OSMANIA UNIVERSITY

HYDERABAD - 500 007, (A.P)

APPLICATION FORM FOR OBTAINING THE DEGREE CERTIFICATE
(IN PLACE OF LOST ORIGINAL CERTIFICATE)
Check List For Counter Use
Name
Ht. No.
Father's Name

AFFIX ONE
PASSPORT SIZE
PHOTO

Name of the College

Applied For
Exam Passed / Appeared
Year of Pass/Appeared

D.D. No.

Signature of the Candidate

D.D. Date

Amount
Signature of the Candidate

Collection Person/Post

----------------------------------------------------------(For Office Use At Counters)--------------------------------------------------------Receipt No. __________

Due Date ________________

Receipt Date ___________

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I Solemenly and sincerely swear on oathe that My

Certificate is lost / is
not in a proper condition (the Certificate is enclosed) and pray that a duplicate copy of the Certificate may be issued
to me.

Date :

Signature of the Applicant

----------------------------------------------------------------------------------------------------------------------------- ----------------------------------Name of the Candidate

(BLOCK LETTERS)

Father's Name
(BLOCK LETTERS)

Address to which the Duplicate

Certificate should be sent (in case it is to
be sent by Registered Post)

Particulars of the
Examination Passed

Examination
Passed

D.D. No. through which the fee of

Rs. 1000/- is paid

Date : __________________

Roll. No.

Year

D.D. No.

Division

Subjects

Date

Signature of the Candidate

1. Attach an Extra Photograph to the Application Form while submitting.

2. As the Original Certificate cannot be issued, a Duplicate copy of the Certificate may be issued to the candidates
on submitting this form to the Controller of Examinations, Osmania University duly filled in and the Identify
Certificate given below duly certified together with the prescribed fee of Rs. 1000/-.
3. Candidate is instructed to be very careful about the entries to be made in the under - mentioned columns. All the
entries should be in candidate's own hand - writing and candidate with be held personally responsible for any
incorrect entry that he / she makes.
4. The name of the candidate and that of his / her father given here under should correspond to those mentioned in
the Examination Form.
5. D.D. amount Rs. 1000/- drawn in favour of Controller of Examinations, Osmania University (from Nationalized
Banks Only).
6. Non - Judiciary stamp paper worth of Rs. 10/- duly signed by Notary (Affidavit).
7. Xerox copies of Certificates / Memorandum of Marks.
8. The requisite fee will have to be paid through Demand Draft within one month from the date of its issue along
with Application Form.
9. Alternatively attestation may be done by the candidate (Self Attestation). If the information furnished is found to
be wrong, the candidate will be fined Rs. 100/- and necessary Criminal Action will be initiated according to the
Rules.
10. Application along with prescribed fees and other documents should be submit to the Controller of Examinations,
Osmania University, Hyderabad - 50 0007.
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----------------------------------------------------------------------------------------------------------------------------- -----------------------------------Received from the Controller of Examinations, Osmania University, the ________________________________
Degree Certificate.
----------------------------------------------------------------------------------------------------------------------------- ------------------------------------

Date : ___________________________

Signature of the Candidate