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No.

_____________________ Dated: ____/_____/_____20

Name of Institution
City

PROVISIONAL CERTIFICATE

This is certify that Mr./Miss _________________________ S/O, D/O ________________________


has completed the course of _________ years in General Nursing/Midwifery/CMW/LHV from this
institution.

He / She has passed the examination in _________ Division in the Session __________ from the
Nursing Examination Board ________________ under Roll No. _______________ and obtained
marks _____________ out of ________________.

His / Her work and conduct during the training has been remained ____________________

Signature & Seal


___________________________

Principal Name: _____________________________


Name of Institution_____________________________
Complete Address:_____________________________________________________________
District: __________ Province: _____________Phone No. _____________________________
Fax No. _______________________________E-mail: ________________________________

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