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Symbiosis Centre For Distance Learning: Service Request Form

This document is a service request form for students of Symbiosis Centre for Distance Learning. It contains sections for students to provide their details and request various services. These services include resending enrollment documents, changing student profiles, submitting assignments, requesting academic documents and making payments. Students must fill the form in block letters, tick the appropriate boxes for the service they need, and attach required documents and a demand draft as payment for administrative charges for certain services.

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jeevarvinder
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© Attribution Non-Commercial (BY-NC)
We take content rights seriously. If you suspect this is your content, claim it here.
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Download as PDF, TXT or read online on Scribd
531 views1 page

Symbiosis Centre For Distance Learning: Service Request Form

This document is a service request form for students of Symbiosis Centre for Distance Learning. It contains sections for students to provide their details and request various services. These services include resending enrollment documents, changing student profiles, submitting assignments, requesting academic documents and making payments. Students must fill the form in block letters, tick the appropriate boxes for the service they need, and attach required documents and a demand draft as payment for administrative charges for certain services.

Uploaded by

jeevarvinder
Copyright
© Attribution Non-Commercial (BY-NC)
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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SYMBIOSIS CENTRE FOR DISTANCE LEARNING

Symbiosis Bhavan,1065-B Gokhale Cross Road,Model Colony,Pune:16 |Tel: 020-66211000 - 20| Fax: 020-66211040 / 41| Website: www.scdl.net

SERVICE REQUEST FORM


Section A. Student Details
(TO BE FILLED IN BLOCK LETTERS ONLY)

Student Query related to (a) Section B Section C Section D

Registration No: Contact No.: Present Address :

Full Name: E-mail id:

If Address / Email id / Contact # has changed pl here and fill Section C. pt. # 1.

Note: Symbolizes Administrative Charges applicable. Student has to pay the Charges through DD in favour "The Director SCDL", at Pune or by cash at the SCDL office at Pune. Refer the revised rate card for the charges applicable, put up on website. Section B. Enrollment
(Please Tick a the appropriate box & attach attested documents & DD respectively, if applicable) Redispatch at above address Barcode Photographs
Name Change (MarriageCert./Affidt.)

1) Admission Letter & Confirmation Kit Not Received 2) Request Duplicate ID/Barcode

Photo (required for duplicate ID Card) Diploma Cert. Work Exp. or DOB Cert.

Request to confirm Grad. / 3) Adm'n status Prov.Cert 4) Request Adm'n Reactivation


Section C. Profile / Demographic 1) Address/Email id/Contact # Change

Did not pay complete program fees

Admission Provisional (if applicable fill section B pt. # 3)

(Please Tick

the appropriate box & attach attested documents & DD respectively, if applicable)

2) Profile Change

DOB (SSC Marklist)

Name Change

Splz Change :

( Mention Any one Splz ) (PGDIM : GI, LI)

( Marriage Certf./Affidivate) Loose Book/s

(PGDBA : MRK, FIN, HR, CRM, OPR) E-Learning CD Recorded Video Lecture CD

3) SLM Dispatches

Kit Purchase / Returned & Redispatch

Semester: 1 / 2 / 3 / 4 / 5 / 6 (Mention the semester number in the check box) Mention subject name for loose book / CD / Recorded Video Lecture CD:

4) DD Transfer from Suspense a/c: 5) Online Assignment Addtional

DD Copy

Bank Issue letter

Bank Encashment Letter ( applicable only if DD is paid but not traceable) Subj. Name/s Note: Apply only if failed in all previous attempts provided by SCDL.

Attempt Release
6)

Project Submission

Late Submission Applied for: Applied for:

Re-Submission Splz(if any): SLM Returned

7) Program Change 8) Dual Specialization 9) Category Change to NRI

(Applicable only for PGDBA Enrolled students. Mention one Splz. other than the primary splz opted: MRK,FIN,HR,CRM,OPR) Visa copy Passport copy Address proof

For the category change student has to attach all the attested photocopy of the documents and the DD with the Service Request Form.

Section D.

Evaluation

(Please Tick Bonafide Cert.

the appropriate box & attach the Demand Draft & documents if applicable.) Provisional Cert. Duplicate Diploma Certificate
(Attach FIR copy)

1) Academic Status Section E. Payment Details Demand Draft Details:

Transcripts

(Attach Diploma cert. & marksheet copy)

(Cash payment is accepted only at SCDL cash counter, Pune. And mention your registration # behind the demand draft. Attach the orignal Demand draft with this form if applicable and fill the following details.)

DD No.:

DD Date:

Amount:

Bank:

Reason For Request / Payment :

Declaration: I here by confirm that the above details provided by me are correct to the best of my knowlegde and I am aware that the above payment is nonrefundable and non-transferable and agree the same.

Date of application:

Student Signature:

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