Notification Service No.

198
6l1Fii:aa6 ~ t-:198
APPLICATION FORM/~ 6'0lf

Issue of duplicate certificates I verification of certificates by Ills

~.~.it. d~ Aa~lfii:ae t=JTal (ffi') 1 Aa<::lfii:aei 'i:!l ~a1f6aa6 iil'd7)T

Technical Education & Industrial Training Department, Punjab
aer61<#1 f'A1lp)(T lJf3' (1 etii Fa1er ~ ~, 1lwlr

(Service Relates to Punjab State Board of Technical Education & Industrial,

Plot No. 1, Sector 36-Chandigarh)

<fuu ~ 1lwlr iJ'iJ aer61a1 ~ lJf3' qetii Fa1er ~ ia'"a,

1.rn"'C -t:-1, Horco 36, ~iilalij ~~a>

1 Name of the Applicant/~ BT o+

2. Father's/Husband's Name/
fu3T/l2l '€ 1' o+
3. Mother's Name I >fT3T BT o+
4. Address I l.fdT City/Village/ P.O/
F.rfJa'I fl:'rcr ~
Pin code/ Distt/
~ ft:Rr'
Phone/Mobile. No/
~~i>:
E-maiiiD, if any/
ffi >ffi" ('Rora' ij')
5. Aadhar Card No. /If any
))f1"Q'TT ~ 3-:;;:r rn 'fr
6. Date of Bi rth/RC))f fi..r3t
7. Registration No.
afMR~F.Io i>:
8. Name of the Institute/Office (for Private
Candidates)
Hm:r' '€ 1' (')T}fl~ (~
~geT)
9.. Name of Course/Trade/Month and Year
of Passing
~ '€ 1' (')T}flm~ »8 wg
10. Session/Year
mrnlwg
11. Nature of Service required:­
fcrn"~~~~~fr:-
DuplicateNerification
~~~alma so
12. Name of the Board/University

Documents to be attached

13. Original Copy of FIR/DDR and Self Declaration, showing will return certificate if found, to be submitted in the
PSBTE&IToffice/~.~.))fl(flm.m.))fl(f. ~ ~ ~ f;:n; ~ra ~~fa" ;::rcio AaclFiiiae firn";:rteT 5" ~
itror ~ ffijT era~ I rew ~I
Self Declaration Letter/Photo copy of Certificate to be verified
~ ~ lfdcr1Raelf6ae el ~ OfTlit f;:n; el ~a'lf'6aF.Io aa~~~<!'l ij-1
14. Fees: Rs. 250/- {Cash/Bank Draft (In favour of Secretary Punjab State Board of Technical Education & lndl.
Training, payable at Chandigarh)/Receipt No./Any other mode of payment accepted by Punjab State Board of
Technical Education & Industrial Training, Chandigarh (website www.punjabteched.com)
6ll:r: (oore/ifor ~ (F~Ci!"3o ~ ar,:r 3ero1al 'I'H"'1:PlfT »8 ~eetfa1a ~ itror, ~dl3 1 otl€ 1
2so1­ ~
~ ~)/d"R'te" i>:!'Rora' fait 5o ~ (')1(? ~ thfc cr't3T W J1cf H itror ~ f<'>dQ 1dd oft3T forw ~I
(~vl:IR 1 ele: www.punjabteched.com)

Note: Verification of academic qualifications etc. of a person applying from a place outside of India i.e. from abroad (per
examination, each time) U.S. $50 or its equivalent in Rupees)
k: 'Rora' f&ft ~ ~ ~ ttaf3T el ~d'lfiiiaF.Io era~~~<!l ;:t fa" m ar,:r 3"' ~ offreT 5" el61J:r <¢ OfTlit)
~ .>mT. 50 ~ ;:rt fuo full eT ofh.8" ~ Pnr Waft I

Date/ fi.rdl:- Signature of Applicant

fu8 er 1a ~ UJidTl:fd"
 Notification Service No. 199
6z1 Fc::as;~o 'ffi!'ful:r ~= 199
APPLICATION FORM/nrm=ft ~
Result declaration of (Re-evaluation)
Jl~~es;~o ~ o3t"R -et ~ ~
Technical Education & Industrial Training Department, Punjab
~ ~ l?B QeGlfcl1a ~ ~. ti'tva"
(Service Relates to I. K. Gujral Technical University, Jalandhar/Majaraja Ranjit Singh State Technical University,
Bathinda
(fuu "fl"fuqT ~.a-.~ eao101M lll<'l1~afHil, ~!1-RJrd'ltl'r ~ fRur RZc eao101M lll<'l1~afRil, ~ '()1"(15 mfts ~)
1
- - -
NameoftheApplicant/~ tT nt
-
2 Father's/Husband's name/
fu3r/l..l3t tT ot
3. Mother's Name I }{T3T tT nt
4. Address I l.f3T City/Village/ P.O/
~
s;ifu"a"l ~

Pincode/ Distt/
~ ~
Phone/Mobile.
No/
~~~:
E-maiiiD, if
any/
~ }R;) (i=t"ac
~)
5 Aadhar Card No. /If any
l?f'U"ltf ~ ~:#r ait ~
6 Date of Birth/MOH' fi.8t
7. Name ofthe I nstitute/F1'Fiw tT (')T}f

8. Name of Course/Trade C«l'Ff tT (')T}f/ffi"

9. Semester/ffifRca'
10. Registration No./Roll No.
aFt1 Fl ~ 13 <'l *!ra/-aM ti:
11. Specimen Handwriting of the Candidate (Student
must fill Re-evaluation form by his/her own
handwriting
~ -et
fucr"it tT (')}fc')T
(~/~ ~ a11HFMQ~w> ~
~ ~ W'B -gfunrr ~
12. Year and Session/FI"'"M nB R1;l7l
13. Month of Year Declaration of Result
tllil;r3" fu tT HUlor nB Ff"'"(l5
?l3T;:rr
14. Name of the University:­
~ I.K.Gujral Technical University,
Jalandhar
~ Maharaja Ranjit Singh State Technical
University, Bathinda

Documents to be attached

15. Particulars subject/sandpaper/sin which re-evaluation of answer book/sis/are desired:­

16. Re-evaluation revised fee Notification attached

• ~ 0'3l';::rT tilfl:r3' iJe 3' 21 fuo+ ~ 'lifeo wo ~ Jl f.;~ fB§IEE<'l ~ 6'C!){ 9d' ~ fr fi:m ~ 1.{31
mr- ofh..r3' 700/- ~ W"aitl
• ~ ~ 0'3l';::rT tilfl:r3' iJe 3' 21 fuo+ ~ 'lifeo wo ~ alf.;~fB§IEE<'l ~ 6'C!){ O<Jl' 9d' ~ fr
~ 0'3l';::rT tilfl:r3' 3' 36 feo'1' ~ Jlfe~fB§IEo ~ 6'C!){ gcr ~ fi:m ~ 1.{31 mr- ofh..r3' 1soo;- ~
W"aitl
• ~ ~ 0'3l';::rT tilfl:r3' iJe 3' 36 fuo+ ~ 'lifeo wo ~ Jl f.;~ FB§I Efl(') ~ 6'C!){ O<Jl' 9d' ~ 5- -at
~ 0'3l';::rT tilfl:r3' 3' 51 feo'1' ~ Jlfe~fB§IE<'l ~ 6'C!){ 9d' ~ fi:m ~ 1.{31 ~ ofh..r3' 2500/- ~
W"aitl
• f'otir3" W 3' ~ 6'C!){ 90?i' ~ ~ ~ 0'3l';::rT 6'C!){ 90?i' ~ fi.8t ~ })fQR"' Be ~ ~ fr I

Date/ fi..r::IT:- Signature of Applicant

~ ~ <Jf!31'l::f0Note:

1. Overseas students may send this filled-in form to apply Re-evaluation as per University norms along with copy of
result notification and requisite fee in the shape of Overseas Demand Draft in favour of "Registrar, Punjab Technical
University. In case of any query you may contact on +91-94780-98036
. ~ . Notification Service No. 200
?ic1 fGa>;to ~ ~: 200
APPLICATION FORM/~~
Attestation of Qualification Certificates
itaJ3r Rac1 fGa<:: ::me1a Cl(Q"(')" H8l:it
Technical Education & Industrial Training Department, Punjab
30((')1 a1 fRfi:rl?fT l'>f3" {lt! Gl fa I()( ~ fwor, tf.t:ra
(Service Relates to I.K.Gujral Punjab Technical University, Jalandhar/Maharaja Ranjit Singh State Technical
University, Bathinda)
(reu~ ~.-&.~. ~ eO!o10!e.> l!Jo1~afRc1, ;ffimr/HWdTi=IT ~ fRur ~ e01ol0!e.> l!Jo1~arn<::1 'Bf5w, (')T8
- ~~) ­
1 Name of the Applicant/ ICI()O(' o tT ot
2 Father's/Husband's name/
fu3T/lffi tT ot
3. Mother's Name I 1-fT3T tT ot
4. Date of Birth I i1i'ilf fi.Bt
5. Add ress/lBT City/Village P.O/
~~ ~

Pincode/ Distt/
~ fill;y
Phone/Mobile. No/
~~i:
E-maiiiD, if any/
ttH-e.> c~~>
6. Aadhaar Card No./lf any
l?fTWd" ~/R ~ ~
7. Name of the Institute/College
Rmrr tT ()T}f/ ~
8. Registration No./Uni.roll no,
afi1Fl~J3o i:/~o9~aFflil ~ iao.
9. Attestation of required DMC/Degree
~ ~ HTOcm Hdil fiilOi e >H3" molOT
~;:!R3 1 ~t=li t~Cif8'r~~
10. Name of the University:­
~ I.K.Gujral Technical University,
Jalandhar
~ Maharaja Ranjit Singh State
Technical University, Bathinda

Documents to be attached

1. Photocopy of Respective Certificate I~ Fldil fuOici ~ ~

11. Fees:- Student will Deposite DD of Rs 100/- (in case of documents to be sent through post with in Punjab only)
and DD of Rs 200/- ( IN Case of Documents to be sent through post outside Punjab/India) In Favour of Registrar
I.K. Gujral Technical University, Payable at Jalandhar/Registrar Maharaja Ranjit Singh State Technical University,
payable at Bathinda
-gffi: ~ -gffi ~ Hd<::lfGokt'lJi:lrg QTH ~ ~ ffift 100/ nB ~t'lJi:lrg 3' ~ ~ ffifl"
200( (~ ~ aftlFlcd'd l?fTET.Oi".~ ~ ZO!olae.> ~ol<iiafA<::l, ~taftlFlcd'd ~ ~
fRur ~ z0!1'>90!8 ~o9~arnil, ~ ~ lfcr W'B- ~al3'oJBt!'

51
Note: Fees: In case of Private Institutions/Companies Rs. 50/- for 1 Copy and Rs. 20/- for subsequent copies of
attestation.

Date/ fi..r:ft:- Signature of Applicant

fiffia'ra" ~~
 Notification Service No. 200
iSi!fGa>:Jo ~ ~= 200
APPLICATION FORM/l?fOtft" ~
Issue of Provisional/Migration Degree Certificate

ijcilt.loM firara9"/H'e1<U:ao HailfGac ~ CXd?> mfdt

Technical Education & Industrial Training Department, Punjab

301o1oCl fi:rfi:p,p- ~ (it!Gl r<na ~ ~. ~

(Service Relates to I.K.Gujral Punjab Technical University, Jalandhar/Maharaja Ranjit Singh State Technical

University, Bathinda)
(fro~~.<}.~. ~ e01olOI8 l!Jo1~aFH<::1, ~~ ~ ffiur ~ e01olOI8 l!Jo1~aFA<::1 "Sf&"r, ~
- 1i1fu3" ~) ­

1 Name of the Applicant as per Matric

Certificate
~ tT (if ~ ~ Hd<::lfGO!c ~
l?fTLPO ~
2 Father's/Husband's name/ as per Matric
Certificate
fu3"r/lr3t tr r;t ~ ~ Ha<::l figQiz ~
l?fTLPO ~
3 Mother's Name /l-fT3T tr (if
4 Address I l.f3T City/Village/ P.O/
Bfua"l ~ ~

Pincode/ Distt/
~ fffi3r
Phone/Mobile. No/
~~i:
E-maiiiD, if any/
it"HM (~~)
5 Aadhaar Card No./lf any
l?fTLPO ~ i: IR fuft ~
6 Date of Birth I t17i1-f fi..8t
7 Registration No./ Uni.Roll No.
f, ~
~r,:m: 13 o ?l: d8 (')8"d"
n '­ n

8 Name of the Institute/ College

Hm:rr tT (iT}-f O{T8tf
9 Name of Course/Branch/
~la"ditr tT (iT}-f
10. Nature of Service required:­
fcm3W~~~~~:-
Provisional Degree/Migration Certificate
if~ fuaral'!~ Flail ~cSic
10. Name of the University:­
)> I.K.Gujral Technical University,
Jalandhar
>Maharaja Ranjit Singh State
Technical University, Bathinda

Documents to be attached

11. 1. Photocopy of lOth certificate,~ -e- Hazlfc;;O!c,

2. Self Attested DMCs {Note: DMC's Are Required only for the batches passed out before 2009 Batch I "At
3Fitfur ~ )-f1Qci(l1 ~ ~ (~ )-f1Qci(l1 Haclfc;;O!c ~ ~ -e­ ~ Ui1 ft:Rr§" 2008-09 3'
l..ffuW -e- 1.fTR Ui'))

12. Fees:- Student will Deposit DD of Rs 300/- including with postal fees (in case of documents to be sent through
post with in Punjab only) and DD of Rs 400/- ( IN Case of Documents to be sent through post outside
Punjab/India) In Favour of Registrar I.K. Gujral Technical University, Payable at Jalandhar/Registrar, Maharaja
Ranjit Singh State Technical University, Payable at Bathinda.
lfu:r: ~ lfu:r fuoRft Haclfc;;O!c~ "d"'"H -e­ ~ ~ 300// (~ lfu:r ffi:l"3-)3" J?8 ~~ 3' ~
~ ~ 400/­ (~ ~ aFtlHcd'd >'>fTit.&.~ ~01<'>9018 !:Qol~a FA<::l, mfuotaFtlHcd'd,
~~ fl:fur RZc- ~01<'>9018 go9~arni1, "8f&r" ~ li'l::f -wtr ~al3'oliJt'

Date/ fi..8t:- Signature of Applicant

~~~
 Notification Service No. 201
<Sc1 rGa>:Jo ~ ?:: 201
APPLICATION FORM/lffirtft" ~
Issue of Official Transcripts~ cd 1HfOJ:UC ~ CXd?) mft:it
Technical Education & Industrial Training Department, Punjab
3ao1a1 fHfl::n?fT »B. {1t!Gl fd1a ~ fuwor, liRr"a
(Service Relates to I.K.Gujral Punjab Technical University, Jalandhar/Maharaja Ranjit Singh State Technical
University, Bathinda)
(fuu ~ ~.&.~. tfi:rra" eotolOIM l!Jolii!afHcl, mfuo~ ~ ffiur RZc eotolOIM l!Jolii!afRcl ~, (')T"M
- m3iE ~) ­

1 Name of the Applicant as per Matric

Certificate
~ tT ot ~ -e- Ha~lfG&c -e­
i}fTQTd" ~
2 Father's/Husband's name/ as per Matric
Certificate
-e-
flsr!tBt tT ot ~ Ha~l fG&c -e­
i}fTQTd" ~
3 Mother's Name I lfi3T tT of
4 Address I 'Lf3T City/Village/ P.O/
Bf<ya-1~ ~

Pincode/ Distt/
~ fRc:y
Phone/Mobile. No/
~~i:
E-maiiiD, if any/
Et }ffi (~ ~)
5 Aadhaar Card No./lf any
i}fTQTd" ~ i;ftt ckT ~

6 Date of Birth I R?iH fi-r3T

7 Registration No./ Uni.Roll No.
f, ~
a·,:IH:J3o o:
n -, n
~ 'OE"d"

8 Name of the Institute/ College

HHar tT ()T}f/ ~
9 Name of Course/Branch/
~18"diB" tT (iT}f
10. Name of the University:­
~ I.K.Gujral Technical University,
Jalandhar
~ Maharaja Ranjit Singh State
Technical University, Bathinda

Documents to be attached

11. 1. Photocopy of lOth certificate,

2. Self Attested DMCs /t!'i'f<fl ~ Haclfii:&<::, ~ ~ ~ }-f1"d'CXH tfln.rt ~
Note: DMC's Are Required only for the batches passed out before 2009 Batch

12. Fees:- Student will Deposite DD of Rs 400/-{one set only) (in case of documents to be sent through post with in
Punjab only) and DD of Rs 500/-(one set only) ( IN Case of Documents to be sent through post outside
Punjab/India) In Favour of Registrar I. K. Gujral Technical University, Jalandhar/Registrar Maharaja Ranjit Singh
State Technical University, Bathinda
~: ~ ~ tfi:rra ~ ~ ~ ~ 400/(fuor He ~)nB W<f3/tfi:rra 3' ~ ~ ~ 5001_
ccfuor Fie~)(~ ~ aft'IH<::a•a ~.&.~ ll't1rs 2aolaM l!Jol<iiafH~l, mfuo;aft'IH<::a•a ~
~ fRw RZc 2ao9aM ~o9<iiafR~, ~ -e- tfl:f WB- ~al3'o~t' tw-"

Date/ fi.Bt:- Signature of Applicant

~-e-~
 Notification Service No. 202
~c1 ~a>:Jo ffiJibr ~: 202
APPLICATION FORM/~~
Issue of Detail Marks Certificate

~ ~ Aae1fGac ;::p-ijt a-ao mftit

Technical Education & Industrial Training Department, Punjab I
3oco1 oil fi::rfi:f>w >'>8 (3€tllf(noc ~ fuwaT, tfRra"
(Service Relates to I.K.Gujral Punjab Technical University, Jalandhar/Maharaja Ranjit Singh State Technical
University, Bathinda)
(reu ~ nrEt:&.~. ~ eao101M !§o1~afHil, ~~ ~ ffiur 'RZc <!ao101M !§o1~afAc1 ~. ~
mfu-3" {J)
1 Name of the Applicant as per Matric
Certificate
~ -er ot ~ ~ H<;Jilfi;:;&<:: ~
»flWW 3
2 Father's/Husband's name/ as per Matric
Certificate
fu3r/l.Bt -er ot ~ ~ H<;Jc1 fc;;&<:: ~
»flWW 3
3 Mother's Name I 1fT3T -er ot
4 Address I 1..f3T City/Village/ P.O/
Bfu"a"; m ~

Pincode/ Distt/
~ ~
Phone/Mobile. No/
~~i:
E-maiiiD, if any/
Et j{(vj (itao ~)
5 Aadhaar Card No./lf any '

»flWW ~ i:!R aEt ~

6 Date of Birth I H7iH fl..BT
7 Registration No./ Uni.Roll No.
<j •f,tlH ~
-~;~ ?i 0: ~ (')"8'"Q
n -, n

8 Name of the Institute/ College

HR"ar -er (ii}f
~
9 Name of Course/Branch/
~faOTB -er (ii}f
10. Name of the University:­
~ I.K.Gujral Technical University,
Jalandhar
~ Maharaja Ranjit Singh State
Technical University, Bathinda

Documents to be attached

11. Photocopy of lOth certificate,

12. Fees:- Student will Deposite DD of Rs 100/- (in case of documents to be sent through post with in Punjab only)
and DD of Rs 200/- ( IN Case of Documents to be sent through post outside Punjab/India) In Favour of Registrar
I.K. Gujral Technical University, Jalandhar/Registrar Maharaja Ranjit Singh Technical University, Bathinda.
lfu:r: ~ lfu1 ~ H<:Jclf~a<::~ "<:l"'t1 ~ ~ ~ 1001 n8 ~~ 3' ~ ~ ~
200( (~ ~ aft"IRco'o >?flET:&.~ titrr8" ZOiolow> ~o1~afHil, ~/aft"IRco'd ~ ~
fl:fur Z01o901M ~:Do9~arni1, ~ ~ lftf fu'B" ~al3'olJe'

Date/ fi.8t:- Signature of Applicant

~~~
 Notification Service No. 202
<'>z1fc;as:~(') ffiJfuFr ii: 202
APPLICATION FORM/nratiT ~
Verification of Qualification Certificates
~ Hac1fc;ac t!t ~a1fc;a>;~<'i
Technical Education & Industrial Training Department, Punjab
3ao1 ofl fHfi:rnrr l?f3" (le&Ha1a ~ ~, ~
(Service Relates to I.K.Gujral Punjab Technical University, Jalandhar/Maharaja Ranjit Singh Technical
University, Bathinda)
(fuu ~ l'>f"lc't:~·.~ ~ eO(o10(M 1!Jo1~afA<:1, ~/H"JTd"l"W "dFtft3" fR'ur eO(o10(M l!Jo1~afAiJ, ~ 0'5 R8i:T3"
- ~) ­
1 Name of the Applicant/ I~OO('<:J -e-r o+
2 Father's/Husband's name/
fl..8r/l.f3T -e-r o+
3. Mother's Name I w:rr -e-r of
4. Date of Birth I tlOH fi.8t
5. Address/lf3T City/Village P.O/
~~~ ~

Pincode/ Distt/
~ fffi;y
Phone/Mobile. No/
~~i:
E-maiiiD, if any/
Et }R;) (ita"a" ~)
6. Aadhaar Card No./lf any
~~i:!R~~
7. Name of the Institute/College
RFn:lr -e-r nrHI 0(1""MR

8. Registration No./Uni.roll no, ~ft4A<.>:Ji'l

?i':!!iJo9~~FRil ~ iao.
9. Name of the University:­
I.K.Gujral Technical University, Jalandhar
Maharaja Ranjit Singh State Technical
University, Bathinda

Documents to be attached

10. Letter from Company I Institution lcfuN I ~R~IB{lc ~ fim ~

11. Photocopy of Respective Certificate I~ Roa fuaci tRnft ~
12. Fees:- Student will Deposite DD of Rs 100/- (in case of documents to be sent through post with in Punjab only)
and DD of Rs 200/- ( IN Case of Documents to be sent through post outside Punjab/India) In Favour of Registrar
I.K. Gujral Technical University, Jalandhar/Registrar Maharaja Ranjit Singh Technical University, Bathinda
-gm-: ~ -gm­ ~ Hazlf<;;et<::/1.J;::r"a or;:r ~ ~ ffi!T 1001 n8 Wd3"/1.J;::r"a 3' ~ ~ ffi!T
200( (~ ~ aft1Hc~ 1 d l'>flc't."&.~ t'fRr8" e()(o10(M !ijol~~fHcl, ~/~ft1Hc~ 1 ~ ~ ~
fR'ur ZO(i'J90(M l!!o9~~fJ::!il, ~ -e-ll'l:f R"B ~al3'i'l~t'

51
Note: Fees: In case of Private Institutions/Companies Rs. 50/- for 1 Copy and Rs. 20/- for subsequent copies of
attestation.

Date/ fi.r3t:- Signature of Applicant

Ma-ra- -e- m:BTlfd"
' .

Notification Service No. 203 & 204

6tm:aao ~~= 203/l.A: 1
Application Form I 'l)f(J'i:ft ~

Issuance of different types of certificates to students of ITis/Polytechnics

lJPl!l.it.lJPl!l.tilMl2aF6a ~ ~ ~ <i'tr <i'tr ftmHt ~ AallFiiiac:: iJ10l d"d'' STS'3"

Technical Education & Industrial Training Department, Punjab

'd'"i'il7ila't 1m'tPw ~ (leGiFa1a ~ ~. ifi:rtlr>

(Service Relates to Polytechnics/ITis )

<fi:.r ~ a!!daolotl ~ (leGiFa1a ~ ~ ~ H'lfl:r3" 5->
1 Name of the Applicant/~ i!T ot
2 Father's/Husband's name/
f1.raT/1..13't i!T ot
3. Mother's Name I )fTdT i!T ot
4. Address I lJdT City/Village/ P.O/
l3'fuoI ftm" ~

Pi ncode/ Distt/
~ ~
Phone/Mobile. No/
~~~i>:
E-maiiiD, if any/
it lffi" (~ 5")
5. Aadhar Card No. /If any ))f11l'1(f ~ ii':/H rn 5"
6. Regd. No./af;:r: ii': ...................................... 7. Date of Birth/;:R)}f ·····················
fi.f3l: ....

8. Registration/Roll No. ...................................... 9. Course,l'itcrR' ·····················

aftu=I~F.ln/~il: Trade/m ....

10 Year of admission I~ 5e i!T 'R""5'

·····························································
....
11 Pass out Year/Present Class I
tf11'1 aoo i!T 'R""5';ft:rA' d"WA' ~ ~ 5"~ 5"
·····························································
....
12 Certificate Needed (Please Specify)/
~ Ad<::lfiii&C:: ~ fr, mfF.rc::' ofi3T ~ ................... .... ~ . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0 •••••••••

....
13 Name of the Institute
Rm:rr i!T ()T}f
14 Service required from ITI/Polytechnic/~ QeGlfa101 ~ Rm:rr 3' ~ ;:rt
ay aaol al c;rrg;::r 3'

Date I fH3l :- Signature of Applicant I ~ ~ \JlfdTlfd'

 Notification Service No. 205
c:S<:lFii:aao ~~= 2os
APPLICATION FORM/>nat:ft G'CJlf

Verification/Authenticate of Diploma/Degree Certificates

~;fuaral Ra<:lfii:a<: ~ ~a1Fii:aao/~S'lf3"

Technical Education & Industrial Training Department, Punjab I

a or o1a1 fR"fu>w ~ ~ eiii fa1or ~ ksrar, ifi::rrl:r

(Service Relates to Department of Technical Education & Industrial Training, Plot No. 1, Sector 36, Chandigarh)
<fuu ~ ~ fR"f'ww ~ (le&iFa1a ~ ~ (')Tg Rirtr3" 5">
1 Name of the Applicant/~~ o+
2 Father's/Husband's name/
fu3'r/l8l ~ o+
3. Mother's Name I }f"3T ~ o+
4 Address I l.f3T City/Village/
J:lfuoI f(m-
P.O/
~
.
Pincode/ Distt/
~ fmr"
Phone/Mobile. No/
to~t:;:
E-maiiiD, if any/
it >fg (R"ao ~)
5 Aadhar Card No. /If Any
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6 Date of Birth I ;:::(7)}f fi8t
7 Name of the Course/Branch
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8 Registration/Roll No.
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9 Session I Hl:io
10 Certificate to be verified
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11 Name of the lnstitute/Am:rr ~ (')T}f
12 University/Board
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Documents to be attached

lB. I Concerned Degree/Diploma Certificate in original

Date/ fi.l3l:- Signature of Applicant

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