Prescribed Date : 1st June to 31st July Bach No. Serial No. After Prescribed Date with Late Fee : upto 31st August (For Office Use only)

UNIVERSITY OF PUNE

Application For Degree Certificate

(PLEASE READ IMPORTANT INSTRUCTIONS GIVEN OVERLEAF BEFORE FILLING THIS FORM)

(PLEASE FILL IN THE BLOCK WITH LETTERS, FIGURES, CODE NOS. ETC. AS THE CASE MAY BE)

To, The Registrar, University of Pune, Pune – 411007. Sir, I hereby apply for a degree of the University at the ensuing convocation to be held in Nov./Dec. 200 . ___________________________________________________________________________

A] PERSONAL DETAILS

1. Applicant’s Full Name in English (as it appeared in the result sheet)

2. Name in Devnagri Script

(Marathi)____________________________________________________

3. Sex : 0 = Male 1 = Female

4. Address for Correspondence (In CAPITAL letters) :________________________ Phone No. _____________________ ________________________________ Email address __________________ ________________________________ ___________________Pin.

B] ACADEMIC AND OTHER DETAILS

5. Name of College/Institute :

______________________________________________________________

6. College Code :

7. Examination :

001 = BA 002 = B.Com. 003 = B.Sc. 011 = MA 012 = M.Com. 013 = M.Sc. 006 = LL.B. 028 = B.Ed. 029 = BE 030 = MBBS 031 = Ph.D. 035 = M.S.W. 107 = LL.B.(5 Year) 047 = M.Lib. 014 = M.Phil. 118 = B.H.M.S. 119 = B.H.M.S. (Graded) 110 = M.Ed. Phy. 101 = B.Ed.Phy. 005 = B.Lib. 007 = B.C.J. 117 = B.C.S. 100 = LL.B. (Gen.) 106 = B.S.L. 020 = B.A.M.S. 043 = M.Ed. 046 = M.B.A. 044 = M.P.M. 045 = M.M.S. 083 = D.B.M. 116 = M.C.M. 110 = D.H.M. 084 = D.M.M. Write the name of the Examination passed which is not listed above :

8. Faculty : 01 = Arts & Fine Arts 02 = Mental, Moral & Social Sciences 03 = Science 04 = Law 05 = Medicine 06 = Engineering 07 = Ayurvedic Medicine 08 = Commerce

09 = Education 10 = Management 11 = Pharmaceutical Sciences 12 = Homoeopathy 13 = Phy. Edn.

9. Month & Year of Examination

___ 04 = April 05 = May 10 = Oct 11 = Nov

10. Seat Number 11. Permanent Reg. No. (if any)

12. Subjects : 1. Special/ Principal/Branch/Method ______________________________ 2. Optional or Subsidiary (a) ______________________ (b) __________________________ 3. Subject for Restructured/Vocational ____________________________________________

13. Class or Class Obtained : 01 = First class with Distinction 02 = First Class 15 = Higher Second Class Grade Obtained 03 = Second Class 04 = Pass Class

Grade Obtained : 05 = O 06 = A+ 07 = A 08 = B+ 09 = B 14 = C+ 10 = C 11 = D Honours : 13 = First Class 12 = Second Class

14. Conv. Status 15. Stud. Status 16. Course 17. Whether passed 0 = In Absentia 0 = Regular 0 = General Partly by papers & 0 = Yes 1 = In Person 1 = External 1 = Special Partly by research 1 = No

18. Whether re-appeared & passed under provisions of 0.168 0 = Yes (under CIS after 16.2.1993) 1 = No

___________________________________________________________________________

C] DECLARATION BY CANDIDATE

I have carefully read & noted the Instructions to the candidates before filling in this form. I declare that the information given above is true and correct to the best of my knowledge and belief. I undertake that I shall be responsible for any omission/errors and wrong/incomplete entries made by me in this form. Place : Date : Signature of Candidate ___________________________________________________________________________

D] FEE DETAILS

Amount of fees remitted Rs.___________Challan No. __________ Dated ___________ of the Bank of Maharashtra, University Extension counter, Pune – 7 OR paid at ______________________________College/Institute OR Demand Draft of Rs.___________ No. ________ Dated _____________ of ____________________________ Bank. ___________________________________________________________________________

E] INSTRUCTIONS TO THE CANDIDATES

1. CONVOCATION FEES : Sr. No. Description Charges

Non Professional Courses Professional Courses 1. Price of Application Form (Excluding Postal Charges) Rs. 20/- Rs. 30/- 2. Degree and Post Graduate Degree Certificates (Within 5 Years) Rs. 200/- Rs. 265/- 3. Degree and Diploma Certificate (After 5 Years) Rs. 395/- Rs. 525/- 4. Late Fee (After Prescribed Date) Rs. 165/- Rs. 220/- 5. Special Fee after Convocation in addition to regular charges Rs. 395/- Rs. 525/- 6. Air Mail Postage for ABROAD Addressee Rs. 150/- Rs. 150/- The prescribed convocation fee should be paid only by challan through Bank of Maharashtra Extension Counter at the University of Pune OR by Demand Draft in favour of Registrar, University of Pune, Pune – 411007 OR at any center notified by the University, from time to time. (Convocation fee sent by Cheque /M.O. will not be accepted) 2. (a) Incomplete forms or those received after the closing date, or those without accompanying Xerox

copy of Statement of Marks, bank challan or details or fees paid not given will be rejected and no correspondence in this behalf will be made.

(b) The challan of Bank of Maharashtra itself is a receipt of fee. It should be preserved carefully till the receipt of Degree Certificate by the Candidate.

3. Convocation Date : The exact date and time of the convocation will be declared in local newspapers Fee receipt is to be Preserved and surrendered at the time of collection of the degree on the day of the convocation or for any enquiry regarding receipt of the degree.

4. Candidates for M.B.B.S, B.H.M.S., B.A.M.S., B.D.S. and B.H.M.S. (Graded) ect. Should submit alongwith their application forms for degree, a certificate from the University Office to the effect that they have satisfactorily completed the Internship Training/Housemanship as required by the Rules

5. Candidates Passing M.A., M.Sc., M.Com. Examination under Improvement of Class Scheme are not eligible for the degree under the old rules. However, those who have re-appeared and passed under provisions of 0.168 (under CIS after 16-2-93) are eligible for degree, provided they surrender their original degree certificate. 6. Candidate should attach Xerox copy of statement of marks of his/her final examination. 7. Ph.D. and M.Phil. candidates should attach a copy of the notification of their declaration of result. 8. The date for receipt of the application forms is notified in the news papers everytime as well as to the Principals of the Colleges. Complaint regarding non-receipt of degree/issue or receipt of wrong degree (viz. name, college, class, subject, year of passing etc.) will be entertained within a period of six months only from the date of concerned convocation. No complaint will be entertained after the specified period. 9. Candidate can submit Convocation Form even after convocation, under Ordinance 104-A, if the result of concerned degree examination is declared before the date of previous convocation, Candidate can apply for Degree Certificate even after the Convocation throughout the year except the period of 30 days before the convocation every year with Special fee after Convocation in addition to regular charges. The Degree Certificate will be issued after one month from the submission of application form for Degree Certificate.