DR.

BALASAHEB SAWANT KONKAN KRISHI VIDYAPEETH,

30th CONVOCATION

(Please read instructions before filling the form)

To,
The Registrar,
Dr. Balasaheb Sawant Konkan
Krishi Vidyapeeth, Dapoli,
Dist. Ratnagiri.

Sir,
I wish to attend the convocation to receive my Degree of _________________
(Examination)
in person Tick as
in absentia

My particulars are as follows :

Name in full (in block letters as per transcript issued by the university)

(Surname) (Name) (Middle Name)

Sex Male Female

Degree Examination Passed in the Month ___________ Year _____________________

Regd. No. _______ Name of College __________________________________________

Class awarded First Class with Distinction / First Class / Second Class

Post Graduate Degree Examination Passed in the Month _______ Year ____________
Regd. No. _______ Name of College __________________________________________
Discipline ________________________________________________________________

Class awarded First Class with Distinction / First Class / Second Class

Doctoral Degree Examination Passed in the Month ______ Year ___________________

Regd. No. _______ Name of College __________________________________________
Discipline ________________________________________________________________

Class awarded First Distinction/First Division/Second Division/By Research

(Copy of transcript enclosed)

[P.T.O.]
 I have read the notes overleaf and accordingly I remit the prescribed fee of Rs.
250/100 (Two hundred fifty / Hundred only) by Demand Draft No. _____________
Date ______________

Address for correspondence (Degree Certificate will be sent on this address)

Name _____________________________________________________________

At.________________________________Post.___________________________________

Tal._______________________________ Dist. __________________________________

State _______________________ Tel / Cell No. _________________________________

Place ______________________

Date _______________________ Candidate’s Signature

(Entries to be made by the University Office)

Result Checked by : Degree Certificate Checked by :

Dealing Assistant Supdt. Dy. Registrar

Demand Draft Rs. _____________ No. _______________ Date _____________

Degree Certificate issued by in person / sent by post on ______________________

Dealing Assistant Supdt. Dy. Registrar

INSTRUCTIONS

1. The fee for admission to the First / Second Degree of this University is Rs. 250/- (in
absentia) and Rs. 100/- (in person). Candidates who seek admission to more than one
Degree at the same Convocation must submit a separate application and pay separate
fee in respect of each Degree.
2. The student should send the prescribed Convocation fee by demand draft in the name
of the Dr. Balasaheb Sawant Konkan Krishi Vidyapeeth, Dapoli, Dist. Ratnagiri and
payable at Dapoli
3. Incomplete forms and those received after the expiry of the prescribed date will not be
considered.