Sam Higginbottom University of Agriculture, Technology And Sciences
Directorate of Distance Education
APPLICATION FORM FOR CORRECTION IN NAME / FATHER’S NAME
Read the Instruction Carefully before filling the Form. All Fields of the Form are Mandatory.
Enrollment Number (As in the ID card) IPIP Code (Optional) Programme Semester/ Year
-
Name of the Student as in the Mark Sheet (Incorrect)
Correct Name of the Student
(Attach Affidavit in original on a Rs. 10/- Notarized Non - Judicial Stamp Paper or Photo Copy of High School Certificate)
Father’s/ Husband’s Name as in the Mark Sheet (Incorrect)
Correct Father’s/ Husband’s Name
(Attach Affidavit in original on a Rs. 10/- Notarized Non - Judicial Stamp Paper or Photo Copy of High School Certificate)
Complete address (Do not repeat the name)
Pin
Mobile Number e-mail ID
DD Number DD Date DD Amount Name of the Bank
d d m m y y y y
Demand Draft of Rs. 750/- to be in favour of “DDE, SHUATS” payable at Allahabad for each mark sheet to be corrected.
Note: Attach all original documents for corrections else the application form will not be accepted.
DD Date Place
d d m m y y y y Signature of the student
The completely filled form must be sent on the fallowing address:
DIRECTOR
Directorate of Distance Education
Sam Higginbottom University of Agriculture, Tech. And Sciences
Naini, Allahabad - 211007
Ph. : 0532-2684317, Email -
[email protected] For Office Use Only
Enrollment Number. ________________________________ DD Number. ______________________________________
Date of Receiving __________________________________ Issuing Branch ____________________________________
Sent for Verification to ______________________________ DD Amount _______________ Issuing Date_____________
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Accepted/ Rejected (if rejected mention reason)
Authorized Signatory
