online.assam.gov.in Application For Duplicate/ Triplicate Pass Certificate : Board of Secondary Education

Organization : Board of Secondary Education
Service Name : Application Form For Duplicate/ Triplicate Pass Certificate
State: Assam

Website : http://online.assam.gov.in/web/seba/
Application Form : https://www.statusin.in/uploads/9322-pass.pdf

Duplicate/ Triplicate Pass Certificate :

I. In case of loss/theft of the Original/Duplicate copy of Certificate a Police Report from a police station clearly mentioning the Roll/No. and year of Examination must be enclosed.

Related : How to apply for Bakijai Clearance Certificate Assam : www.statusin.in/6020.html

II. In case of damage of certificates (including duplicate one) the damage documents be submitted along with the application. No Police report will be necessary with damaged documents.

III. The applications are to be submitted through the Head of the School from which the candidate appeared along with the necessary fees of Rs. 500/- (Five hundred) only through A/c payee Bank Draft/Challan (SEBA’s) in Assam Co-operative Apex Bank, Bamunimaidam (SEBA Complex) in favour of Secretary, Board of Secondary Education, Assam, Guwahati-781021.

IV. Duplicate / Triplicate Pass Certificate will be handed over directly to the candidate/applicant or an authorised person subject to submission of authority letter with attestation of signature of the Authorised person along with original Marksheet and Admit Card of the applicant.

V. Duplicate/Triplicate Certificate will be sent to the Head of Institution concerned by post under Registered post if not collected personally/by Authorised person from the office.

Fees : K 500/-

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Application Format:

Application Form For Duplicate/ Triplicate Pass Certificate

To
The Secretary,
Board of Secondary Education, Assam
Guwahati- 781 021
Through the Principal/ Headmaster/ Head Mistress/ Superintendent.
_____________________________________________________________________
_____________________________________________________________________

Sir,
I have the honour to request you kindly to issue me a DUPLICATE/ TRIPLICATE CERTIFICATE. My necessary particulars are shown below:-

1. Name in Full (In Block Letters) :_________________________________________________

2. Father’s Name in Full :_________________________________________________

3. Name of the Examination with course (NEW/OLD) and year _________________________ __________________________________________________________________________________

4. Roll : ____________________No. : ______________________year _______________________

5. Result Passed in _______________________________Division __________________________

6. Regular/ Private/ Supplementary/ Compartmental (With Chance) ____________________

7. Group (In case of HSSLC Exam.) __________________________________________________

8. School from which appeared _________________________________________________

9. Home Address Address for Correspondence
Vill/ Town_____________________________ Vill/ Town ____________________________
P. O. __________________________________ P.O. __________________________________
P.S. __________________________________ P. S. _________________________________
Dist. __________________________________ Dist. ___________________________________
PIN __________________________________ PIN___________________________________

10. Purpose for which the document is necessary ______________________________________

11. Reason of application for duplicate/triplicate certificate : Lost/damaged/theft of the original document ________________________________________________________

12. Enclosed.: Apex Bank Challan No. ________________________________________________
Bank Draft No. _____________________Date. ____________________

Yours faithfully,

Full Signature of the Candidate _____________________________________________________

Memo No. ____________________________________________________Date._______________

Forwarded and recommended for issue of the above DUPLICTE/ TRIPLICATE PASS CERTIFICATE. Particulars furnished are checked and found correct. The above candidate received his Original/ Duplicate Certificate from this institution.

Signature of the Head of the Institution with Seal