This form should be submitted by all degree recipients.
Enrollment No.

Date of Birth
(MM/DD/YYYY)


12th Convocation 2017
Information for Degree
Recipient
1. Program
2. Enrollment No.
3. Full Name (English)
4. Date of Birth
5. Declaration
pl. see pdf file of degree recipients at convocation webpage to check your details. 		I have verified my Program, Enrollment No., Name in English, Date of Birth and
    Name in Hindi and found it in correct order.
If you need any correction (pl. see pdf file of degree recipients at convocation webpage) Please mention here and also send an email regarding this correction at convocation@iiita.ac.in
6. Gender Male   Female  
7. Permanent Email Address
8. Mobile No.
9. Convocation Souvenir Back Pack     Photo Frame (For details of souvenir Click Here.)
10. Your consent to attend convocation in person YES    NO   

11. Fee Paid (Applicable only for receiving degree in absentia by post)DD/Online Transaction No.    Dated :
12. Details of accompanying persons with
     gender and relationship with
     the candidate
13. Accomodation requirement YES    NO
14. ArrivalDate    Time    Train/Flight No.
15. DepartureDate    Time    Train/Flight No.

Email: aaa@iiita.ac.in, ar.aaa@iiita.ac.in (for UG), ar.rd@iiita.ac.in (for PG)      Phone: 0532-292 2030, 2032, 2033, 2085, 2282, 2286  

   
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