attachment 13 application duplicate marksheet admitcard

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  • 8/17/2019 Attachment 13 Application Duplicate Marksheet Admitcard

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    Board of Secondary Education, Assam: Guwahati- 781021seba.assam.gov.in, email : [email protected]

    APPLICATION FOR DUPLICATE MARKSHEET/ADMIT CARD

    (ONE APPLICATION FORM CAN BE USED FOR ONE DOCUMENT ONLY)To

    Secretary,

    Board of Secondary Education, AssamGuwahati-21

    Through the Headmaster/Headmistress/Principal/Superintendent

     ______________________________________________________________Sir,

    I have the honour to request you kindly to issue me a ______________________________________

     ______________________________________. My particulars are given below :

    1.   Name in full (IN BLOCK LETTERS) ____________________________________________________

    2.   Name of Examination _________________________________________________________________

    3.  Whether the examination is Regular/Private/Supplementary/Compartmental (1st, 2

    nd, 3

    rd Chance)

    (a)  Roll ____________________No. ____________________ Year____________________ (Regular)

    (b) Roll ____________________No. ____________________ Year____________________ (Private)

    (c)  Roll ____________________No. ____________________ Year___________ (Compt. 1st, 2

    nd, 3

    rd)

    (d) Roll ____________________No. ____________________ Year_____________________ (Suppl.)

    4.  Total Marks Obtained _________________________________________________________________

    5. 

    Result : Passed in _____________________________________ Division/Failed __________________6.  School from which the candidate appeared in the above Examination ___________________________

     ___________________________________________________________________________________

    7.  Father’s name in full __________________________________________________________________  

    8.  Home Address Address for Correspondence

    Village/Town …………………………………..  C/O …………………………………………….. 

    P.O. ………………………PIN……………….  Village/Town…………………………………... 

    P.S. …………………………………………….  P.O. …………………………PIN……………. 

    Dist. ……………………………………………  Dist. ……………………………………………. 

    9. 

    Mode of sending the document : By post/to be delivered to authorised person (The certificate shown

    over-leaf per column 14 must be filled up and signed properly)/to be collected personally by the

    candidate.

    10. Purpose for which the document is necessary ______________________________________________

    11. Details of fees paid :

    (i) Challan of Assam Co-operative Apex Bank, Bamunimaidam Branch,(SEBA Complex),Guwahati-21

    Challan No. ___________________ Rs. ________________________ Date _____________________

    (ii) Bank Draft No. ________________________ Rs. ____________________ Date ______________

    (Any Nationalised Bank)

    12. 

    Reason of application for issue of the document :Loss/damage/theft of the original document ______________________________________________

    Yours Faithfully

    (Full Signature of the Candidate)

    Date ___________________

    Forwarded and recommended for issue of the above document. Particulars furnished were checked and

    found correct.

    (Signature of the Head of the Institution with Seal)

    Date

    Memo No.

    mailto:seba.assam.gov.inmailto:seba.assam.gov.inmailto:[email protected]:[email protected]:seba.assam.gov.in

  • 8/17/2019 Attachment 13 Application Duplicate Marksheet Admitcard

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    (2)

     _____________________________________________________ May/may not be issued

    Approved/not approved

    Secretary

    RATE OF FEES :

    K  100.00 for Duplicate Admit Card

    K  300.00 for Duplicate Marksheet

    NOTE :

    ** The Application must come through the Head of the Institution through which the candidate appeared

    in the Examination. In case of a candidate appearing in the old course without Test Examination,

    he/she may submit application through a Gazetted Officer also.

    II..  In case of the document to be delivered on authority letter, applicant must attest the signature of the

     person authorised.

    IIII..  Full particulars along with attested signature of the person authorised must invariably be furnished.

    IIIIII..  Document will be sent by post if the candidate does not collect his/her document within 30 (thirty)

    days from the date of submission of the same.

    IIVV..  If the original document is lost/stolen, a police report testifying the loss/theft mentioning the Roll &

     No. with year must be enclosed with the application. In case of Triplicate Copy of the Marksheet and

    Admit Card paper notification must be enclosed with the application.

    VV..  If the original one is partially damaged, the remaining portion must be attached with this form (In such

    an event, police report is not necessary provided, the remaining portion bears the Roll and No. of the

    candidate.)

    VVII.. 

    Delivery After 3.30 pm (every day)

    CERTIFICATE OF AUTHORITY (As per Column No. I. above)

    I hereby authorize Sri _______________________________________________

    Of Village ______________________________P.O. ______________________

    Dist. _____________________________ to receive the document/ documents as

    mentioned in the application.

    FULL SIGNATURE OF THE AUTHORISED PERSON

    FULL SIGNATURE OF THE CANDIDATE