To

Pro-Vice Chancellor
University of Petroleum & Energy Studies
Dehradun

Authority Letter to Collect the __________________________________________

for Program__________________ Batch _____________ in respect of Enroll.
No._____________ SAP ID_____________ Name _______________________

authorize

Mr./Ms./Mrs.____________________________________________,

R/o ________________________________________________________________
Telephone No._____________________ whose three specimen signature are
appended below, is hereby authorized to collect the Degree Certificate on my behalf
due to my inability to come personally to collect the same.

_______________

_______________

_______________

Specimen Signature

Specimen Signature

Specimen Signature

Signature of the Student :

_________________________

Name of the Student

_________________________

Enrolment of the Student :

_________________________

Program & Batch

_________________________

Telephone No.

_________________________

Date

_________________________