Consent Form: For The Graduands For Receiving The Degree / Medals

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CONSENT FORM

FOR THE GRADUANDS


FOR RECEIVING THE DEGREE / MEDALS
Dated: _______________, 2011

To
The Dean
Faculty of ___________________
Banaras Hindu University
VARANASI – 221 005

Sir,
I wish to attend the 93rd Convocation (for the examinations of the year 2010)
of the University in person. Relevant Information about myself is given below:
Name (in BLOCK Letters) : ________________________________________
_
Father’s Name : ________________________________________
_
Year of Passing : ________________________________________
_
Examination Roll No. : ________________________________________
_
Enrolment No. : ________________________________________
_
Degree to be received : ________________________________________
_
Department / School : ________________________________________
_
Current Engagement (Higher : ________________________________________
Studies/Research/Employment _
etc. details may be provided)
Full Address : ________________________________________
_
Mobile/Telephone : ________________________________________
_
e-mail ID : ________________________________________
_

I shall report to the Faculty / Institute as per prescribed time schedule to


collect my Academic Robes on payment of prescribed fee.

Yours faithfully,

________________________________
(Full Signature of the Candidate)

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