COLLEGE CODE
H.T.No: APPLICATION FOR PROVISIONAL CERTIFICATE
JAWAHARLAL NEHRU TECHNOLOGICAL UNIVERSITY ANANTAPUR ANANTHAPURAMU – 515 002, A.P. NAME OF THE CANDIDATE *(IN BLOCK LETTERS AS PER S.S.C)
FATHER’S NAME (IN BLOCK LETTERS AS PER SSC)
Degree/Diploma Branch
COURSE AND BRANCH
MONTH & YEAR OF PASSING EXAM (To be filled by the candidate, who completed the course)
PERMANENT ADDRESS
Pin Code FEE PARTICULARS: (Rs.200/-) Bank: __________________D.D./Challan No ____________________ Date: _________________ NOTE: 1. SBI Challan (Power Jyothi A/C 32950804752) University Copy for Rs 200/- /Demand Draft for Rs. 200/- drawn in favor of the REGISTRAR, J.N.T.UNIVERSITY ANANTAPUR, payable at Anantapur should be enclosed. 2. Xerox Copy of SSC (attested by the college principal) should be enclosed. Date: SIGNATURE OF THE CANDIDATE --------------------------------------------------------------------------------------------------------------------------------------For College Office Use only
Certificate of Identification I certify that Mr. / Mrs. / Miss. ________________________________________________________ S/o / D/o of ___________________________________________________ is a bonafide Student of (College Name):________________________________________________________________ College Code: __________ during ________ to _________ with H.T.No. ____________________
Date:
Signature of the Principal With Office Seal
