THE WEST BENGAL UNIVERSITY OF HEALTH SCIENCES
DD–36, Salt Lake, Sector–1, Kolkata, W.B, PIN – 700 064
Website: http://www.wbuhs.ac.in; EPBX: (033) 2321 – 3461, (033) 2334 – 6602; Fax: (033) 2358 - 0100
Application Form for ‘ACADEMIC TRANSCRIPT’
01. NAME
(in BLOCK letters as written in your registration
certificate of the University)
02. Communication address with
Pin code (where acknowledgment /other
communication may be sent )
03. Phone No. / Mobile No. E-mail:-
04. Registration No. of WBUHS (as Year
printed in your registration certificate issued by
WBUHS)
05. Details of first admission to a College affiliated to this University
Name of the College
Date of first admission
06. Details of Examination(s) passed under WBUHS
Examination (as printed on mark-sheet) Roll No. Year of passing Result (as per mark sheet)
07. Reason for applying transcript
08. Furnish the Address of University, Email, Fax No, Website where the certificate(s) is/are to be
sent (include separate sheets if required)
University / Institute / College Address E-mail, Phone No., Fax No., Website etc.
09. No. of total copies of certificate required
10. Payment details: - Particulars of enclosed DD (Draft)
N. B: While submitting the Draft to the University Full Name along with the Mobile No. should be written on the reverse side of the draft.
Name of the Bank Branch DD No. Date Amount
1. All entries are to be made strictly according to WBUHS documents like Registration Certificate / Mark-sheet.
2. The application is to be forwarded by the Head of the Institution last attended.
3. One (1) set of attested copy of all Mark-Sheet(s) including failed Mark-Sheet(s), where it is applicable and University Registration
Certificate are to be enclosed along with this form at the time of submission.
4. Fee: Rs. 2,000/- (Rupees two thousand) only per copy by means of Demand Draft in favour of ‘The West Bengal University of Health
Sciences’ payable at Kolkata.
5. Two computer typed address of the Institution in plain paper to which the transcripts is to be sent, duly signed by the candidate at the
bottom is required.
6. All the above columns should be filed in block letters.
Date: Full signature of the candidate
Signature of ‘Head of the Institute’ with official seal Date:
Enclosures: a) Bank Draft
b) Attested photocopy of Registration Certificate
c) Attested photocopy of all mark sheets including failed mark sheets arranged in chronological order
d) Letter of authorization if a messenger is to get the Transcript on behalf of the applicant
i.doc
