Request for Diploma/Degree by LC

To be filled by Learning Center For Office Use

Student Name _______________________ Case
Father Name________________________ No.________________________
Course_____________________________
University Roll No.___________________ Request received on in office
LC Name___________________________ Dated __/__/06.
ARLFC____________________________ Case sent to Dealing Hand
Phone & Mobile No.__________________ (Name)______________
E-Mail id___________________________

List of Encl… Fee to be paid by student:

1. Matriculation Certificate(attested)___________(Yes/No)
2. Eligibility proof for Diploma/Degree concern (attested) Fee Receipt No. _______________
_________(Yes/No)
3. DMC’s (attested): - Fee book No. ________________
Semester Previous DMC’s No. Regular/Re-appear
1. ________ ___________ ______________ Dated ______________________
2. ________ ___________ ______________
3. ________ ___________ ______________
4. ________ ___________ ______________
5. ________ ___________ ______________
6. ________ ___________ ______________

(Signature & Seal of LC)

FOR RLFC/ARLFC Use:

Authority letter from RLFC/ARLFC attached ___________ (Yes/No)
Name of authorized person__________________________________
I have received the complete documents(Name)____________for(Dip/Deg)________________
Received By (Name)________________________ Sign______________ Date______________
Designation___________________________________________

Comments:______________________________________________________________________
________________________________________________________________________________
_______________________________________________________________________________
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -- - - - - - - - - - - - - - - - - - - - - - - - - - - - -
Punjab Technical University, Jalandhar
Case No _______________Dated___/___/06

We have received the application of (RLFC/ARLFC)_________________________in this office

Please come to collect the DMC’s on ___/___/06.

Received by___________________________ Dated_____________________