ORIGINAL CERTIFICATE RECEIPT

Laxmi Narain Verma Memorial Society Group of Institutes

Students are requested to fill the form so that you can get copy of receipt of orignal documents. On submitting the form, it will go to the AUTHORIZED PERSONAL. You will have to contact him/her for submission of documents and taking the hard copy of receipt, duly signed by the authorized signatory.

Name of Student

Title

Name of Father

Title

Reg Number

Total Number of Certificates in Words

Phone

OTHER DOCUMENTS (WHICH WILL NOT BE RETURNED BACK TO STUDENTS)

Anti Ragging Affidavit by Student

Adhar Card (Xerox)

Anti Ragging Affidavit by Parent

10 Photograph

Medical Certificate (REAP)

1 Photograph of Parents

Medical Certificate (AME)

Caste Certificate (Xerox)

Message

Signature of Student

Date of Submission

2025

FOR OFFICIAL USE ONLY

Agreement

I understand that if I have filled all the details carefully. I will be responsible for any type of mistake in filling the form.

Signature of Approver

Please check the payment details, and approve the same.

Verification