Convocurrent.gtu.ac.in Convocation 4o6h65

11/16/2017

convocurrent.gtu.ac.in/convocation.aspx?x497Z8nR8yPYg0niWOMYynF9r5w2bjza

Gujarat Technological University

Convocation Year :2017

Application form for GTU Degree / Diploma Certificate

110820109055 Institute

[082] DR. JIVRAJ MEHTA INSTITUTE OF TECHNOLOGY, MOGAR, ANAND

1. Name of Applicant : JALIYA DILIPKUMAR BHARATBHAI 2. Correspondence : Address : 2803, devkapura pandoli petlad Anand Gujarat 388160 Email : [email protected] . (Phone) :

(Mob.) : 8780376195

Aadhar : 463945824674 4. ing Out Educational Qualification :

BE Branch : [09] ELECTRICAL ENGINEERING Month & Year ing : Jun 2017 I : 4.96 CGPA : 5.54 5. Whether willing to receive degree in person or in absentia (Tick) : 6. Coming with parents :

Absentia

No

7. Transaction Details : Degree/Diploma Payment Detail Challan No. : DU81049858 Total Amount. : 500 Branch Name. : SBI Challan Date. : 16-Nov-2017 8. Part of GTU Allumni : Allumni. : NO : Declaration : I agree that I have submitted my own detail, the detail are right as per my confirmation. If this information will be wrong then I may be bound with legal affairs or advocate illegal activity. I am also confirmed that I here for my own convocation application, if i found with ing other's information, then GTU can claim illegal activity to me. I must use every effort to keep my safe and should not disclose it to any other person. I shall also not permit, either directly or indirectly, any other person to utilize my ID or . GTU not responsible, if any other person misuses the service by logging into your .

Very Important: * I have verified all my details (Including Name , Photo & Other Degree Certificate Details) and I know that it cannot be changed later on after printing Degree Certificate. Date : 16/11/2017 Place :

http://convocurrent.gtu.ac.in/convocation.aspx?x497Z8nR8yPYg0niWOMYynF9r5w2bjza

Signature of Applicant

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