RANI DURGAVATI VISHWAVIDYALAYA, JABALPUR
    		   (Formerly, University of Jabalpur)
 				APPLICATION FORM
		(For obtaining Duplicate copy of Marksheet)
To,
	The Registrar,
	Rani Durgavati Vishwavidyalaya, Pachpedi, Jabalpur. M.P.INDIA.
Sir,
I need a duplicate copy of the marksheet because the original 
marksheet is lost or mutilated.  My details are as under:

1.	Name of the Applicant	:
	( In Block Letters)
2.	Father's/Husband's Name	:

3.	Name of the Examination	:

4.	Month and Year of the Exam:

5.	Roll Number		:

6.	Enrolment Number	:
	Please issue me a duplicate copy of the above marksheet/
	send it on the address given below:
						                                       ...........................

	----------------------------	Signature of the Applicant
							
	----------------------------	Date
__________________________________________________________________________________________	
              (Certificate by the Attesting Officer*)
     I certify the signature of the above candidate.  He has signed
before me.

			        Signature  : .................

			        Name       : .................         

                           Designation: .................
                           Office SeaL:
(*Principal of the College/Head of Uni. Dept/Gazetted Officer)
__________________________________________________________________________________
				( for office use only )
Application form checked:
Accepted/Rejected					Accepted/Rejected

						Asst./Dy. Registrar/Sr.Supdt.
Dealing Examination Clerk			       Examination Section