Form No.

JAYOTI VIDYAPEETH WOMEN’S UNIVERSITY, JAIPUR

DUPLICATE MARKSHEET/CONSOLIDATED STATEMENT OF MARKS CUM
PROVISIONAL DEGREE/DIPLOMA/CERTIFICATE FORM
Please read the instruction carefully. Fill in all the relevant information, provided in
this form and attached all the required documents. Incomplete form will be rejected.

For office use only

Please mark (√) on your requirements No.:

Duplicate Marksheet: Trimester (T) Semester(S) Year(Y) All ……………………………
……
Name of Particular (T/S/Y)

Consolidated Statement of Marks Cum Provisional Degree (Original) Duplicate

________________________________________________________________________________________________________

1. Name of the Course with Discipline:

2. Enrolment No.
3. Year
of Passing

4. Name of the candidate (in Block letters) as per 10th Marksheet

5.5.Mother’s Name (in Block letters) as per 10th Marksheet

6.6.Father’s Name (in Block letters) as per 10th Marksheet

7.Date of Birth as per 10th Marksheet

D D M M Y Y Y Y
ADDRES
S:

CITY:

STATE: PIN
CODE

PHONE
NO:
(with STD
Code)
MOBILE
NO.
E-mail

8. Permanent Address-(in Block letters)

9.Cheque/DD Detail (for Duplicate Marksheet(s))

Amount ___________________________ Dated
__________________________________
Drawn on _________________________ Branch Name
____________________________
Cheque/ DD No. ____________________
(DD will be in favor of “JAYOTI VIDYAPEETH WOMEN’S UNIVERSITY”,
payable at Jaipur)
• Please write your Name & Enrolment No. on Back side of
DD/Cheque.

5.Documents to be attached :
 Form No.

✔ An attested photocopy of all Trimester/Semester/Year Marksheets

available.
✔ FIR copy/Xerox of lost & found news published (if Applying for Duplicate
copy )
✔ Amount of Rs. 200/per Duplicate Marksheet [cash/cheque/DD]
✔ Amount of Rs. 500 for Duplicate Consolidated Statement of Marks Cum Provisional Degree
[cash/cheque/DD]

5.Postal charges :

If the document is to be send through post, an Amount of Rs. 100 shall be

borne by the student and shall be included in the above draft.

Applicant

Signature

______________________________

________________________________________________________________________________________________________________

Application to be send to: Contact Details:

Controller of Examinations Phone: 01428 – 515253, 287427-29

Vedant Gyan Valley, Village Jharna, E-mail:
exam.studentquery@gmail.com
Mahala-Jobner link road, Website:
www.jvwomensuniv.com
Jaipur - Ajmer Express Way,
NH- 8, Jaipur, Rajasthan (India).
PIN - 303007