FORM - D
GOVERNMENT OF GOA
BOARD OF TECHNICAL EDUCATION
Alto, Porvorim - Goa
APPLICATION FOR ISSUE OF TRANSCRIPT IN FAVOUR OF FOREIGN MISSION/UNIVERSITY
1. Name of the Student: _______________________________________________
2. Address: ___________________________________________________________
3. Telephone No.: __________________
4. Institute where the student was studying: __________________________
___________________________________________________________________
5. Diploma Programme undergone: ___________________________________
6. Enrol. No.: ________________
7. Month & year of Diploma completed:
8. Last Exam appeared: _______________
9. Address of the Organisation to whom the transcript to be sent.
_________________________________________________________________
10. Copies of document ( Original to be produce for verification):
a) Final diploma certificate of diploma programme
b) Mark sheet of diploma programme.
c) Set of non attested photo copies of Mark sheets of all semesters (one set per Transcript)
d) One copy of attested SSC Mark sheet (photocopied both sides)
Date: Signature of the candidate
FOR OFFICE PURPOSE ONLY
Details of payment of Fees
Rs.500/- per set.
Receipt No:
Date:
Cashier
Transcript issued
On:
Signature: