APPLICATION FOR DUPLICATE MARKSHEET OR FOR CORRECTION IN MARKSHEET Note: 1. 2. 3. 4.

Write in CAPITAL LETTERS Strike off what is not applicable Pay the necessary fee for duplicate marksheet in College Office and attach the fee receipt. Marksheet will be handed over only to the applicant student on production of a valid photo ID proof such as College ID card/Aadhar Card/Passport/PAN Card or other documents as may be specified by the Govt. 5. Attach following documents with this application: a. Xerox copy of Identity card/fee receipt b. Photo-identity proof (PAN Card / Aadhar card / passport / identity card issued by college or your current employer) c. For correction in marksheet, please attach the original marksheet. d. For duplicate marksheets, please attach the following documents: i. Original copy of complaint registered with Police Station. ii. Copy of the marksheet (if available) iii. Affidavit on Rs 100/- stamp paper duly notarized iv. Copy of complaint registered at a police station

Student’s Name (as mentioned in SSC marksheet) ______________________________________________ Class : FYJC ARTS/ SCIENCE/COMMERCE Year of Passing: _________________

Roll No ____________

Reason for applying for marksheet: __________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________

Fee for Duplicate Marksheet: _________________ Receipt No: ______________ Date: __________ Mobile No: _____________________ Date of Application:

Signature of Applicant

FOR OFFICE USE ONLY Duplicate/Corrected Marksheet issued on _______________ If rejected, reason ________________________________________________________________________ Issued by: _________________

New marksheet collected by: ________________ (Name and Signature)

MNT/102012

Form For-DUPLICATE MARKESHEET.pdf

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