Page 1 of 2
Application for Corrections / Changes in name / DOB / Any other in
University Certificate / Document (Version 2023/10)
To:
Registrar
MGM Institute of Health Sciences, Kamothe
Navi Mumbai – 410 209
Respected Sir/Madam,
I hereby request you to make change / correction in my Name / Date of Birth / my Father’s / Mother’s
Name / Other correction (specify):________________________________________ in my University
Certificate / Document__________________________________________________________________
(Mention the name of Certificate/ Document)
from_________________________________________________________________________________
(Mention the misprinted / mis-spelled / existing old name / DOB / etc.)
to___________________________________________________________________________________
(Please mention the correct / new name / DOB / etc.)
My personal details are given below:
1) Name of Candidate : _____________________________________________________
2) Name of program : _____________________________________________________
3) Email ID: _________________________________________ Mobile No.: _________________
4) Address: _______________________________________________________________________
_______________________________________________________________________________
5) P.R. No. :
6) Name of College / School : ________________________________________
7) Month & Year of completion of Course:
(In case of passed out student)
Before applying, please check on
www.mgmuhs.com that latest version of the
form is being used
University office use
only
:
• Request received to University within 10 days of PRN generation
• Request received to University beyond 10 days of PRN generation
Page 2 of 2
Instructions to the candidate:
(i) Application form is to be submitted through respective Institute Head if student is pursuing
the course at the time of application. If student is already passed out than application form
can be submitted directly to the University office.
(ii) Please attach the Certificate (if any) in original on which correction is required.
(iii) Please attach the proof of valid supporting documents on which correct details are mentioned
(for example previous qualifying Mark sheet or Gazette copy of Government). Without valid
supporting document University cannot make any correction.
(iv) Corrections will be effected only in those documents which are issued by University after the
date of Gazette Notification.
(iv) Correction charges:
a. Rs. 1000/- for correction in University Database only
b. Rs. 1000/- for correction in University documents (except Degree Certificate)
c. Rs. 5000/- for correction in Degree Certificate
(v) Please pay correction charges through ‘SBI Collect online payment portal link’ available on
www.mgmuhs.com and attached e-receipt of SBI collect payment. Please note that other
mode of payment will not be accepted.
(vi) No charges will be applicable in following conditions:-
a. If the application is received within 10 days of PRN generation.
b. If correction is due to mistake of University staff.
Thanking you,
Date: ……/……/20 Signature of Student
_____________________________________________________________________________________
_____________________________________________________________________________________
(To be filled if student is pursuing the course)
(The PRN list received from MGMIHS was shown to the concerned student)
Checked By:…………………………………
Forwarded By …………………………………... Date: …... /……/20
(Dean/Director/Principal)
