COCHIN UNIVERSITY OF SCIENCE AND TECHNOLOGY Application for Degree/Diploma Certificate under Fast Track

(Please read the Instructions overleaf carefully, before filling this form)

1. 2. 4. 5. 6. (i) (ii) (iii) 7.

Name of the applicant in full, as enrolled in the University records (in block letters) Date of Birth
(DD/MM/YYYY)

3. Gender (Male / Female)

Address to which the Degree / Diploma should be sent (in block letters & PINCODE to be
compulsorily indicated)

Contact references: (i) Landline (ii) Mobile No. Details of fees paid: (see Instruction No.5 ) Amount of fees paid (in figures)
If remitted in Cash at University Cash Counter,

STD code: (iii) Email address Rs. Receipt No: DD No:

No:

Cash Receipt reference (copy of Receipt to

be enclosed)
If remitted by Demand Draft, Demand

Dated: Dated:
Month / Year of passing final semester

Draft reference (see Instruction No.6 - IMPORTANT) Details of Examination passed:

Name of the Degree Subject / Branch

Class

Reg. No

Month / year of back-semester, if any, cleared later on

8. 9.

Subject of Specialization, if any

Whether the Course was Full-time (or) Part-time

10(i) where the Degree was obtained (ii) Period (academic years) of study / research
In case of Research Degree (D.Sc/D.Litt/

Name of the Uty Dept/Institution from

From:

To:

11(i) Ph.D/M.Sc {By research}- Title of the Thesis (ii) (iii) 12.
University Notification details regarding eligibility for award of the Degree Name & Address of the Supervising Guide Details of the semesters for which the candidate has applied for revaluation, results of which are yet to be released

Notfn No:

Dated:

Place: Date: Signature of the applicant

INSTRUCTIONS TO THE CANDIDATE 1. Applications for issuance of degree certificates under fast track system shall be submitted directly to the office of the Controller of Examinations. 2. Candidates will be eligible to apply for the Degree/Diploma Certificates under the scheme only after publication of the result of the semester examination by which he/she becomes eligible for the same. 3. In the case of candidates who have applied for revaluation, they will be eligible to receive the degree certificate under the scheme only after publication of the revaluation result, unless the application for revaluation has been permitted to be cancelled at the request of the candidate. 4. Candidates applying for degree certificates under fast track will be eligible to receive the degree certificate within 20 days from the date of receipt of application in the University subject to eligibility. 5. Rate of fee for the certificate under fast track is Rs.1000/- + Normal fee for issue of Degree Certificate + Search fee (if applicable). For details of Normal fees and Search fees, please visit our website www.cusat.ac.in Current Student Download forms. 6. If the fee is sent by way of Demand Draft (DD), (i) The DD should be drawn on: (a) State Bank of Travancore (SBT) or (b) State Bank of India (SBI) or (c) Any associate bank of SBI (ii) In favour of: The Registrar, CUSAT (iii) Payable at: (a) If drawn on SBT Cochin University Campus branch (Code: 70235) ; (b) If drawn on SBI or any associate bank Ernakulam (iv) The DD should be enclosed to this application form

7. Kindly ensure that the Degree Certificates are not kept in tight plastic files/folders/envelopes for long as this could damage the printing on the Degree Certificates.