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Duplicate MemoCertificates

This document is an application form for obtaining duplicate or triplicate pass certificates and consolidated marks for diploma examinations conducted by the State Board of Technical Education and Training, Andhra Pradesh. It outlines the necessary information and documents required from the applicant, including reasons for the request, affidavits, police certificates, and payment details. The application must be submitted through the principal of the concerned polytechnic along with the required enclosures.

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64 views3 pages

Duplicate MemoCertificates

This document is an application form for obtaining duplicate or triplicate pass certificates and consolidated marks for diploma examinations conducted by the State Board of Technical Education and Training, Andhra Pradesh. It outlines the necessary information and documents required from the applicant, including reasons for the request, affidavits, police certificates, and payment details. The application must be submitted through the principal of the concerned polytechnic along with the required enclosures.

Uploaded by

gopivinay.8639
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOC, PDF, TXT or read online on Scribd
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APPLICATION FOR THE ISSUE OF “DUPLICATE / TRIPLICATE PASS

CERTIFICATE & DUPLICATE / TRIPLICATE CONSOLIDATED MARKS” OF DIPLOMA


EXAMINATIONS CONDUCTED BY THE STATE BOARD OF
TECHCHNICAL EDUCATION AND TRAINING
ANDHRA PRADESH, HYDERABAD.
***********

01. Name of the Applicant :


(IN BLOCK LETTERS)
02. Father’s Name :

03. Address of the Applicant :

04. Polytechnic through which the applicant appeared :


for the Examinations.

05. Registration No./PIN of last appearances course, :


month and year of Examination.

06. Which of the following Duplicate Certificates :


required.
i). Duplicate/Triplicate Certificate
ii). Duplicate/Triplicate Consolidated Marks
iii). Duplicate/Triplicate Memo of Marks.

07. Reasons for which the application for the issue of :


Duplicate Certificate/Consolidated Marks.

08. Whether any complaint was given to the Police :


about the loss of the Certificates/Consolidated Marks
and a certificate to that extent from the above
authorities? If so enclose the same.

09. Whether the affidavit made on a stamped paper :


worth Rs. 20/- regarding loss of the Original
Certificates/Consolidated Marks and signed by the
First Class judicial Magistrate is attached?

10. Whether the DD for Rs.__________ for Duplicate :


Original Certificate /Rs._________ for Duplicate
Consolidated Marks obtained towards fee from any
Nationalised Bank for issue of Duplicate/Triplicate
Original Certificate/Duplicate/Triplicate Consolidated
Marks. Furnish Bank Name, Number and date.

11. Whether the Diploma Certificate/Consolidated Marks :


has at any time been suspended or enclosed.

12. Whether any Photo copies of the above is enclosed :


for ready reference.

P.T.O.
DECLARATION

I solemnly declare that the particulars furnished above are true to the best of my knowledge
and belief.

Date: _______________ SIGNATURE OF THE APPLICANT

Note:- Furnishing of inaccurate and false particulars will be viewed seriously besides withholding of
the Duplicate Diploma Certificate and disciplinary action as may be called for or deemed fit
by the Secretary, State Board of Technical Education and Training.
--------------------------------------------------------------------------------------------------------------------------------
IDENTIFICATION CERTIFICATE OF THE PRINCIPAL

I Certify that above particulars furnished by the candidate have been verified and found
correct with reference to the records of the Institute / Polytechnic and the applicant Sri/Smt/Kum.
________________________________________________________________ (Name to be given)
is the same person to whom the Original Diploma Certificate was issued and that the issue of
Duplicate to the candidate is recommended.

Station: SIGNATURE OF THE PRINCIPAL


Dated: WITH SEAL
--------------------------------------------------------------------------------------------------------------------------------
DECLARATION

I do hereby declare that my Original Pass Certificate / Consolidated Marks Diploma


bearing Sl.No. ____________________with Regd.No./PIN_____________________ of________
_________________________________ issued by the State Board of Technical Education and
Training, Andhra Pradesh, Hyderabad is neither suspended nor cancelled by the competent
authority.

Date: ____________. SIGNATURE OF THE CANDIDATE


Note:- The following Certificates should be sent alongwith the application without fail.

1 .Bank Draft for Rs.2500/- for Duplicate Diploma Certificate & for Rs.3000/- for Triplicate
Diploma Certificate for schemes (OS/NC/C-90,C-96,C-00,C-05, C-09 &ER-81& 91PH)
2. Bank Draft for Rs.1500/- Duplicate/Triplicate Consolidated Marks NC/C-90 Schemes only
3. An Affidavit in the prescribed proforma (copy enclosed) on stamped paper worth for Rs. 20/-
Certified by First Class Judicial Magistrate with the seal of the court concerned .

4. A declaration by the candidate that the Original Certificate/Consolidated Marks was not
suspended or cancelled by the competent authority.

5.An Identification certificate from the concerned Principal of the Institute/Polytechnic to the
effect that the candidate is the same person to whom the Original Diploma Certificate was
issued.

6. Police enquiry certificate in Original.

7. Photo copies of the Certificates if available.


8. Demand Draft should be drawn in favour of the SECRETARY, SBTET. A.P., HYDERABAD.

The application along with necessary enclosures should be forwarded to the Secretary,
SBTET through the Principal of the concerned Polytechnic.

Note:- 1) No documents are required for issue of Duplicate/Triplicate Memo of marks. Rs.600/-
for Fee each memo of marks) & Month/Year of passing the exam shall be clearly
mentioned.
AFFIDAVIT

I ________________________________________________________________

Son/Daughter of ________________________________________________________________

Age _________ Occupation____________________________________________resident of

________________________________________________________________________on
solemnly oathand affirmation do are as under.

1.That I have appeared for ______________________________________________________

Examination held in the month of _____________________________________________

with Regd. No./PIN_____________________________________________________ through


Polytechnic, ___________________________________________________________________.

2.That the Original Diploma Certificate/PCCM issued to me by the State Board ofTechnical
Education and Training has been lost by me while __________________________________

______________________________________________________________________________

_________________________________ (details ) __________________________________

______________________________________________________________________________

_______________________ and in spite of my by best efforts I am unable to trace it and it is lost


beyond recovery. In case it is traced in future I shall submit it to the State Board Of Technical
Education And Training, Andhra Pradesh, Hyderabad for cancellation.

3.That I am in need of Duplicate copy of the said certificate for which purpose, I am hereby making

this declaration as required by the SECRETARY, State Board Of Technical Education And Training,

Andhra Pradesh, Hyderabad

SIGNATURE OF DEPONENT

SWORN BEFORE ME
Date:
(Court Seal)

FIRST CLASS JUDICIAL MAGISTRATE

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