1 APPENDIX II

Uyqntv tbmKyXm kn^nv e`npXn\pthnbp At]m t^mdw APPLICATION FOR ISSUE OF A DUPLICATE QUALIFICATION CERTIFICATE

hnZym`ymk Pn//Educational District :

1. At]Is t]cpw ]q tahnemkhpw Name of the applicant with full address

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2. At]Is Ctmgs tahnemkw Present address of applicant

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3. cImhns t]cv Name of Parent/Guardian

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4. P\\obXn (ae_m/{InkvXp hjw) Date of birth in Malabar and Christian Era

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5. BhiysSp kn^nns t]cv Name of duplicate certificate required

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6. ]com kw_amb hnhc Particulars of the Examination

: cPn. \Reg. No.

hjhpw amkhpw

Year & Month ]com tI{w

Centre of the Examination

Hmw Ahkcw/I appearance

cmw Ahkcw/II appearance

aqmw Ahkcw/III appearance etc.

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:

:

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7. Uyqntv kn^nn\v At]nm\p kmlNcyw (\jvSsS/tISp]mSv kw`hn)

Circumstances under which a Duplicate Certificate is applied for (lost/damaged)

:

8. A kn^nv dmnbXmsWn AXns HmU \cpw dmnb XobXnbpw ImWnpI

If the Original Certificate was cancelled, give order number and date of cancellation

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9. At]I CXn\papv Uyqntv kn^nn\v At]nnptm ? Dsn HmUdns Hcp tImn CXnt\msSmw kanpI

Has applicant applied for a duplicate certificate before? If so, enclose a copy of the order, if any, passed on that application

:

10. ^okv HSppXv kw_n hniZhnhcw Details regarding remittance of fees

:

sNem \cpw XobXnbpw

Number & Date of Chalan sNem XpI

(Amount) {SjdnbpsS t]cv

Name of Treasury

11. A`n{]mbpdnv/Remarks :

Rm ChnsS kmysSppsXsm Fs A kn^nv Fs AdnthmSpIqSn bmsXmcphn[ A\mhiyImcymbn D]tbmKnnnm Fpw AXv XncnsI e`npIbmsWn DSs\ Xs sk{Idn, ]com `h, ]qPpc, Xncph\]pcw-14 F tahnemkn FnpXcpXpamWv.

I hereby declare that the Original Certificate has not been allowed to be misused and that if it is recovered it would be surrendered to the Secretary, Board of Public Examination, Trivandrum 14.

ew (Place)

XobXn (Date) . At]Is Hv (Signature of applicant)

2 At]I BZyXhW ]co FgpXnb kvIqfnse taeptZymKs kmy]{Xw

CERTIFICATE OF THE HEAD OF THE SCHOOL FROM WHICH THE APPLICANT WAS PRESENTED FOR THE EXAMINATION FOR THE FIRST TIME

Rm ChnsS kmysSppsXsm Fs Adnhpw hnizkvXXtbmSpw IqSn \Inb Cu At]Is A

kn^nv Xncnp Inm hn[n \jvSsncnpp/tISp]mSpI kw`hnncnpp/dmnbncnpp. At]Is apIfn ]dncnp hnhc Rm hniZambn ]cntim[npIbpw icnbmsWv IspIbpw sNbvXp. AXn\m Cu At]I\v Uyqntv kn^nv \IWsav Xmev]cysSpp.

Certified that to the best of my information and belief the original certificate issued to the applicant was irrecoverably lost/damaged/cancelled. I have carefully verified the particulars furnished above by the candidate and found them correct. I recommended that duplicate certificates may be issued to the applicant.

ew (Place) .. slUvam/Headmaster :

XobXn (Date) .. Name of School : with Post office and

Educational District (office Seal)

NB :- At]bn kqNnnnp Fm hnhcfpw tcJsSpnsbv Ddv hcpnbXn\ptijw am{Xta ]ckyw ASn

]{Xt]tPmsSmw slUvam ]com`h sk{Idnv At] Abbvphm ]mSpq. ]qam At] bmsXmcphn[ AdnbnpanmsX \ncknpXmbncnpw.

\nti/INSTRUCTIONS

1. Fkv.Fkv.F.kn, Sn.Sn.kn., av kn^npI FnhbpsS Uyqntn\v thnbp ^okv 200 cq] The rate of fees for issue of duplicate in the case of SSLC, TTC or any other Certificate is Rs.200/-

2. aqmas XhW kn^nv e`npXn\p thnbp ^okv 500 cq]. The rate of fees for the issue of triplicate certificate is Rs.500/-

3. At]I tIcf kwm\nse GsXnepw Khsav {Sjdnbn 0202-0110292 Other Receipts F Auv sln sNem FSpv ^okv HSpWw. At]I tIcfn\v ]pdmsWn tv _mv Hm^v Cybn

Auv \ 077 _n (kn) sF.Fkv.Fkv.F.tIcf F t]cn sNem FSpv ^okv HSpWw. The amount of fees should be remitted in the name of applicant into a Govt. Treasury of the Kerala State under Head of Accounts 0202-01-102-92 Other Receipts. In the case of applicants residing outside the state the amount may be remitted into the State Bank of India in Chalan under the Head of Account 077 B (c) I.S.S.A Kerala

4. A kn^nv Xncnv Inm hn[n \jvSsnpsn Hcp Hmw mkv aPnkvt{Sns tImSXn ap{Z ]Xn kmy]{Xw kantXmWv. Phm\msWn, IamnwKv Hm^okdpsS kmy]{Xw kantXmWv.

If the Original Certificate is irrecoverably lost, produce declaration of the candidate attested by a Magistrate of the Judicial Department under the seal of his court or by the Office Commanding in the case of Jawans, detailing the circumstances under which it was lost.

5. A kn^nn\v tISp]mSpI kw`hnnpsn AXns\ Ipdnp hniZhnhc \IptXmsSmw tISmb kn^nv kanpIbpw thWw.

If the Original Certificate is damaged, give details and enclose its remnants, if Remnants are not available give reasons. 6. kn^nv hntZiv hv Xncnp Inm hn[n \jvSsnpsn At]tbmsSmw Cy Fw_knbpsS

PpUojy A[nImcap DtZymKs kmy]{Xhpw IqSn DsSpnbncnWw.

If the Original Certificate was irrecoverably lost in foreign country, produce affidavit of the Indian Embassies Officer who has a judicial power.

7. Uyqntv Fkv.Fkv.F.kn _pv e`npXn\mbn At]tbmsSmw PRD AwKoIcn GsXnepw Zn\]{Xn \tI ]ckyns amXrI.

The prescribed notice to be published in any dialy newspapes approved by PRD for obtaining the duplicate SSLC

DSw : 1. sNem 2. aPnkvt{Sns kmy]{Xw 3. ]{X]ckyw 4. A kn^nv kn^nn\v tISp]mSpI kw`hnXmsWn)

t\mokv

.. hjs .. cPn \cnep Fs Fkv.Fkv.F.kn. _pv hosSpm ]m hn[n ssItamiw h hnhcw CXn\m Adnbnpp. {]kvXpX _pns Uyqntv ]In\mbn ]comIojWdpsS sk{Idn ap]msI \nbam\pkcWap At] \IpXn\v Xocpam\nncnpp. CXnt Bt]aph Cu ]ckyw hv 15 Znhkn\Iw sk{Idn, t_mUv Hm^v ]_vfnIv FIvkmant\jkv, ]com`h, ]qPpc, Xncph\]pcw F hnemkn tcJmaqew ]cmXn \tIXmWv.

t]cpw hnemkhpw

Notice My SSLC Book bearing Reg. No. . Year . has been irrecoverably lost. It is decided to submit an application for the Duplicate SSLC Book before the Secretary to the Commissioner for Government Examinations (in the prescribed form) as per approved procedure. Those who have any objection to issue a duplicate SSLC Book to me may file their objection before the Secretary, Board of Public Examinations, Pareeksha Bhavan, Poojappura, Thiruvananthapuram within 15 days from the date of this advertisement. Name and Address

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