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Examination Section: BITM/ES-04: Application Form For Transcript

This document is an application form for students of Birla Institute of Technology, Mesra to request transcripts. It requests information such as the student's name, roll number, branch, and year of graduation. Students can order multiple transcripts and choose whether to collect in person or have them sent. Payment can be made via bank draft, receipt, or reference number. Details such as names, addresses, and contact information are required depending on if picking up personally or having transcripts sent. There are instructions at the bottom on checklist documents needed like demand draft, provisional certificate copy, and identity proof.

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80 views1 page

Examination Section: BITM/ES-04: Application Form For Transcript

This document is an application form for students of Birla Institute of Technology, Mesra to request transcripts. It requests information such as the student's name, roll number, branch, and year of graduation. Students can order multiple transcripts and choose whether to collect in person or have them sent. Payment can be made via bank draft, receipt, or reference number. Details such as names, addresses, and contact information are required depending on if picking up personally or having transcripts sent. There are instructions at the bottom on checklist documents needed like demand draft, provisional certificate copy, and identity proof.

Uploaded by

Domo Arigato
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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Birla Institute of Technology, Mesra

Ranchi-835215, Jharkhand, India


Email: [email protected]
Examination Section Phone: 0651-2275138 (Extn-4483)

BITM/ES-04: Application Form for Transcript


Date:
1. Full Name: ________________________________________________ 2. Roll No: __________________________
3. Branch : ______________________________________________________________________________________
4. Passing Year: _______________ Month: ____________________Session: _________________________________
5. No of Transcripts Required: _______________________________________________ (Examples: 02,04,06,08 etc.)
6. Payment Method : (SBI Collect/ Account Office/ Demand Draft)
Demand Draft/ Receipt/ Reference No:
Issuing Bank/Institute Name:
Date:

7. To whom the transcript should be sent to:


Request-I: For personal collection, please fill in the Request-II: For sending it to organization/employer etc.,
details below. Please fill in the details below.
Full Name: Complete Postal Address:
____________________________________________ _____________________________________________
Mobile: _____________________________________ _____________________________________________
_____________________________________________
_____________________________________________
N.B: The applicant has to produce the original valid ZIP Code/PIN No: ______________________________
Identity Card for collecting the transcript personally. Email:________________________________________
Contact Number: _______________________________

Place:
Date: Signature of Applicant
---------------------------------------------------------------------------------------------------------------------------------------------
The filled in form duly signed by the applicant with the requisite fee and checklist documents will be submitted/sent
to: Examination Section
Birla Institute of Technology Mesra,
Ranchi-835215, Jharkhand, India
---------------------------------------------------------------------------------------------------------------------------------------------
Check List for Applicant:

₹ 500 per pair for sending it within India or collecting personally.


Demand Draft or Payment Slip
₹ 500 per pair for transcript and additional ₹ 2000 for sending it to abroad.

Self-attested Copy of Provisional Certificate Self-attested copy of Identity

N.B: Write your Name and Roll No at the back side of Demand Draft. Attach the self-attested copy of provisional certificate and
Identity. Application without signature is invalid.

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