Off: 02762-286080, 286924
Ganpat Vidyanagar- 384012 Fax: 02762-286080
Mehsana-Gozaria Highway Toll Free 180023312345
Mehsana, GUJARAT, INDIA E-mail : info@[Link]
Web site : [Link]
APPLICATION FORM FOR OBTAINING THE DUPLICATE CERTIFICATE
(Certificate for which applied for: Mark Sheet or Grade Card/ Degree or Diploma Certificate)
Enrollment No./Examination No.:
(As per GUNI last Mark sheet)
Details of payment made (Cash/Online)
Degree & Branch: NEFT/RTGS/UPI/UTR No.
College/Institute Name: Amount Paid Rs.
1. Name of the Candidate
(As per the last semester/year
Marksheet or Grade Card)
2. Address for
Communication
PIN CODE
Contact No. (M) (M)
E-mail ID
3. Gender: Male Female Please tick ( )
(a) For duplicate Marksheet: Semester/Year
4. Mention the semester/year for which
Marksheet requested. Exam Type Regular/Remedial
b) For duplicate Degree/Diploma
certificate: Mention the Year in which Convocation Year:
degree/diploma was conferred
5. Reason for seeking the Duplicate Certificate:
6. Declaration: I solemnly declare that the particulars given above are correct to the best of my knowledge
Place:
Date: / /20 Signature of the Candidate
FOR OFFICE USE ONLY
a. Application Checked by: d. Request Approved by the Executive Registrar
b. Office Record Verified by:
Recommendation of
c. e. Certificate issued on:
Controller of Examination:
INSTRUCTIONS FOR CANDICATE
1. Application after completion of all the formalities should be submitted in the prescribed format at
Ganpat University Central Building,
Academic Section,
Ganpat Vidyanagar- 384012,
Mehsana-Gozaria Highway,
Mehsana, GUJARAT, INDIA
2. The following documents should be enclosed along with the application form.
(a) An affidavit duly signed and notarized by a First Class Magistrate detailing the circumstances
under which the original certificate was lost/destroyed. (As per the format attached herewith)
(b) Photocopy of the marksheet / degree or diploma Certificate for which duplicate certificate is
required (if available)
(c) If payment is online mode, then attached payment proof
3. The fees for the issue of various certificate is as follows:
(a) Marksheet/Grade Card -- Rs. 1000/- per Marksheet/Grade Card
(b) Degree or Diploma Certificate -- Rs. 3000/-
4. The fees should be paid in the form of Cash or Online mode only
Online payment through any online option e.g., RTGS/NEFT/IMPS/UPI Details as under
The Mehsana Urban Co-op Bank Ltd.,
Branch: Ganpat Vidyanagar
Account Name: Ganpat University
Account No. 00261001000948
IFSC Code: MSNU0000026
Type of Account: Saving
5. Fee once paid will not be refunded nor adjusted for any other certificate under any circumstances.
FORMAT OF AFFIDAVIT TO BE EXECUTED ON NON-JUDICIAL STAMP PAPER OF THE VALUE OF
RS. 50/- BEFORE A FIRST CLASS MEGISTRATE FOR ISSUE OF DUPLICATE CERTIFICATE
1) I Son/Daughter of aged Years,
an alumni / student of <Degree Name> Degree of <Institute Name>
constituent college of Ganpat University, Ganpat Vidyanagar, Mehsana - Gandhinagar Highway, Dist:
Mehsana, Gujarat, Pin: 384012 with Enrollment/Examination number _________________and
residing at <Your Home Address> do hereby solemnly
and sincerely state as follows.
2) My (i) * Marksheet / Grade Card of Semester/Year , Examinations held during
(ii) * Degree/Diploma certificate issued at the Convocation held on
is/are lost.
3) I file this affidavit for the purpose of receiving duplicate certificate.
4) I will return immediately the duplicate certificate(s) to the University once
my originalCertificate (s) is / are recovered by chance.
5) The facts stated are true and correct to the best of my knowledge and if found
false by theUniversity, I shall abide by the decision of the University.
6) I also undertake that if my original Diploma/Degree/Certificate which has been lost, if put to
any unfair use by the person who may lay hands on it, I shall stand for the damages which
may accrue from such use.
Place :
______________________
Date : Signature of the Candidate
Solemnly affirmed
at ........................................... (place)
this …………………..day of ………….. 20..….
and his / her signature is affixed in my presence. Signature of Deponent
Address:
Office seal:
* delete which is not applicable and add in case of Multiple Marksheets.
