RANI DURGAVATI VISHWAVIDYALAYA, JABALPUR
    		   (Formerly, University of Jabalpur)
			    APPLICATION FORM                                       
(For all Undergraduate & Postgraduate Degree/Diploma Certificate)
To,
	The Registrar,
	Rani Durgavati Vishwavidyalaya,Pachpedi, Jabalpur,M.P. INDIA.
Sir,
I have passed  the  following  Examination for  the  Degree/Diploma 
Certificate of Rani Durgavati Vishwavidyalaya, Jabalpur.  I  hereby
apply for issue of the Degree/Diploma Certificate:
1.	Name of the Applicant	:
	( In Block Letters)


   	iwjk uke fgUnh esa           ---------------------------------------------------------


2.	Father's/Husband's Name	:

3.	Name of the Examination	:				
	Main/Supplementary (Please enclose Photocopy of the marksheet)

5.    Roll Number of the Exam: ............ in words .................

6.    Appeared as Regular/Non-collegiate/Ex-student. If you were a 
      Regular student then mention the name of the College
      ................................................................

7.    Prescribed Fee Rs. ........ Receipt/Bank Draft No. .............
        .................................Date ............ (Enclosed)

8.    Please send my Degree/Diploma Certificate by Regd.Post on the

      following address:..............................................
	
      ................................................................
 
      (Please note that the certificates are not issued on the basis 
       of authority letter)

      Date:                                 (Signature of Applicant)
_______________________________________________________________________
        I Certify the Signature of the above candidate

Signature of Attesting Officer:......................................

Name of the Attesting Officer : .....................................

with seal                     : ....................................

                              : .....................................