NATIONAL INSTITUTE OF TECHNOLOGY

JAMSHEDPUR - 831 014, JHARKHAND

(An Institution of National Importance under MHRD, Govt. of India, New Delhi)

Degree Recipient Registration Form

1). Name of student : ………….……….………………………………………………………

(as per 10th certificate)
2). Institute Registration No. : ………….……….………………………………………………………

Affix photo here

3) Father’s name : ………….……….………………………………………………………

4). Discipline : ………….……….………………………………………………………

5). Degree (UG/PG/Ph.D.) : ………….……….………………………………………………………

6). Year of Passing : ……………………………………………………………………….........................................................

7). Phone No. (i). Land Line : ……………………………………………………………………….........................................................

(ii). Mobile No. : ……………………………………………………………………….........................................................

7). E-mail ID : ……………………………………………………………………….........................................................

8). Mailing Address : ……………………………………………………………………….........................................................

for receiving the Degree
(with PIN Code) ……………………………………………………………………….........................................................

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

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

9). I-Collect SBI Reference No. : ………………………………………………………………………........................................................

10). Attach photocopy of Provisional Certificate : Yes / No …………………………………………………………….....

11). Attach photocopy of Final Semester Grade Card : Yes / No …………………………………………………………….....

Please fill-up this form and send it to Dean (Academic), NIT Jamshedpur, Jharkhand 831 014 along with soft copy of
fee payment proof to this email: dean.ac@nitjsr.ac.in . Also enclose self-attested copy of Final Semester Grade
Card and Provisional Certificate.