... Ctfn71f : K?,/t. /.t:r. .

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Appendix A : Certifi ca t e from ll•' ad ol th~ Oc~par-tml'nt/ ln ~ti t ul«·

Certific~te frqm_ l:f_ead Qf the Depa~mentllnstitutc

(§19ib1II~ Docum«:nt fgr GA TE 2020 Appllcat1(m)

This Is to cenlfy that Mr. I Ms. ,k?,/t.«. ... &0:.IR:f. ... £/i,,.,11.f".f..~r..( .........
Slo o r Olo,5;./WJ?~.M.t.{ ..../l/;.H.?.(~(.(:. Is a student enrolled
in the depanment of ..Ctfn71f«/.t:r. ..<:k:,.w.r,1u:__fl .. f.7JP
,1-t the Institute/
College . . Cz.I.T.//; ..8/JM.-./?.?.{r:f::atf21J. for the program 11!1 per the

details given below:


Do not attest
k~>e,, ,, /f.tv,,, 11 , Do not aign on
Sign maadc the ad1acc:n1 box photo
& /4 , >t~.R.>t /

1. Roll Nol Registration No I Student ID {bf) {'l S' 1/..'J..?. ! .. ..


2 The student 1s m the final year ot . fJ.. .'""Tt;_c.f.c ...... (8.E. / B.Tech / B.S./ 8 .Sc Resear ch/
M .Sc/ lnlegrated M .Sc/8.Arch/ M.C.A). OR

3 The sludent 1s 1n the pre-fi nal year ot . •. .. . (ME/ M Tech/ Dual Degree/ Integrated
M.E .I M Tech) .

4 Oura11on ot the program which lhe sludent Is studying :...1) /(i . Yea1 s
5. The student 1s pursuing the undergraduate progrnrn on latdral entry. 1. n Yes 2. vi N o
Ju,,~ /(;11/(.,J d.✓/.,11/ll~J(I
r;. \.{ - "' A/1v'~/ J q
Signature of the Ca11d1dale w1lh date -< ' '

Signature of the Head of the OeQprtment/ lr stitute with seal


p n n c 1pa
Date: '.23,-~- i "1 GITA . Bhub aneswar

~ - Wlthou1 a lgnature o f the HHtl o f th e Depa r1me 111J111alllute & aeat , the t utlflt ate la not v ■ lld .

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