OFFICE OF THE CONTROLLER OF EXAMINATIONS

ANNA UNIVERSITY, CHENNAI 600 025

APPLICATION FOR ISSUE OF DUPLICATE CERTIFICATE APPLICATION FOR ISSUE OF DUPLICATE CERTIFICATE
Certifcate for which applied for * Details of payment made
--------------------------------------
Degree / Branch Demand Draft No.

DD Date :
College through which --------------------------------------
Studied / Studying Bank :
--------------------------------------

Amount paid Rs. :
1. Name of the Student
2. Registration Number
3. Sex
4. (a) If applying for duplicate Statement of Marks /
Grade Sheet, fll in the Month and Year of Exam
for which Statement of Marks / Grade Sheet is required
(b) If applying for duplicate Degree certifcate, fll the

(i) Month and Year in which qualifed for the Degree

(ii) Date of convocation in which the Degree
was conferred

(c) If applying for Duplicate Provisional Certifcate /
Consolidated Statement of Marks / Grades fll in the
Month & Year of last appearance in which
qualifed for the Degree
5. Circumstances under which the certifcate was lost

6. Whether the prescribed afdavit has been enclosed
with the application

7. Address to which the certifcate is to be sent
Place:
Date: SIGNATURE OF THE CANDIDATE
FOR OFFICE USE ONLY
Certifcate issued on : Prepared by :
Folio No. : Examined by :
Date on which the D.D. was
sent to Finance Section : CONTROLLER OF EXAMINATIONS
* Write as Degree Certifcate / Statement of Marks / Grade Sheet
Provisional Certifcate / Consolidated Statement of Marks / Grades.
(Please see Instructions)
INSTRUCTIONS
1.Duplicate certifcate will be issued only when it is lost or destroyed irrevocably.
2. Application should be made only by the candidate in the prescribed format and should be
sent to the Controller of Examinations directly. Application received on behalf of the
candidate will not be accepted.
3. The following documents should be enclosed along with the application.
(a) an afdavit explaining the circumstances under which the original certifcate was
lost.
The afdavit should be duly executed in the prescribed format before the Notary Public/
Principal of the College where he / she had studied.
(b)self - addressed stamped envelope (for Registered Post).
(c)photocopy of the Statement of Marks / Grade Sheet / Degree Certifcate for which
duplicate is required (if available).
(d)the Demand Draft.

In addition to the above, candidates applying for the Duplicate Degree Certifcate should
enclose:
(e)Non traceable certifcate obtained from the Police Authority.
(f)The original Newspaper in which Notifcation was issued for loss of certifcate.
4.While publishing such notifcation in the newspaper, the name of the applicant with initial,
Registration No., Name of the University in which certifcate was obtained etc. to be
provided without fail.
5.Application should be completed in every respect. Failure to furnish correct details
may cause delay in the issue of the certifcate.
6.The fee for the issue of various certifcate is as follows:
(a) Statement of Marks / Grade Sheet -- Rs. 200/- each
(b) Provisional Certifcate -- Rs. 500/- up to Convocation.
No Provisional Certifcate will be issued
after the Convocation.
(c) Consolidated Statement of Marks /Grades -- Rs. 500/-
(d) Degree Certifcate -- Rs. 3000/-
7.The fee should be paid in the form of Demand Draft drawn in favour of the CONTROLLER
OF EXAMINATIONS, ANNA UNIVERSITY, CHENNAI payable branch at Chennai.
8.Fee once paid will not be refunded or adjusted for any other certifcate under any
circumstances.
9.Duplicate Certifcate is to be surrendered to the University immediately if the Original
Certifcate is recovered later.

AFFIDAVIT TO BE FILED FOR ISSUE OF DUPLICATE CERTIFICATE
Afdavit of Thiru / Selvi
1. I... Son / Daughter of
.aged.. Years,
an old student / student of . Degree of ..
college with Register numberand residing at.
....
do hereby solemnly and sincerely state as follows.
2. My (i) * Statement of marks / Grade Sheet issued relating to the Examinations held during

(ii) * Degree certifcate issued at the Convocation held on
(iii) * Provisional Certifcate / Consolidated Statement of Marks / Grades issued by the
Anna University has irrevocably been lost / destroyed.
3. I fle this afdavit for the purpose of receiving duplicate certifcate.
4.I will return immediately the duplicate certifcate(s) to the University once my original
certifcate(s) is / are recovered later.
5. The facts stated are true and correct to the best of my knowledge and if found false by the
University, I shall abide by the decision of the University.
Place :
Date : SIGNATURE OF THE CANDIDATE

Solemnly afrmed
at (Place)
this ..day of .. 20.
and his / her signature is afxed in my presence. Notary Public / Principal
Address:
Ofce seal :
* Delete which is not applicable.