COLLEGE OF ENGINEERING GUINDY CAMPUS
ANNA UNIVERSITY CHENNAI :: CHENNAI – 600 025.
APPLICATION FOR ISSUE OF TRANSFER CUM CONDUCT CERTIFICATE FOR UG/UG (PT) / PG & PG(PT)
(SHOULD BE FILLED IN CAPITAL LETTERS)
1 Name of the Student and Roll No.
2 Father’s Name
3 Mother’s Name
4 Date of Birth (DD/MM/YYYY)
5 Community & Caste (Enclose a copy of
Community Certificate)
6 Date of Admission
7 Degree and Branch / Specialization
(Full – time / Part – time)
8 Duration of Programme in Semesters
9 Semester studied at the time of leaving
10 Academic score (CGPA).
11 Actual date of leaving : Month & Year of
Passing / Date of discontinuation
12 Whether the student has successfully
YES / NO
completed the programme
13 Whether copy of Provisional/Degree
YES / NO
Certificate is enclosed
14 Whether a copy of No Dues Certificate is
YES / NO
enclosed
15 Whether late fee chalan is enclosed
YES / NO
(if applicable) *
16 Extra Curricular Activities NCC / NSS / NSO / YRC
17 Current / Permanent postal address for
future communication
18 Telephone No; Mobile No; Email-id
19 Memo / Suspension (if any)
20 Prizes / Medals awarded (if any)
Important Note:
1. The following documents should be enclosed
(I) Xerox copies of Provisional/Degree Certificate, No Dues Certificate, Community Certificate & NCC /
NSS / NSO / YRC Completion Certificate.
(II) Self addressed envelope (27x12cms) affixed with Stamp to the value of Rs.35/-
2. If TC is applied after 1 year – Rs. 500/-
3 years – Rs.1000/-
5 years – Rs. 2000/-
10 years– Rs. 5000/- from the date of leaving/completion of the programme,
the applicable amount has to be paid and copy of Chalan should be enclosed.
SIGNATURE OF THE STUDENT WITH DATE
Endorsement by the HOD for UG Students and Professor in – charge for PG students regarding character and conduct
of the student.(please tick in the relevant box)
Very Good Good Satisfactory
SIGNATURE OF THE HOD / PROFESSOR IN-CHARGE WITH OFFICE SEAL
________________________________________________________________________________________
FOR OFFICE USE ONLY
TC No.:
JA/ASST. Ch.SUPDT. D.R. DEAN, CEGC
