STATE BOARD OF TECHNICAL EDUCATION AND TRAINING

ANDHRA PRADESH :: VIJAYAWADA

APPLICATION FOR THE ISSUE OF DUPLICATE CERTIFICATE FOR TECHNICAL

EXAMINATIONS CONDUCTED BY SBTET, AP.
Name of the Applicant
01
(IN BLOCK LETTERS)

02 Father’s Name

03 Address of the Applicant

04 Mobile No
Commercial Intt./Polytechnic through
05 Which the applicant appeared for the
Examination

Registration No./PIN of last appearance,

06
Course, month and year of examination

Detailed circumstances under which the

07 Application for the issue of duplicate
certificate is made
Number of times the applicant appeared
for the Certificate examination with
08 month and year Of the examination and
the Registered Number Assigned to each
appearance.
Whether any complaint was given to the
Police about the loss of the certificate
09 from above authorities obtained That
after enquiry the Certificate is beyond
recovery. If so enclose the same
Whether the affidavit made on a stamped
Paper for Rs.20/- regarding loss of the
10 original Certificate beyond recovery from
the First class magistrate/Notary is
attached.
Whether the D.D. for Rs.3500/- of the
Nationalised Bank obtained towards Fee
for issue of duplicate Certificate in Favour
11
of Secretary, S.B.T.E.T, A.P., Vijayawada
(Furnish Name of the Bank with D.D.
number and date)
Whether the certificate TWSH/CCIC has
12
at any time been suspended or cancelled
Whether any Photo copies of the above is
13
enclosed for ready reference.

DECLARATION
 I solemnly declare that the particulars furnished above are true to the best of my
knowledge and belief.

Dated:______________ Signature of the Applicant

NOTE: The furnishing of in-accurate or false particulars will be viewed seriously besides
with – Holding of the duplicate certificate and disciplinary action as may be called for or
Deemed fit by the secretary, State Board of Technical education and Training, A.P.,
Vijayawada.
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IDENTIFICATION CERTIFICATE OF THE PRINCIPAL

I Certify that the above particulars furnished by the candidate have been verified and
found correct with reference to the records of the Institute/polytechnic and the
applicant Sri./Smt./Kum._______________________________(Name to be given) is the same
person to whom the original certificate was issued and that the issue of the Duplicate to
the candidate is recommended.

STATION:

DATE: SIGNATURE OF THE PRINCIPAL WITH SEAL

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DECLARATION

I do hereby declare that my original Pass certificate bearing SL.No._________________

with the Regd. No. ____________________ of _________________________ issued by the State
Board of Technical Education and Training, Andhra Pradesh, Vijayawada is neither
suspended nor cancelled by the competent authority.

Dated: SIGNATURE OF THE CANDIDATE

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NOTE: The following Certificate should be sent along with the applicant without fail.

1) Bank Demand draft for Rs. 3,500/- in favour of the Secretary, SBTET, A.P.
payable at Vijayawada.
2) An Affidavit on Stamped paper worth of Rs. 20/- duly signed by FIRST CLASS
MAGISTRATE/NOTARY.
3) A Declaration by the candidate that the Original Certificate was not suspended or
cancelled by the competent Authority.
4) An Identification certificate from the concerned Principal of the Institute to the
effect that the candidate is the same person to whom the original certificate was
issued.
5) Police Enquiry Certificate.
6) 02 (Two) Passport size Photos without Signature.

AFFIDAVIT
 I ________________________________________________________________

Son/Daughter of _______________________________________________________________

Age _________ Occupation____________________________________________resident of

________________________________________________________________________on solemnly

oathand affirmation do are as under.

1. That I have appeared for _______________________________________________________

Examination held in the month of ____________________ conducted at __________________

with Regd. No./HT. No. _____________________________________________________ through

Institute, ___________________________________________________________________.

2. That the Original Certificate of _________________________ issued to me by the State

Board of Technical Education and Training has been lost by me while

_____________________________________________________________________________________

_________________________________ (details) _______________________________________

______________________________________________________________________________________

_______________________ and in spite of my best efforts I am unable to trace it and it is

lost beyond recovery. In case it is traced in future I shall submit it to the State Board
of Technical Education and Training, Andhra Pradesh, Vijayawada for
cancellation.

3. That I am in need of Duplicate copy of the said certificate for which purpose, I am
hereby making this declaration as required by the Secretary, State Board of
Technical Education and Training, Andhra Pradesh, Vijayawada.

SIGNATURE OF DEPONENT

SWORN BEFORE ME
Date:

(Court Seal)
 C E R T I F I C AT E
(Issued by the Gazetted Officer)

This is to certifiy that Sri/Smt./Kum. ______________________S/o,

D/o.______________________R/o,________________________________________________ has
appeared for________________________________________________ Examination from
_______________________________________ Centre and Passed with Registered Number
_____________________________. The Photo attested by me is of
_______________________________________________________.

DATED: SIGNATURE

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C E R T I F I C AT E
(Issued by the Institute Principal)

This is to certify that Sri/Smt./Kum. _________________________________

S/o,D/o. __________________ R/o, ________________________________________________ is a
student of this Institute. He/She appeared for _______________________________
Examination held in ___________________________from______________________________
Centre and passed the Examination with Registered Number _____________________. The
Photo attested by Gazetted Officer is of Sri/Smt./Kum.
________________________________________Only.

DATED: SIGNATURE