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    Duplicate Certificate(1)

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    Duplicate Certificate(1)

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    Copyright:

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    15 views2 pages

    Duplicate Certificate(1)

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    © All Rights Reserved
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    DUP ­ 1

    BHARATIAR UNIVERSITY, COIMBATORE ­ 641 046.


    APPLICATION FOR ISSUE OF DUPLICATE CERTIFICATE

    1. Duplicate of which Certificate* required :

    2. Name of the Candidate :

    3. Register Number :

    4. College through which studied/Studying :

    5. Degree of study :

    6. Branch :

    7. Period of Study :

    8. Sex :

    9. (a) If applying for duplicate statement of


    Marks, fill in the Month and year of exam.
    For which mark statement was issued. :

    (b) If applying for duplicate degree certi­


    ficate fill in the :

    i. Month and Year in which quali­


    fied for the degree :

    ii Name in Tamil :

    iii Date of convocation in which


    the degree was conferred :

    © If applying for duplicate provisional


    Certificate / consolidated statement
    of marks fill in the Month & Year of
    last appearance in which qualified
    for the degree :

    10. Circumstances under which the certificate


    Was lost / destroyed :

    11. Whether the prescribed affidavit has been


    enclosed with the application. :

    12. Address to which the certificate is to be sent :

    13. Fees paid :

    DD/Challan No.: Bank : Amount : Rs. Date:

    Place :
    Date :
    FOR OFFICE USE ONLY Signature of the Candidate
    Certificate issued on Prepared by:

    Folio No. Examine by:

    Date on which the D.D. was Controller of Examinations


    Sent to Finance Officer
    *Write as Degree certificate / Statement of marks/
    Provisional Certificate / Consolidated statement of marks.
    (for instruction see over leaf)
    AFFIDAVIT TO BE FILED FOR ISSUE OF DUPLICATE CERTIFICATE

    Affidavit of Thru / Selvi……………………………………………………………………

    1. I………………………………………………………………………………………….

    son / daughter of ………………………………………..aged…….………………....years,

    an old student / student of ………………………………………………………….college

    with register number …………………………………….and residing at …………………

    street………………………………………………………………………………………...

    do hereby solemnly and sincerely state as follows.

    2. My *( I ) ………………………….(degree) statement of marks issued relating to the

    examinations held during……………………..……/ (ii) Degree certificate issued at the

    convocation…………………………..

    held on ……………………………../ (iii) Provisional Certificate / Consolidated statement of marks

    issued by the Bharathiar University, Coimbatore – 46 has irrevocably been lost / destroyed.

    3. I fill this affidavit for the purpose of receiving duplicate certificate.

    4. The duplicate Certificate shall be returned to the University once my original certificate /s is / are
    recovered by chance.

    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.

    Solemnly affirmed.

    at (place)_______________________________________________________

    this (date___________________________________day of Signature of the Candidate

    (month)________________________________________________________

    and his / her signature affixed in my presence.

    Before me

    Place :

    Date :

    Notary Public / Principal


    Address____________________________________
    ___________________________________________
    ___________________________________________

    Office Seal :

    * delete which is not applicable.

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