Shiats: Sam Higginbottom Institute of Agriculture, Technology and Sciences

Sam Higginbottom Institute of Agriculture, Technology and Sciences
(Formerly Allahabad Agricultural Institute)

Deemed-to-be-University
SHIATS
A University
Directorate of Distance Education With
GLOBAL REACH
APPLICATION FORM FOR THE ISSUE OF DEGREE/DIPLOMA + PROVISIONAL CERTIFICATE
Read the Instructions carefully before filling the Form. Incomplete form will be rejected without any notice.
1. Enrollment Number (As in the ID card) 2. DESC Code 3. Programme Revised on 13 Feb 2015
–
4. Name of the Student as registered with the University at the time of admission (BLOCK LETTERS ONLY)
5. Father’s Name of the Student as registered with the University at the time of admission (BLOCK LETTERS ONLY)
Please affix a
recent Passport
The Demand Draft of Rs. 1,650/- Size photograph of
6. Demand Draft No. 7. Date 8. Amount (Rs. 1,500/- for Degree + Rs. candidate
d d m m y y y y Rs. 1 6 5 0 150/- for Provisional Certificate) in
favour of DDE, AAI-DU, A/c
payable at Allahabad
9. Name of the Bank 10. Date of Birth
d d m m y y y y
11. Academic Details: Marksheet details of Programme.
Sl. Programme & Semester/Year Month & Year of passing DESC Code Marks obtained Maximum Marks Markseet SL No.
1
2
3
4
5
6
7
8
Note : Attach self-attested copies of Mark-Sheets of all Semesters/Years. 6 month Internship certificate (IF ANY, ONLY FOR for AAI-DU) PROGRAMME.
Declaration
I hereby declare that all the information given by me in this form is true and correct to the best of my knowledge and
belief. I have attached all required documents and demand draft with this form.
Date Place Signature of the Student

Full Address for Correspondence/mailing the degree /diploma /certificate (in Capital Letters):
Name :
Father Name :
Address :
Landmark:
District:
State:
PIN:
Phone / Mobile:
Full Address for Correspondence/mailing the degree /diploma /certificate (in Capital Letters):
Name :
Father Name :
Address :
Landmark:
District:
State:
PIN:
Phone / Mobile:
Important Instructions
 This Degree/Diploma + Provisional Certificate Form is to be filled by the student in his/her
own hand writing in English, using black ball point pen very carefully in Block Letters only.
 All fields of the application form are mandatory fields must be filled in with legible
handwriting. The applicant must ensure the completeness of the application form in all
respect, including contact details. Partially filled application forms shall summarily rejected,
without assigning any reason(s) whatsoever, and no separate communication by the
university to the applicant shall be made thereof. No complaint will be entertained in this
regard. Fees, once paid, cannot be refunded or held in reserve.
 Please ensure that your name in the MARKSHEET is correctly spelled as per the HS/SSC or
equivalent exam before applying for issue of Certt/Dip./Degree.
 The address of the students must be complete in all respect. It is compulsory to mention PIN
Code, Telephone/Cell No. and e-mail address (if any).
 Internship certificate (only for AAIDU paramedical courses.)
 The Demand Draft of Rs. 1,650/- (Rs. 1,500/- for Degree + Rs. 150/- for Provisional
Certificate) in favour of DDE, AAI-DU, A/c payable at Allahabad. No CASH payment
will be accepted. On back-side of the draft applicant must write their name, Enrolnment
Number and Contact number.
 Candidates are advised to send their applications by Speed/ Registered Post, to avoid loss
in postal transit. The Degree/ Diploma will be sent to the candidate by Speed/ Registered
Post.
 No separate Provisional Certificate will not be issued.
 If required urgently, student can come in-person to deposit form between 09:00 AM to 1:00
PM (Monday to Friday) and collect same after 5:00 PM.
 The following certificates duly attested by a Gazetted Officer should be enclosed with
this application; (a) Copy of High School Certificate and Mark Sheet (b) Copy of
Intermediate Certificate and Mark Sheet (c) Copy of the Under Graduate Degree
Certificate in the case of P.G. applicants. (Attach all documents as applicable for
eligibility of the programme as submitted at the time of Admission.)
The complete Degree/Diploma Forms along with demand drafts are to be sent on the
following address:
The Assistant Registrar
Directorate of Distance Education
Sam Higginbottom Institute of Agriculture, Tech. & Sciences
Deemed to be University (SHIATS)
(Formerly Allahabad Agricultural Institute)
Naini, Allahabad - 211007
Ph. : 0532-2684317 Email - [email protected]
CHECK LIST: (Please tick  the boxes or write ‘NA’ if not applicable)
DD is attached
The candidate has signed Declaration
Copy of High School Certificate and Mark Sheet
Copy of Intermediate Certificate and Mark Sheet
Copy of the Under Graduate Degree Certificate in the case of P.G. applicants

Shiats: Sam Higginbottom Institute of Agriculture, Technology and Sciences

Uploaded by

Copyright:

Available Formats

Shiats: Sam Higginbottom Institute of Agriculture, Technology and Sciences

Uploaded by

Document Information

Original Description:

Original Title

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

Shiats: Sam Higginbottom Institute of Agriculture, Technology and Sciences

Uploaded by

Copyright:

Available Formats

Sam Higginbottom Institute of Agriculture, Technology and Sciences

(Formerly Allahabad Agricultural Institute)

Date Place Signature of the Student

You might also like