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Application Form Photo Correction

This document outlines the application process for changing a photograph in certificates issued by Anna University in Chennai, India. It provides an application form that requests information like the student's name, registration number, program details, contact information, and which certificates require a photo change. It also lists the required enclosures like original certificates, forwarding letter, ID copies, sworn affidavit, fees, and photos. The process involves submitting this form, affidavits, fees, and documents to the Controller of Examinations for approval and issuance of certificates with the updated photo.

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Muthu Kumaran
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727 views2 pages

Application Form Photo Correction

This document outlines the application process for changing a photograph in certificates issued by Anna University in Chennai, India. It provides an application form that requests information like the student's name, registration number, program details, contact information, and which certificates require a photo change. It also lists the required enclosures like original certificates, forwarding letter, ID copies, sworn affidavit, fees, and photos. The process involves submitting this form, affidavits, fees, and documents to the Controller of Examinations for approval and issuance of certificates with the updated photo.

Uploaded by

Muthu Kumaran
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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ANNEXURE

ANNA UNIVERSITY :: CHENNAI – 25


OFFICE OF THE CONTROLLER OF EXAMINATIONS
Phone: +91-044-22357244, 22357295, 22357296

APPLICATION FOR CHANGE OF PHOTOGRAPH IN CERTIFICATES


(Please fill complete form in capital letters)

Name of the Student………………………………………………….…………………...……………………..

Register No.………………………..……… Gender: MALE / FEMALE/TRANSGENDER

Father’s Name…………………………………………………………….…………………………………….

College Code/Name…………………………………………………………………..………………………...

Programme and Branch Name………………………………………………………………………………...

Month and Year of Passing …………..……………..….……………………………………………………...

Passing Division (as mentioned in Degree) ……………………………………………………………………

Contact No. (Landline) ……………………………… (Mobile No.)…………………………………… ……

E- Mail ID ……………………………………………………..................................................................……..

Aadhaar Number……………………………….…….... Ration Card No……………………………………

Voter ID No…………………………………….…….... PAN No…………………………………………..

Photograph to be Semester
Changed in
Statement of
I II III IV V VI VII VIII IX X
Grades/Marks
Make a tick mark in
which photo to be
changed

Give the details, if the photograph is to be changed in Consolidated Statement of Grades/Marks or/and
Degree Certificate:

Month and Year of issue of Consolidated Statement of Grades/Marks with Serial No.………………………

Month and Year of award of Degree (as mentioned in Degree) ………………..

Degree Serial No.…………………..

Date …………. Signature of the Candidate

Signature of the Principal


Date …………. with Name and Seal

Page 1 of 2
Sworn Affidavit:-

(Sample copy of Affidavit to be sworn before an Oath Commissioner/ Judicial First Class Magistrate)

AFFIDAVIT
Photograph
of the
candidate
executing
the affidavit

I, ________________________________________ Son / Daughter of _______________________ major in age (state


here profession / occupation) resident of (Full Address in which you are residing) do hereby solemnly affirm and state on
oath as under:
1. That I was a (State the Programme and Branch) student of (State the Name of the College), an affiliated college
under Anna University, Chennai with Register No. _____________________ . I appeared for all the examinations
and successfully completed my degree in (Month and Year of award of Degree as mentioned in Degree
Certificate).
2. I state that the photograph printed in my Statement of Marks / Grades , Consolidated Statement of Marks/Grades /
Degree Certificate is/are not mine, and the wrong photograph printed in the said certificate(s) was/were noticed by
me now and the reason for not reporting the same in time are mentioned below:
(a) ________________________________________________________________________________________
(b) ________________________________________________________________________________________
3. I now declare that the photograph I produced herewith for the process is mine and I am fully responsible for the
change of photo in the Statement of Marks/ Grades, Consolidated Statement of Marks/Grades / Degree Certificate
and also liable for any legal action to be initiated, if any wrong claim is made by me.
4. That I am swearing this affidavit in order to produce the same before the Controller of Examinations, Anna
University for obtaining the Statement of Marks/ Grades, Consolidated Statement of Marks/Grades / Degree
Certificate with my photograph.
VERIFICATION
I, (full name _______________________S/o____________________________) on solemn affirmation and oath state
that all the facts stated in paragraphs 1 to 4 are correct to the best of my knowledge and belief and nothing is false or
concealed. The contents being true I swear this affidavit.

Solemnly affirmed at ______________ on ____ day of ______ 20


Name of the Deponent
Before Me

Statement of Grades/Marks Consolidated Statement of Grades/Marks Degree Certificate


Fees Rs.1000/- (per semester) Rs.2000/- Rs.3000/-

Enclosures:-
1. Original Statement of Marks/ Grades, Consolidated Statement of Marks/Grades / Degree Certificate.
2. Forwarding letter from college concerned stating the reason for the delay in reporting for the change of
photograph.
3. Photocopy of all Statement of Grade/Mark sheet(s), Consolidate Grade/Mark Sheet, Provisional degree certificate
and Degree Certificate duly self-attested and attested by the Principal of the College.
4. Demand Draft/Challan should be in favour of “The Controller of Examinations, Anna University, Chennai”
payable at Chennai.
5. One Passport Size color photograph, preferably with blue background.
6. Photocopy of mark sheets of class X and class XII.
7. Photocopy of personal ID (Aadhaar Card, PAN Card, Ration Card and Voter ID Card).
8. Sworn affidavit executed in Rs.100/- stamp paper.
Note:-
1. All documents should be properly legible, otherwise change of photograph cannot be made.
2. In case of any wrong information provided in the form, candidate will be fully responsible for the same
and University may take appropriate action against him.
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