HITS/RO/11

Date:
Application Form for the issue of Bonafide Certificate

1. Name of the Student :

2. Roll No. :

3. Gender :

4. Department :

5. Branch :

6. Year of study :

7. Father’s Name :

8. Receipt No. (ERP) :

9. Amount Paid in Rs. :

10. Reason for Bonafide Certificate :

(1)

(2)

(3)

11. Remarks of the Class Teacher :

12. Remarks of the HOD :

Recommended and
Forwarded to Registrar

Signature of Class Teacher Signature of HOD

(To be submitted to Registrar Office)