COURSE CERTIFICATE

(To be issued by the Head of School / Institution where the applicant has completed or is completing
his / her studies in Standard XII or equivalent / Diploma in Engineering)
(Candidates who have passed the Plus Two/equivalent examination can attach
the self-attested copy of the marksheet/pass certificate to prove academic eligibility)

CERTIFIED that Shri./Smt./Kum. ……………………………………..…………….…………………, an applicant for the Entrance
Examination(s) 2012, who is the son/daughter of Shri./Smt. …………………….…………………...………………………………. of
……………………………………………………………………………………………………..………………………..……………………
……………………………………………………………………………………………………………………………………….(address)
*(a) is/was a student of Standard XII/equivalent during the year ………………………….……………….. with subjects as*
(i) PHYSICS (ii) CHEMISTRY (iii) MATHEMATICS (iv) BIOLOGY (v) …………………………………………..………
(vi) ………………………………………. and second language as ………………………..
*(b) is/was a student for Three Year Diploma in Engineering.
The date of birth of the candidate as per school records is ………….…………………………………………………………….

Signature of the Head of the Institution : ………………………………………
Name : ………………………………….……
Place
Date

:
:

Designation : ………………………………….……
Name of Institution : ………………………………….……
(Office Seal)

* Strike out whichever is not applicable.

District : ………………………………….……

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