MANIPUR UNIVERSITY
CANCHIPUR, IMPHAL
APPLICATION FORM FOR DUPLICATE REGISTRATION CERTIFICATE
1. Name of student :
(in block letters) :
2. Name of father/guardian :
3. Name of Mother :
4. Original Regn.No. with year of registration:
5. College from which Regn. Certificate was received:
6. Name of college/Institution attended last:
7. Roll No. with year of the University examination he/she passed/appeared Examination
. . . . . . . . . . Roll No. . . . . . . . . . .
Date: . . . . . . . . . . Signature of applicant
Memo No. Date:
The name and other particulars of the application have been checked, verified and found correct, forwarded and recommended.
Date: . . . . . . . . . . . . . . Signature of Head of Deptt./ Institution
Seal
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FOR OFFICE USE
Verified the name, father’s name and the Regn. No. with year and found correct. Duplicate Registration Certificate may be issued.
Asstt. Scribe Section Officer
Asstt. Registrar/Deputy Registrar
Fee for Duplicate Registration Certificate: Rs. 400/- (Rupees four hundred) only.
I. Fee for duplicate registration should be paid in the University Cash Counter.
II. No Duplicate Registration Certificate shall be issued except in very exceptional cases when the loss of the Original Certificate is proved by an affidavit, Police report, publication in one of the local dailies, etc.
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