Application for admission to the Convocation – 200_
Note: In returning the application, please superscribe on the cover the year of
CONVOCATION-200_ ”
INSRTUCTION TO CANDIDATE – SEE OVERLEAF
IN-PERSON
IN- ABSENTIA
(Please √ tick any one of the above. This is only for collection
at the time of “Convocation- 200_ function”
To be filled in & sent to the Registrar (Evaluation),
Rajiv Gandhi University of Health Sciences, Bangalore,
Karnataka, through the college concerned so as to reach this
office.
Degree for which the application made
…………………………………………………………
For office use only:
Eligibility Sl.No.
Page No.
Convocation:
Year of passing: Reg. No.
Subject:
Case worker Signature of officer
1
Name of the candidate in full (in block letters) as
registered for the University examination
2
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3 Gender
Male Female
4 Nationality
Indian NRI
5
Correct postal address to which certificate may be sent
(in block letters) with pin code.
(With Phone number)
Final Exam.
Reg. No.
Month
Year
6
Examination passed with details
Note: Attested Xerox copies of marks card of all the
University examinations should be enclosed.
7 Whether passed lower examination after
passing final examination? Submit details if
yes.
Yes / No
Final year passed year & month:
Lower exam passed year & month:
8 College from which appeared
9 Have you undergone the compulsory
Housemanship / Internship / Training (If
applicable)?
From date: To date:
10 Whether the prescribed fee has been remitted? If so
furnish details. If paid while paying the final
examination fee details of the same along with a
certificate from the college to that effect should be
enclosed.
D.D.