wee ere eH ep A ELD APPLICATION FOR ISSUE OF DUPLICATE COPY OF ‘MATRICULATION/AISLC CERTIFICATE. 1 terete lai Be Cn (ws ener ine cgi cence) des of he conidte Fother's Kame Sate of Bh The School though which ‘he oppcont appeared forthe Naticdaton/SLC fxaination 6 Rese oe condoms Register No. Sel. heel Nob: i) Month and Yeor of he Exoninatin ‘8 Fish te deed crcunstonces under which he rig ‘Natinveton/SLCcerifccteswosksbejound covey: 1, Whether 0 ceriiate regarding the less of the certfcate ‘yond ervey ctied ord anced broi and sony henare, desipetnn rade ha wth ~ thei Sat The ag ef het ce wt ‘san shel be mantel nthe afte. @ Mh en a cl Oe fbn titer boo (Home ofthe Tensuy/Sub recy 8) Chon No, ond Date of etonce DECLARATION, (0. The partzlrsfurshed above re ue othe bes of my knowkge and bebe, My ogi! NSLC/MarialsonCefete has ihr been suspended nor conceled by the ashorty competent nd tht have nether previously oped foro dla, STATION : ATE ‘Signature of the Candidate,HEADMASTER’S CERTIFICATE, Ceti that he particulars ished by tho cadre inthe opplcaian ore cre when empared with efrence fo the schol ‘records oe thot he appant ‘son olf student of ts instttion ond he heel _pescn fo whom the orginal crate wos sued, Hence the duplicate cece maybe sued to hier ‘Signature of the Principal. CERTIFICATE OF LOSS. {Tobe sued by Tost ofthe especie Tok Ofc of Revere Degrent of he Goverment Tom Nod The Aesigtin Sel ond ice sec ofthe ofl shou he fine in tect sued) coffe at Thty/Tuati/Sehi hor df Hotitin/AS LC Ceri beaing No, 19 empered trough Noticotion Sha, basa! his/her gil Naiedotion Crate tayo recover. | recommend forthe issue of a duplicate Matriculotion/AISLC Certificate to the above condidate, Sige Nee Desaon fice Sed STATION ; Owe OTE Te plein wih ts endosues shod be sano tha concer hepa of ation Schok pedro Bnglon “Shoo, Cems hog th Hat a the Schl wh e/sho seid as,INSTRUCTIONS YO THE CANDIDATES Mofussol candidotes (i. other than Chennai) shold remit the fee with sence charges under the flowing Hend of Account. Chen Cty contest the fe under ihefolowng Head of cout ot anyone tha branches Sia Bonk ci, Chena, Thousand Ligh, Soap! ond Abate No other mode of poyment wil be ecceped (Lean Pestle, Demand Des). Aum of 8.102 (The Feral fe of s.100 end serie charge of SZ shouldbe eed unde the Heed of Axo . #0202 Eduction, Spor, rts on Cute. 01 Gener Education YO2 Secondary Edin ‘AR eon and oer fees (02 Director of Government Exarinations- Exoinatin fees. DP. Code No.0202 01 102 AA 0205 - Fees for he sue of dopat copy of ASK /atiuoon Cerificate”, «he ogo chlan encased lng wh te pcan. The nerox copy of cel ant be eceped. The eppcain shouldbe submit to he Heot ofthe nsituton where he/she, as shi ‘The reasons forthe fs afte gal eric shoud be supported wih safc rot. 4) the ceicate hos been tom or enten away by white nls or destroyed partly by fie ot torn by stoke or by cxcient or damaged due fo flex of tine the rents shoul be prods! cong withthe pplication. (In cose os ing toe oars or due othe the ess cating concrng thera ofthe {os of he rina cific orth fnl dings ofthe poie uty to whom rept wos mode shouldbe enclosed along withthe pptatin (® The cai offs obcnedforn 0 vesponsble Goverment OF lost fam the cae 8 Gazp is ‘ampeatve to comply withthe request of ssue of dupont copy of certticate without this crete, application for isu of dpe wil be summary rected, Aplications shld not be sent direc fo ths ace: {cose the cignl ceria once ist wos fund ltr, het souk! be surendstd to this office for cancelation,‘ORIGINAL CCHALAN No. PROVINCIAL LP. Code 220201 102 AA 0205 (0202 Education Sports, As and Culture ‘Ot General Education 102 Secondery Education ‘AA. Tutlon and ther foes ‘02 Drei of Goverment Examinatons Feet fo MaticlstonASLC OupleatelCerien copy of Markt ‘Dae of Beth CANDIDATE'S FEE RECEIPT Received rom the sum of Rupees being he fees paid for Maticuistion/ASLC OuplcatelCerified copy of Marka/Dete of Bith CHALAN No. PROVINCIAL D.P. Code 2202.01 102 AA 0205 (0202 Education Sports, Arts and Cuture ‘01 General Education 102 Secondary Education ‘AR Tullon and ober fees (02 _ Directo of Gverhmert Examinations Fees for Mabiculaton/ASLC Dupicata/Certet copy ‘of MerksrDete of ith ‘CANDIDATE'S FEE RECEIPT Received from the sum of Rupees ‘being the fees paid for Maticulaion/ASLC Duplcate/Cerfed copy of Marka/Date of ith Name of Trany Date of R Officer lemitance: : 200 eeu Oe {Tebesigned and retumed to the candidate remit) TRIPLICATE CHALAN No. PROVINCIAL Code 2202 01 102 AA G25 0202» Edveation Sports, Arts and Cuture Of General Education 102 Secondary Education ‘AA Ttlon and other foes ‘G2 Director of Government Examinations Fees for Maticulaton/ASLC Duplioate/Certiied copy ‘of Marka/Date of Birth ‘CANDIOATE’S FEE RECEIPT Received from the aum of Rupees. being te fees pad for Maticulatin/ASLC DupiatrCenties copy of Maka/Dat of ith Name of Tonsury | “Spey Date of Remitance