TEZPUR UNIVERSITY
Application form for Dummy Transcript

Name of the applicant :
Roll No. / Enrolment No. :
Name of the programme completed from T.U. :
CGPA of the final semester end examination :
Year of completion of the programme :
No. of transcript(s) required :
Purpose for applying the Dummy Transcript(s) :
Names of the Organisations/ Institutions/Universities where the transcript(s) will be sent :

Whether Organisation/ Institution/University sought for the transcript(s) :
(Copy of the letter should be enclosed)

Mailing address (in case the transcripts are desired to be sent by post) :

Signature of the applicant
Issue of ………..number of transcript(s) is allowed/not allowed

Asstt. Registrar(Acad) Controller of Examinations Received an amount of Rs……………………. (Rupees………………………………………………………)
Vide receipt No. …………………………………… dated………………..
Junior Accountant
………….number of Transcript(s) prepared, Transcript(s) signed
verified and forwarded for your signature.

Dealing Asstt. Asstt. Registrar(Acad) Controller of Examinations

Rs.50/- (Rupees fifty) only per transcript.
A copy of original Transcript, duly attested should be enclosed.
A separate application in plain paper justifying the requirement should be enclosed alongwith this form if the requirement is more than 05(five).