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Appendix II

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28 views

Appendix II

Uploaded by

bensonalex777
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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APPENDIX - II

APPLICATION OF ISSUE OF A DUPLICATE QUALIFICATION CERTIFICATE

1) Name of applicant :
(In block letters) with
full address
:

2) Name of Parent/Gaurdian :
3) Date of birth in Malabar and
Christian era :

4) Name of duplicate certificate


required :

5) Particulars of the examination Year & Centre of the


Reg No
Month examination

1st appearance :
nd
2 appearance :
3rd appearance etc.etc :

6) Name of the institution where the trainee :


had under gone the course

7) Circumstances under which the Duplicate :


certificate is applied for (Lost/Damage)

(a) If the original certificate is :


irrecoverably lost, produce
declaration of the candidate
attested by a Magistrate of
the department under the
seal of his court

(b) If the original certificate is damaged, :


give details and enclose its remnants.
If remnants are not available give
reasons

(c) If the original certificate was :


cancelled. Give order No & date
cancelling it
8) Has the applicant applied for a Duplicate :
certificate before? If so, enclose a copy of
the order , if any passed on the application

9) Details regarding remittance of fees :


(a) Number and date of the chalan :
(b) Amount :
(c) Name of Treasury :

10) Remarks

Place :
Date : Signature of the applicant

I……………………………………………………… hereby declare that the original


certificates has not been allowed to be misused and that if it is recovered it would be
surrendered to the Director of Training Thiruvananthapuram
Place :
Date : Signature of the applicant

Certificate of the ITI/ITC/R.I Center from which the applicant was presented for the
examination for the first time

Certified that to the best of my information and belief of 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 a
duplicate certificate may be issued to the applicant.

Place :
Date : Principal/Training Officer
Name of ITI/ITC/RIC with
post office
(Office seal)

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