The Maharaja Sayajirao University of Baroda

Fatehgunj, Vadodara-390 002, Gujarat (India)

http://msub.digitaluniversity.ac/
Student's Application for Convocation
[April-2018] B.E. - Regular - FoTE [BE] 2012-Textile Technology-SSBE-IV-SSBE-IV
PRN : 2014033800101064 Eligibility Status : Eligible Application No. : 0000025724
Student Details
Student's Name: DEEPANSHU KAKKAR Mother's Name: SANGEETA Gender: Male
Address: FLAT NO. 101, 1ST FLOOR, TOWER-V(22)
RAJESWAR GOLD VIEW, NEAR WALLAM HALL, HARNI ROAD , Vadodara, Vadodara, Gujarat - 390022
Telephone no.1: - Mobile no: 918866221207 Email 1:
DOB: Jul 29, 1996 Category: Open Physically Handicap: -
College Name (College Code): Faculty of Technology & Engineering (3386)
College Address (Pin code): Kalabhavan, Vadodara, Vadodara, , Gujarat(390002)
Previous Examination Details
Exam Name : SSBE-IV Event : April-2018 Seat No/Roll No : 811021 Percentage : 77.2

Documents attached
1. Statement of Marks of Current Year/ Semester
Application Payment Details
Application for Convocation Fee on 6 Jan 2019 for Application No.0000025724 for Faculty of Technology & Engineering - B.E. -
Regular - FoTE [BE] 2012 - Textile Technology
Invoice No. : 0000025962 Invoice Amount : Rs. 500.00
List of Payment(s)
Sr. Payment Payment Payment Transaction Bank Bank DD/Cheque MICR No Bank
No. Type Date Amount ID Branch No. Challan No
1. Online 06/01/2019 Rs.500.00 2019010612 - - - - -
Payment 1722667257
24
Student Declaration
I hereby declare that, I have read the rules related to Application for Convocation and the information filled in this form is
accurate and true to the best of my knowledge. I will be responsible for any discrepancy, arising out of the form signed by me.
Place:
Date: Signature of Student
For College/ University use
Designation Remarks / Particulars / Recommendations Signature and date
Office Clerk Cash Received: Rs. Receipt No.:
Accountant/Cashier
Principal/ Authorized Signatory