Date:

Name of Student ____________

Student Code
Centre
Course _______________ Course Fees
Amount Paid Amount Due

Sub: Approach for “MODULAR CERTIFICATE”.

I do hereby declare and notify that I have approached ICA for

modular certificate as I can’t complete the course because
_________________________________________________
_______________. Please issue a modular certificate on
basis of my completed modules. On receipt of the modular
certificate I would not claim for any further classes,
certificate and Job from ICA as per my said declaration, as I
do understand that my Job Guarantee stands cancelled
because of not completing the course and taking modular
certificate.

Thanking You.

(Student Signature)