COLLEGE of APPLIED SCIENCE,VATTAMKULAM (Managed by IHRD, a Govt of Kerala Under Taking) Naduvatam, P.O

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COLLEGE OF APPLIED SCIENCE,VATTAMKULAM (Managed by IHRD, a Govt of Kerala Under taking) Naduvatam, P.O. Sukapuram, Edappal,Malappuram D.T, Tel: 0494 2689655 e-mail [email protected], [email protected] Application for Student Verification Sl. Particulars Details claimed by the Applicant 1 Name of Candidate 2 Date of Birth 3 a) Course attended b) Branch : 4 a) Duration of Course b) Scheme : 5 a) Admission No. b) Year of study: Month& Year of Final Semester 6 Exam. 7 Register No. of University Exam. Final year Result of Exam. as per college 8 marks/: records Grade(CGPA) Additional information required, 9 if any Details of Documents attached for 10 Verification.(attach photocopy/ scanned image with email) Details of Institution/Agency requesting verification 1. Name of Company/Agency/Institution 2. Adderss 3. Phone No. 4. Email ID Name & Designation of person 5. requesting information Emai-ID to which verification report to 6. be send Address to which verification report to be send by registered post 7. ( please add Rs.50/- towards postage along with the fee paid) DD. No. ……………………………. For Rs. /- 8. Details of Verification fee enclosed dated ………………………… Bank remittance on at branch Note : 1. For each candidate use separate form. But Fee for multiple candidates can be paid by a single DD drawn in favor of Principal/bank remittance. Fee once paid is non- refundable under any circumstance. 2. Processing Fee of Rs. 500/- per candidate (add Rs. 50/- for postage, if necessary) should be paid in the form of DD drawn in favor of “The Principal, College of Applied Science, Vattamkulam” payable at “ SBT, Edapal” or bank transfer to the SB Account no. 67000647960 (IFSC code: SBTR 0000687 ) 3. Verification report will be forwarded within 4 working days from the date of receipt of application along with fee. Date Signature STUDENTS VERIFICATION CERTIFICATE .

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