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Please Send The Duly Filled-In Form With Enclosures To: Indian Institute of Technology (Indian School of Mines) Dha Nba D

This document is a form for students at the Indian Institute of Technology (Indian School of Mines) to request transcripts. It outlines the required information, payment details, and associated charges based on the student's status and time since graduation. Additionally, it specifies the necessary documents to be attached for processing the request.

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nitu7625
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91 views2 pages

Please Send The Duly Filled-In Form With Enclosures To: Indian Institute of Technology (Indian School of Mines) Dha Nba D

This document is a form for students at the Indian Institute of Technology (Indian School of Mines) to request transcripts. It outlines the required information, payment details, and associated charges based on the student's status and time since graduation. Additionally, it specifies the necessary documents to be attached for processing the request.

Uploaded by

nitu7625
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd

Form No: A12

INDIAN INSTITUTE OF TECHNOLOGY (INDIAN SCHOOL OF MINES) DHA NBA D


OFFICE OF THE DEAN (ACADEMIC)

FORM FOR ISSUING TRANSCRIPT


[Please send the duly filled-in form with enclosures to [email protected]]

1. Name of Student
2. Admission No. Department
3. Program Branch (if any)
4. Email ID
5. Contact Number
6. Father’s / Guardian Name

Communication Address
7.
(with Pin Code)
Month & Year of
Month & Year of
8. Completion of Academic
Admission at IIT (ISM)
Program
Name and Addresses of the
Institutions in favour of
9. which transcripts(s) are
required

Total Sets of Transcript


10. Required

Payment Details (if applicable) - https://www.onlinesbi.sbi/sbicollect/icollecthome.htm?corpID=272342


(Select payment category: OTHER ACADEMIC FEES/FINES)
11. SBI Collect Reference No. / UTR No.
Amount Paid (in Rs.) Date of Payment DD/MM/YYYY
Encl: Please attach online payment receipt.

Date:
(Signature of the Student)

……………………………………………………………………………………………………………….…………………………………
Charges and Documents to be attached for issuing transcript:
Sl. No. Student Type Charges Documents to be Attached
(i) For Existing Students Rs. 500/- per set and  Scanned Copy of Last Semester Grade
Postal Charges (if applicable) Sheet.
(ii) Within 5 Years of Passing Rs. 2,000/- per set (for first two sets)  Scanned Copy of Grade Sheets of all the
Rs. 1,000/- for each additional set Semester / Consolidated Grade Card
and Postal Charges (if applicable) (both side).
(iii) After 5 Years of Passing Rs. 3,000/- per set (for first two sets)  Scanned Copy of Degree / Provisional
Rs. 1,500/- for each additional set Certificate.
and Postal Charges (if applicable)
Rs. 100/- per set of transcript to be posted within India.
Applicable Postal Charges Rs. 1,000/- per address for up to two sets of transcripts to be posted outside India.
(The role of the institute in sending the document is limited to booking at the post office. The Institute will not be responsible for the safe
passage and delivery of the documents to the addressee.)

Page 1 of 2
FOR OFFICE USE ONLY

Verification:
The facts, as stated above are CORRECT/NOT CORRECT Date of Receipt of Application:
as per records available.
Remarks, if any:
Issuing Date of Transcript:

Date:

Signature of Dealing Assistant AR (Academic – UG/PG)

Page 2 of 2

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