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DIBRUGARH UNIVERSITY

Application form for Migration Certificate


1. Name in Full (in Block Letters) :
2. Registration Number (with year) : ______________________________________________________________
3. Migration fee paid : DD/Cash Receipt No. __________________ Date _____________
4. College/ University where studied last :
5. The name of the last Pre-Degree/ Degree :
Examination in which appeared
6. The Roll & Number with year in the :
aforesaid Examination
7. Whether passed, failed or simply appeared :
in the annual examination
8. Whether passed or failed as a regular :
student or a private candidate
9. Migration to :
10. Reason for Migration :
11. Whether expelled from appearing at any : Yes/ No.
examination previously
12. Complete address to which the certificate : Vill./Town :________________________________________________
should be sent by post.
P.O. : __________________________ Dist. : ______________________
State :________________________ PIN :_________________________

_____________________________
Signature of Candidate
Phone No. : ………………………………..

Forwarded and strongly recommended that the student is eligible for Migration Certificate.

______________________________________
Principal/ Head of the Institution
Date :
Seal

RULE
(a) Application for a Migration Certificate should be made through the Head of the Institution in which he/ she prosecuted
his/ her studies last, along with a Migration fee of Rs. 1,000/- (Rupees One thousand) only in cash/ by demand draft
drawn in favour of the Registrar, Dibrugarh University payable either at SBI, DU Branch (Code : SBIN0002051) or
PNB, DU Branch (Code : PUNB0994000).
(b) Migration Certificate is issued only to registered student of this University. If he/she is private student his/ her
application will have to be countersigned by a Gazetted Officer.
(c) No action will be taken unless the prescribed fee is received in this office.
N.B. : (1) Original Registration Card/ Duplicate Registration Card (in case of loss of Original Registration Card)
must be surrendered along with the application form.
(2) Loss of Original Registration Card must be accompanied by an affidavit.

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