DR. BALASAHEB SAWANT KONKAN KRISHI VIDYAPEETH,

30th CONVOCATION

(Please read instructions before filling the form)

To, The Registrar, Dr. Balasaheb Sawant Konkan

Krishi Vidyapeeth, Dapoli, Dist. Ratnagiri.

Sir, I wish to attend the convocation to receive my Degree of _________________

(Examination) in person Tick as in absentia My particulars are as follows :

Name in full (in block letters as per transcript issued by the university)

(Surname) (Name) (Middle Name) Sex Degree Examination Passed in the Month ___________ Year _____________________

Regd. No. _______ Name of College __________________________________________ Class awarded

Post Graduate Degree Examination Passed in the Month _______ Year ____________

Regd. No. _______ Name of College __________________________________________

Discipline ________________________________________________________________ Class awarded

Doctoral Degree Examination Passed in the Month ______ Year ___________________

Regd. No. _______ Name of College __________________________________________

Discipline ________________________________________________________________

Class awarded

(Copy of transcript enclosed) [P.T.O.]

Male Female

First Class with Distinction / First Class / Second Class

�

First Distinction/First Division/Second Division/By Research

First Class with Distinction / First Class / Second Class

I have read the notes overleaf and accordingly I remit the prescribed fee of Rs. 250/100 (Two hundred fifty / Hundred only) by Demand Draft No. _____________ Date ______________

Address for correspondence (Degree Certificate will be sent on this address) Name _____________________________________________________________ At.________________________________Post.___________________________________ Tal._______________________________ Dist. __________________________________ State _______________________ Tel / Cell No. _________________________________ Place ______________________ Date _______________________ Candidate’s Signature

(Entries to be made by the University Office) Result Checked by : Degree Certificate Checked by :

Dealing Assistant Supdt. Dy. Registrar

Demand Draft Rs. _____________ No. _______________ Date _____________ Degree Certificate issued by in person / sent by post on ______________________

Dealing Assistant Supdt. Dy. Registrar

INSTRUCTIONS

1. The fee for admission to the First / Second Degree of this University is Rs. 250/- (in absentia) and Rs. 100/- (in person). Candidates who seek admission to more than one Degree at the same Convocation must submit a separate application and pay separate fee in respect of each Degree.

2. The student should send the prescribed Convocation fee by demand draft in the name of the Dr. Balasaheb Sawant Konkan Krishi Vidyapeeth, Dapoli, Dist. Ratnagiri and payable at Dapoli

3. Incomplete forms and those received after the expiry of the prescribed date will not be considered.