SIT- PUNI

"syMBIOSIS
'"'. .... INl fRNATIONAL UNIVERSITY
(E stJbli~hcd under section 3 of the UGC Act. 1956
v1dc notification No. F.9·12/2001·U3 Govt. of lndi.a)
He-accredited by NAAC with 'A' gr;tde

Application for XIV Convocation Certificate

To,

The Registrar,
Symbiosis International University,
Lavale-412115

Sir,

Submitting application form to obtain degree I diploma convocation certificate.

IAJ ACADEMIC DETAILS :
l)Name SUBHADEEP BHAKTA
2)1nstitute SIT - PUNE
3)Degree/Diploma : B TECH. (MECHANICAL ENGINEERING)
4)PRN 14070121780
S)Passing Year APRIL- 2017

IBI PERSONAL DETAILS:

1) Address for Dispatch of Degree I Diploma Certificate
Address: D/2212, Saratpally, West Medinipur
City: Midnapore District: West Medinipur State: West Bengal Country: India Pin Code:
721101
2) Telephone No.
Res. Tel. No. : 03222297665 Mobile No. : 7350980676
3) E-Mail ID : subhadeep. bhakta@sitpune.edu.in
4) Aadhar Number (For Indian Students) I Passport
657004677347
No. (For International Students)
5) Please dispatch my Degree/ Diploma certificate to the above mentioned address: No
I wish to collect my Degree I Diploma certificate personally: Yes
Transport:
6) Is your parent attending the Convocation? :No
ICJ OTHER DETAILS:
Current Occupation :Are you preparing any competitive exam?
Name ofthe
: Combined Graduate Level (CGL)
examination
I have carefully read and noted the instructions to candidates before filling in this form. I declare that the information
given above is true and correct to the best of my knowledge and belief. I undertake that I shall be responsible for any
errors and wrong or incomplete entries by me in this form.
. \\ \ \
Thankmg you, "-·

Date: 14110/2017 Signature of the Alumni