Birla Institute of Technology Form A

BIRLA INSTITUTE OF TECHNOLOGY FORM A

MESRA, RANCHI

APPLICATION FOR

VERIFICATION OF DEGREE CERTIFICATE / EDUCATION

Fee Details

Amount :………………………………………………..

DD No.Date :………………………………………….

Name of the Bank :……………………………………….

Branch :…………………………..……………………….

______

To Date:

The Registrar,

Birla Institute of Technology, Mesra,

Ranchi, PIN- 835215 (Jharkhand)

Sir/Madam,

We need the verification of the following passed out student / existing student of Birla Institute of Technology, Mesra. The details are as follows:

Name of the Candidate: ……………………………………………………………………………

(In BLOCK LETTER - as per the Certificate)

Gender: ……………………………………………………………………………………………..

Name of the Degree: ……….……………………………………………………………………...

Roll No. ……….……………………………………………………………………………………

Mesra Campus / Off-Campus where studied: …………….………………………………………..

Period of study: …………………………………………………………………………………….

Year of Passing: ……………………………………………………………………………………

CGPA obtained: ……………………………………………………………………………………

Purpose of verification:……………………………………………………………………......

Name & Location of the agency / company:……………………………………………………...

Any other remarks:…………………………………………………………………………………

Address for Communication where the verification report has to be sent:

……...……………………………………………………………………………………………….

……………………………………………………………………………………………………

Signature

Name & Designation

Name and address of the agency / company

(Including Email address and Phone)

Note: Fee has to be paid in the form of Demand Draft to be drawn in favour of “Birla Institute of Technology, Mesra “payable at Mesra, Ranchi or submission of fee receipt and to be sent to In-charge, Students Section, Birla Institute of Technology, Mesra, Ranchi- 835215.

NOTE:

On proof of payment of verification fee in the form of Demand Draft in favor of “Birla Institute of Technology, Mesra” or proof of payment of fee receipt with clearly mentioning the DD details or fee receipt details against each candidate with documents to be verified has to be sent.

Without receiving verification fee, verification process shall not be carried out.

Central Govt. / State Govt. / Autonomous organizations / PSUs etc. claiming for waiver of payment of verification fee has to submit proper document where it should be mentioned that their organization is empowered through certain O.M.for fee waiver.