7/3/2017 Convocation Form

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Application Form Number:17158239254

Application For Supplementary Convocation Degree Certificate

Personal Data:

Surname: JOHN First Name: SOJIN Middle Name: Mother's Name: SOBHANA

Gender: Male

Address for Correspondence: UBISOFT,LEVEL 6, B-3, KUMAR CEREBRUM, KALYANINAGAR, PUNE, MAHARASHTRA , PUNE,
MAHARASHTRA, MAHARASHTRA
Pin Code: 411006
Phone: Mobile: 9673553229 Email ID: sojinjohn@hotmail.com

College/Institute Details:

Name of College /Institute : Government College of Engineering,

College Code: 0001

Examination: Bachelor of Business Administration Faculty: Commerce
Month of Examination: April Year of Examination: 2016
Date of Result Declartion: 2016-05-30
Seat Number: 21097 Permanent Registration Number (If Any): 1011400823

Special/ Principal/ Branch/ Method: Marketing

Optional or Subsidiary a]: b]:
Subject for Restructured/Vocational:

Course: NA
Whether Passed Partly by Papers & Partly by Research (For M.Sc/M.E. Students Only) : No

Whether Re-appeared & Passed Under Provision of Class Improvement Scheme : No

Application Fee Details: (Payment Mode : Online Payment)

Declaration:
I hereby declare that all statements made in this application are true, complete and correct to the best of my knowledge and belief.
I understand that in the event of any information being found false or incorrect, my candidature is liable to be cancelled or rejected.

Name in Devnagari Script (Marathi): सोिजन जॉन

Mother's Name(Marathi): शोभना

Please sign
Place: Date:
inside box

Faculty Name:Commerce , Exam Code : Bachelor of Business Administration (096 )

Note : Attach Photocopy of last Marksheet

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7/3/2017 Convocation Form

Online Payment Details

ApplicationID : 17158239254
Transaction ID : 3551303412171840
Amount : 990.0
Date & Time : Jul 3 2017 9:47PM
Result Description : CAPTURED
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