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    Degree Form - MUHS

    Uploaded by

    jyotiisingh0520
    The document is an application form for graduates to apply for their degree or diploma certificate from Maharashtra University of Health Sciences, Nashik. It requests personal details of the applicant like name, program details, and declaration. It also provides instructions to applicants on filling the form and collecting the certificate.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd

    Degree Form - MUHS

    Uploaded by

    jyotiisingh0520
    56 views2 pages
    The document is an application form for graduates to apply for their degree or diploma certificate from Maharashtra University of Health Sciences, Nashik. It requests personal details of the applicant like name, program details, and declaration. It also provides instructions to applicants on filling the form and collecting the certificate.

    Original Title

    Degree Form- MUHS

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    © © All Rights Reserved

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    The document is an application form for graduates to apply for their degree or diploma certificate from Maharashtra University of Health Sciences, Nashik. It requests personal details of the applicant like name, program details, and declaration. It also provides instructions to applicants on filling the form and collecting the certificate.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    56 views2 pages

    Degree Form - MUHS

    Uploaded by

    jyotiisingh0520
    The document is an application form for graduates to apply for their degree or diploma certificate from Maharashtra University of Health Sciences, Nashik. It requests personal details of the applicant like name, program details, and declaration. It also provides instructions to applicants on filling the form and collecting the certificate.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
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    MAHARASHTRA UNIVERSITY OF HEALTH SCIENCES, NASHIK
    fnaMksjh jksM] EgljQG] ukf'kd&422004
    Dindori Road, Mhasrul, Nashik-422004
    EPABX: 0253-2539100/300, Ph: 0253-2539226
    Email:coe@muhs.ac.in, examadmin@muhs.ac.in Website: www.muhs.ac.in

    Tel:MBBS-0253-2539216/138, BDS-0253-2539217/261, BAMS/BUMS-0253-2539218/210,


    BHMS–0253-2539225, ALLIED-0253-2539221, PG Courses-0253-2539251

    Application for Degree / Diploma Certificate Affix a


    photograph of
    (Before filling this form, please read the instructions given at size 35mm
    the end. Fill up the form in CAPITAL letters only.) x45mm duly
    signed across
    To, & attested by
    The Registrar, Dean/
    Maharashtra University of Health Science, Principal of
    Nashik the concerned
    college
    Mandatory Enclosures
    (i) Attested photo copy of Final Year Passing Certificate.
    (ii) Attested photo copy of Internship Completion Certificate issued by
    the University.
    (iii) Attested copy of XII Std. Statement of Marks/Passing Certificate.
    (iv) One additional passport size photograph.

    Sir,
    I hereby apply for Degree / Diploma certificate of the University at
    the ensuing Convocation Ceremony, to be held in the month of . . . . . . . .
    PERSONAL DETAILS
    1) Applicant’s Full Name (as per XII Std. Statement of Marks or XII Std.
    Passing Certificate. One block to be kept blank between two words)

    2) Name in Devnagri Script (Marathi).. . . . . . . . . . . . . . . . . . . .


    3) Sex: Male Female
    4) Phone:. . . . . . . . . . Mobile:.. . . . . . . . .
    5) Postal Address: . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
    . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
    . . . . . . . . . . . . . . . . . . . . . . . .PIN Code . . . . . . . . .
    6) College Code:. . . . . Name of College:.. . . . . . . . . . . . . . . . .
    7) Course :. . . . . . .Month & Year of passing final year: .. . . . . . . .
    8) University PRN. . . . . . . . . . . . Final year Seat No.:. . . . . . . .
    9) Convocation Attendance Status (P -In Person, A -In Absentia)
    DECLARATION BY THE CANDIDATE
    I have carefully read & noted the Instructions to the applicant,
    before filling up 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 and accountable for any omission/errors and
    wrong/incomplete entries made by me in this form.
    Place :
    Date : Signature of Applicant
    INSTRUCTIONS TO THE APPLICANT
    1) Incomplete forms and forms without attested photo copies of Final Year
    Passing Certificate, Internship Completion Certificate issued by the
    University and XII Std Statement of Marks or Passing Certificate and
    additional passport size photograph, will not be accepted.
    2) The acknowledgment of this form should be preserved carefully and
    produced at the time of collection of the Degree/Diploma Certificate on the
    day of the Convocation Ceremony, or as and when the Degree/Diploma
    Certificate is collected.
    3) Any complaint, regarding non-receipt of Degree/Diploma Certificate, (viz.
    Name, College, Class, Subject, Final Year of Passing, etc.), will be
    entertained within a period of three months from the date of the concerned
    Convocation Ceremony. No complaints will be entertained after the specified
    period.
    4) Two identical passport size photographs (size 35 mm X 45 mm), of which
    one duly attested by Dean/Principal of the concerned college should be
    pasted on the form at the space provided for it and other photograph should
    be enclosed in a small envelope and attached with the application. The name,
    course and University PRN should be mentioned on the reverse side of photo.
    No photograph, other than the stipulated size i.e. 35mm X 45mm (Visa type),
    will be accepted.
    5) Please check the details of Convocation Ceremony on the University web
    site<www.muhs.ac.in>, which will be notified one month in advance from the
    date of Convocation Ceremony.
    6) Candidates are advised to collect his / her degree certificate within one
    year from the date of convocation or else retention fee will be charged as
    per University rules prescribed from time to time.
    For Official Use only
    The applicant’s name, academic and other details as stated in this
    application have been checked with the office record and found to be
    correct/incorrect.
    Acknowledgement/Discrepancy letter no. . . . . . . . . . . . . . . issued.

    I/c Faculty

    NAME & POSTAL ADDRESS OF THE APPLICANT


    (To be filled in by the Candidate)
    . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
    . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
    . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
    . . . . . . . . . . . . . . . . . . . . . . . . .PIN Code . . . . . . . .

    ACKNOWLEDGEMENT SLIP
    (For Official Use only)
    Convocation application in respect of . . . . . . . . . . . . . . . . . .
    PRN. . . . . . . . . . . . has been duly received and found to be correct
    in all respects. Degree/Diploma Certificate will be issued in person to
    the applicant on production of this receipt and photo identity OR to the
    blood relatives, i.e. Father/Mother/Brother/Sister, of the applicant on
    production of their photo identity and an authority letter from the
    applicant, on the day of the Convocation Ceremony or any working day,
    after a month of the Convocation Ceremony.
    I/c Faculty

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