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This document is an application form for students of Visvesvaraya Technological University to request official transcripts, degree certificates, grade cards, and other academic documents. It collects the applicant's contact information and details of the documents and destinations requested. Fees must be paid via SBI Collect and are specified for each document type. For overseas delivery, an additional postage fee is required. The form provides tables to include academic results for provisional degree certificate and consolidated statement of marks applicants. It includes spaces for office use and the postal address where documents should be sent.

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Kishan Raj
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Download as PDF, TXT or read online on Scribd
143 views

Common PDF

This document is an application form for students of Visvesvaraya Technological University to request official transcripts, degree certificates, grade cards, and other academic documents. It collects the applicant's contact information and details of the documents and destinations requested. Fees must be paid via SBI Collect and are specified for each document type. For overseas delivery, an additional postage fee is required. The form provides tables to include academic results for provisional degree certificate and consolidated statement of marks applicants. It includes spaces for office use and the postal address where documents should be sent.

Uploaded by

Kishan Raj
Copyright
© © All Rights Reserved
Available Formats
Download as PDF, TXT or read online on Scribd
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VISVESVARAYA TECHNOLOGICAL UNIVERSITY

“Jnana Sangama”, Belagavi- 590018


Application for Issue of Documents to UG and PG Students
Common application format for sending application by email as per Notification VTU/BGM/Reg(E)/PS/2019-2020/01 dated 05-05-2020
Submit separate application form and payment ID for each different destination address
APPLICANT CONTACT INFORMATION (Fill electronically or write in a legible handwriting, ALL CAPS where possible) Date: __ __ – __ __ – __ __ __ __

Name: _____________________________________________ Address: _____________________________________________________________________

Email: _____________________________________________ ____________________________________________________________________________

Mobile: ____________________________________________ ______________________________________ Signature: ____________________

Name as on Grade/Marks Card: _________________________________________________ USN: ___ ___ ___ ___ ___ ___ ___ ___ ___ ___
Status of College when enrolled:  Non-autonomous/ Autonomous;  CBCS/ Non CBCS Old USN (if applcable): ___ ___ ___ ___ ___ ___ ___ ___ ___ ___
Document Fee
Official Transcripts (Number of Transcripts = ____________ )  ₹ __________ ₹ 500 + ₹ –
Transcripts and Documents to sent To WES/NCEES/IQAS/.  ₹ 500 for Transcript ............................................................ Required for WES
University abroad or other similar institutions  ₹ 300 Degree Certificate/Provisional Degree Certificate .... Attach copy
(Note: WES/NCEES/IQAS/University applicants must attach the Academic  ₹ 300 (1 to 9 Marks/Grade cards) ....................................... Attach copy
Records Request Form and documents to be attested)  ₹ 600 (10 or more Marks/Grade cards) .............................. Attach copy
Medium of Instruction  ₹ 250
Provisional Degree Certificate–If Degree completed in Jan 2020  ₹ 400
Semesterwise Consolidated Marks Card–Non CBCS students only  No. of Semesters ____ ₹ 500 per Semester = ₹ ________(Enclose All Marks Card)
All semester single Consolidated Statement of Marks–Non CBCS students only  ₹ 1000 ( Enclose 8th Sem Marks Card )
FEE DETAILS Total ₹ _________________
 Postage (For addresses outside India) ₹ 1,500 Grand Total: ₹ ______________
OR
 Processing fee (WES/NCEES/IQAS/Universities etc.) ₹ 1,500 Fee Payment ID ___ ___ ___ ___ ___ ___ ___ ___ ___ ___
Pay fee by SBI Collect on https://vtu.ac.in/en/online-fee-payment. Choose “Category F – Fees to be paid by student Examination”

RECIPIENT OF DOCUMENTS and MODE OF DISPATCH


Send documents to Send by post/courier Send Softcopy by email to the below email address
 Applicant   _____________________________________________
 WES/NCEES/IQAS/University or ___________________________________   _____________________________________________

PDC APPLICANTS ONLY Undertaking: I have not applied for revaluation of any course/subject of the current exam. Signature:
 UG Non CBCS First attempt total marks of last four semesters (excluding CIP and CIV)  UG CBCS Non CBCS and CBCS
UG Programs 5th Sem 6th Sem 7th Sem 8th Sem 9th Sem 10th Sem Total CGPA Class
B.E./B.Tech./B.Arch
PG Programs 1st Sem 2nd Sem 3rd Sem 4th Sem 5th Sem 6th Sem Total  PG CGPA Class
MBA/MCA/M.Tech.
CONSOLIDATED MARKS CARD APPLICANTS ONLY (Non CBCS Students only) BE/B.Tech. Semesters 1 to 7, B.Arch. 1 to 9
Semester 1 2 3 4 5 6 7 8 9
First Attempt Marks
Max. Marks (Out of)
Final Result
CONSOLIDATED STATEMENT OF MARKS APPLICANTS ONLY (Non CBCS Students only) BE/B.Tech. Semesters 1 to 8, B.Arch. Semesters 1 to 10
Non CBCS CBCS
Semester
1 2 3 4 5 6 7 8 9 10 CGPA
First Attempt Total
FOR OFFICE USE ONLY
Case Workers: 1) _____________ 2) _____________ 3) _____________ Special Officer: __________________ Registrar (Eval): ____________________

To be filled in by applicant:  Send by post/courier (Give postal address below)  Send by email (Give email address below)
POSTAL ADDRESS TO WHICH DOCUMENTS ARE TO BE SENT (This portion will be cut and pasted on envelope. Verify for accuracy)

WES/NCEES/IQAS/University Ref:
Name
Attach WES Academic Record Request Form or similar document
Address

Email of Recipient:
PIN/ZIP
Give email for institutions/organizations other than WES. Documents are sent to WES electronically.

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