclosed herewith carefully and undertake to abide by the same. Date : ---------------Yours faithfully, Signature--------------------Name---------------------------

JODHPUR NATIONAL UNIVERSITY

Jhanwar Road, Narnadi,JODHPUR
Cont..

FOR OFFICE USE ONLY

Receipt No.------------------------- Date.------------------------- Rs.---------------

Checked by. Issued Degree S.No.: __________

Checked from R.R. by

Verified by Supdt./Asstt.Registrar/Dy Registrar

JODHPUR NATIONAL UNIVERSITY

Jhanwar Road, Narnadi,JODHPUR

INSTRUCTIONS FOR FILLING IN APPLICATON FORM FOR DEGREE & DIPLOMA CERIIFICATE
1) Name in Full (IN CAPITAL LETTERS) Should write as given in the mark sheet of qualifying exam which should match with 10th board certificate/marksheet. 2) Phone Number STD Phone No Mobile Number -+91 3) Name of the Exam. Passed - Nomenclature as mentioned in the marksheet-and write First with Distinction, First, Second or Pass as the case may be If there is any controversy in the name written in application for admission to the examination and the name in convocation form or the name in English & Devnagri Script, no degree/diploma will be issued. If due to incorrect information in the convocation form, the degree/diploma is issued with incorrect name, the candidate will have to pay the additional fee of Rs.500/- for the same. Self attested true copy of the statement of marks should invariably be attached to the application form along with 10th board certificate/marksheet. 4) Availability of Forms: The form of application may be downloaded from the University web site www.jodhpurnationaluniversity.com 5) Fees : Candidates applying for Diploma/Degree Certificate will have to pay the prescribed fee of Rs. 3000/- for each certificate. 6) Submission of Forms : To be submitted to Registrar, Jodhpur National University, Jhanwar Road , Narnadi,Jodhpur by post/person. 7) Mode of Payment and Timing : The prescribed fee, may be paid in University office/ faculty office by D.D. Drawn in the name of JODHPUR NATIONAL UNIVERSITY, JODHPUR payable at Jodhpur (Raj.) on all working days, between 9.00 a.m. to 3.00 p.m. 8) General : a) Candidates applying for their degree/diploma/certificate is required to write legibly in their applications their residential address in full in English as will as in Devnagari Script. b) Candidates applying for two or more degree/diploma certificate must submit separate applications and pay separate fee for each certificate. c) If the certificate is returned back to the University as undelivered, concerned candidates have to collect the same in person from the University between 9.00 a.m. to 3.00 p.m. survey upon the submission of original fee receipts. 9) Enclosures to the Application form : a) Demand Draft ,drawn in favor of University payable at Jodhpur. b) A self attested copy of the statement of marks & mark sheet/certificate of 10th. c) Candidates applying for a diploma / degree certificate of D. Pharm/ B. Pharm/Dentistry/MPH etc., they must submit a self attested copy of the University internship certificate or training certificate, as the case may be, along with the application form. By Order REGISTRAR