Dr.

NTR UNIVERSITY OF HEALTH SCIENCES::AP

VIJAYAWADA 520 008
APPLICATION FOR OBTAINING
CERTIFICATE ON LOSS OF ORIGINAL DEGREE
1. As the Original Certificate cannot be issued, a Certificate on loss of the Original degree
certificate may be issued to the candidate on submitting this form to the Registrar, Dr.
NTR UHS, duly certified by the Principal concerned together with the prescribed fee of Affix recent colour
₹.6500/- and documentary evidence related to. passport size
2. Candidate is instructed to be very careful about the entries to be made in the under photograph.
mentioned columns. All entries should be in candidate’s own handwriting and candidate
will be held personally responsible for any incorrect entry that he/she make.
3. The name of the candidate and that of his/her father given hereunder should correspond
to those mentioned in the examination form.
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I solemnly and sincerely swear on oath that my Original Degree 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 in support of details furnished
under:
1. Name of the candidate:
(BLOCK LETTERS)
2. Father’s name
(BLOCK LETTERS)
3. Address to which the Certificate
should be sent.

4. Course of study
5. Details of Permanent Registration
No., date of registration & State
6. Details of Study 1. Hall Ticket No.
2. Course passed in (Month & Year)
3. Division
4. College Studied
5. Internship completed :From: To:
7. Details of the fee paid vide
Demand Draft No., date, and name
of bank

Place:
Date: SIGNATURE OF THE CANDIDATE
IDENTIFICATION CERTIFICATE
(To be signed by the Principal of the College where the candidate completed the course)

This is to certificate that Dr.____________________________________________________________________________________________

son/daughter of ____________________________________________________________________________________ completed the mention

courseCourse of Dr. NTR UHS of the last examination held in ______________________________________________ with Hall Ticket
No.____________________ in ______________________________________ Division and consequently completed the one year compulsory
Rotatory Internship from _______________________ to ____________________.

The photo affixed above is that of the Candidate and he has signed this certificate in my presence and bears
the following identification marks:
1.
2.
Signature of the Principal
Signature of the Candidate
(In the presence of the Principal
of the College where studied)
Enclosures.
1. Should execute a Notarized Affidavit on the Non-Judicial Stamp Paper of Rs.100/- value
to the effect that he is applying for a Duplicate, Certificate specifying the reasons and it
will be returned in the case he found the Original at later date.
2. Non-traceable certificate from the competent authority(Viz, if the degree is lost in transit
or stolen at any place, the certificate from the Sub-Inspector of Police from the Police
Station of the concerned jurisdiction.)
3. Demand of Rs..6500/- drawn in favour of the Registrar, Dr. NTR UHS on any nationalized
bank, payable at Vijayawada.
4. Copy of Original Degree Certificate already issued or Provisional Certificate.
5. Copies of all Marks Memos.
6. Copy of Bonafide Certificate.
7. Copy of Internship Certificate.
8. Copy of the Intermediate Certificate.
9. Copy of the permanent registration Certificate.