APPENDIX II
•»³¸¨°¶¾Ý¸ ¶¤¯‹»˜¯ −ÜÈ°ý°¾Ý¸ §¢°¾²Ò˜°œ²¶ªÊ°¤²á ¶À¯ ¶ý¯¦¹
APPLICATION FOR ISSUE OF A DUPLICATE QUALIFICATION CERTIFICATE
ª°š»¯¢»¯− °ß/Educational District:
1 ¶À‰µú ¶¥²¹ ³ÜË ¶£Þª°§¯−ª²¹ :
Name of the applicant with full address
2 ¶À‰µú ƒ¶Ô¯©µÌ ¶£Þª°§¯−¹ :
Present address of applicant
3 ¥À‰Ü̯ª°µú ¶¥¸ :
Name of Parent/Guardian
4 œœÌ±¤˜° (£§¡¯Ü/½‰°−¸˜² ªÜ¬¹) :
Date of birth in Malabar and Christian Era
5 ‚ª«»µÔ“²Ò −ÜÈ°ý°¾Ý°µú ¶¥¸ :
Name of duplicate certificate required
6 ¥±À¯ −¹¡œ¸›£¯¤ ª°ª¥Äà : ¥°. ªÜ¬ª²¹ ¥±À¯
Particulars of the Examination œØÜ £¯−ª²¹ ¶‰½Ñ¹
Reg. No. Year & Centre of the
Month Examination
ˆÒ¯¹ ª−¥¹/I appearance : ........................................................................
¥Ê¯¹ ª−¥¹/II appearance ........................................................................
£³Ò¯¹ ª−¥¹/III appearance etc. etc. ........................................................................
7 •»³¸¨°¶¾Ý¸ −ÜÈ°ý°¾Ý°œ¸ ¶À°¾¯œ²á :
−¯®ü¥»¹ (œ¬¸“µÔ“Þ/¶‰“²¯“¸ −¹¢ª°¾Þ)
Circumstances under which a Duplicate
Certificates is applied for (lost/damaged)
8 æÞ −ÜÈ°ý°¾Ý¸ ¦Í¯¾°¤˜¯µ—Ã°Þ :
˜°µú ˆ¯Ü•Ü œØ¥²¹ ¦Í¯¾°¤ ˜±¤˜°¤²¹
‰¯—°¾²‰
If the Original Certificates was cancelled, give
order number and date of cancellation.
9 ¶À‰Ï ƒ˜°œ²£²Ø¸ •»³¸¨°¶¾Ý¸ :
−ÜÈ°ý°¾Ý°œ¸ ¶À°Å°È²¶Ê¯? „µÊðÞ
ˆ¯Ü•¦°µú ˆ¥² ¶‰¯Ô° ƒ˜°¶œ¯µ“¯Ô¹
−£ÜÔ°¾²‰
Has applicant applied for a duplicate certificate
Before? If so, enclose a copy of the order, if any,
passed on that application
10 ý±−¸ ˆ“²¾²Ò˜¸ −¹¡œ¸›°Å ª°«šª°ª¥¹ :
Details regarding remittance of fees
µü§¯Ï œØ¥²¹ ˜±¤˜°¤²¹ µü§¯Ï ˜²‰ ½“¬¦°¤²µ“ ¶¥¸
Number & Date of Chalan (Amount) Name of Treasury
11 ¢°½¯¤¾²¦°Ô¸/Remarks
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’¯Ï .................................................... ƒª°µ“ −¯À»µÔ“²Ì²Òµ˜µÐÒ¯Þ †µú æÞ −ÜÈ°ý°¾Ý¸
†µú ¦°¶ª¯“²‰³“° ¤¯µ˜¯¥²ª°› œ¯ª«»‰¯¥»Äྯ¤° „¶¤¯‹°Å°È°ß¯ †Ò²¹ ˜¸ ˜°¥°µ‰
§¢°¾²‰¤¯µ—Ã°Þ „“µœ ˜µÒ µ−½‰È¦°, ¥±À¯ ¢ªÏ, ³Ô²¥, ˜°¥²ªœÐ²¥¹-14 †Ò
¶£Þª°§¯−Ì°Þ †Ì°Å²˜¥²Ò˜²£¯—¸.
I, .......................................................................... hereby declare that the Original Certificate has not been
allowed to be misused and that if it is recovered it would be surrendered to the Secretary, Board of Public
Examination, Trivandrum-14.
𧹠(Place) ........................................................
˜±¤˜° (Date) ......................................................... ¶À‰µú ˆÔ¸ (Signature of applicant)
¶À‰Ï ‚š»˜ª— ¥±À †©²˜°¤ −¸‰³¨°µ§ ¶£§²¶š»¯‹ðµú −¯À»½˜¹
CERTIFICATE OF THE HEAD OF THE SCHOOL FROM WHICH THE APPLICANT WAS PRESENTED FOR THE EXAMINATION FOR THE FIRST TIME
’¯Ï ƒª°µ“ −¯À»µÔ“²Ì²Òµ˜µÐÒ¯Þ †µú ¦°ª²¹ ª°«¼−¸˜˜¶¤¯“²¹ ‰³“° œÞ‰°¤ ƒ· ¶À‰µú
æÞ −ÜÈ°ý°¾Ý¸ ˜°¥°Å² ‰°È¯Ì ª°›Ì°Þ œ¬¸“µÔÈ°¥° ¾²Ò²/¶‰“²¯“²‰à −¹¢ª°Å°¥°¾²Ò²/¦Í¯¾°¤°¥°¾²Ò².
¶À‰µú £²‰¨°Þ ¦Ç°¥°¾²Ò ª°ª¥Äà ’¯Ï ª°«š£¯¤° ¥°¶«¯›°¾²‰¤²¹ «¥°¤¯µ—Ò¸ ‰µÊ̲‰¤²¹
µü¤¸˜². ˜°œ¯Þ ƒ· ¶À‰œ¸ •»³¸¨°¶¾Ý¸ −ÜÈ°ý°¾Ý¸œÞ‰—µ£Ò¸ ˜¯Þ¥»µÔ“²Ò²..
Certified that to the best of my information and belief 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 duplicate certificate may be issued to the applicant.
ð§¹(Place) : .......................................... µ®•¸£¯èÜ/Headmaster :
˜±¤˜°(Date): ......................................... Name of School :
with Post office
and Educational District
(Office Seal)
„ᓾ¹ : 1 µü§¯Ï 2. £°−¸¶½“È°µú −¯À»½˜¹ 3. ½˜¥−»¹
4 æÞ−ÜÈ°ý°¾Ý¸ (−ÜÈ°ý°¾Ý°œ¸ ¶‰“²¯“²‰à −¹¢ª°Å˜¯µ—ðÞ)
NB: ¶À¤°Þ −³ü°Ô°Å°È²á †ß¯ ª°ª¥Ä¨²¹ ¶¥ŠµÔ“²Ì°µ¤Ò¸ „¦Ô¸ ª¥²Ì°¤˜°œ² ¶«¬¹ £¯½˜¶£ ¥−»¹
Å“°Å ½˜¶¶¯µ“¯Ô¹ µ®•¸£¯èÜ ¥±À¯¢ªÏ µ−½‰È¦°¾¸ ¶À ¤¤¸¾²ª¯Ï ¯“²á³. ³Üˣ߯Ì
¶À ¤¯µ˜¯¥²ª°› ¦°¤°Ô²£°ß¯µ˜ œ°¥−°¾²Ò˜¯¤°¥°¾²¹.
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œ°Ü¶Í«Äà/INSTRUCTIONS
1. †−¸.†−¸.†Þ.−°., “°.“°.−°, £Ý¸ −ÜÈ°ý°¾Ý²‰à †Ò°ª¤²µ“ •»³¸¨°¶¾Ý°œ¸ ¶ªÊ°¤²á ý±−¸ 200¥³.
The rate of fees for issue of duplicate in the case of SSC, TTC, or any other Certificates is Rs.200.
2. £³Ò¯£µÌ ˜ª— −ÜÈ°ý°¾Ý¸ §¢°¾²Ò˜°œ² ¶ªÊ°¤²á ý±−¸ 500 ¥³
The rate of fees for the issue of triplicate certificate is Rs.500.
3. ¶À‰Ï ¶‰¥¨ −¹ð¯œÌ°µ§ ‡µ˜Ã°§²¹ ‹ªÉµ£ú¸ ½“¬¦°¤°Þ "0202-01-102-92 Other Receipts" †Ò ¾·Ê¸ µ®é°Þ
µü§¯Ï †“²Ì¸ ý±−¸ ˆ“²¾—¹. ¶À‰Ï ¶‰¥¨Ì°œ¸ ²¦Ì¯µ—Ã°Þ ¶èݸ ¡¯Ã¸ ˆ¯ý¸ ƒÐ»¤°Þ ¾·Ê¸ œØÜ "077¡°
(−°) µ†.†−¸.†−¸.†. ¶‰¥¨" †Ò ¶¥°Þ µü§¯Ï †“²Ì¸ ý±−¸ ˆ“²¾—¹.
The amount of fees should be remitted in the name of applicant into a Govt. Treasury of the Kerala State under Head of Accounts "0202-01-
102-92 Other receipts". In the case of applicants residing outside the State the amount may be remitted in to the State Bank of India in
Chalan under the Head of Account "077 B(c) I.S.S.A. Kerala".
4; æÞ −ÜÈ°ý°¾Ý¸ ˜°¥°Å¸ ‰°È¯Ì ª°›Ì°Þ œ¬¸“µÔȰȲµÊÃ°Þ ˆ¥² ˆÒ¯¹ ‰¸¨¯−¸ £°−¸¶½“È°µú ¶‰¯“˜° £²½š ¥°Å
−¯À»½˜¹ −£ÜÔ°¶¾Ê˜¯—¸. ª¯œ¯µ—Ã°Þ ‰£¯ú°¹‹¸ ˆ¯ý±−¦²µ“ −¯À»½˜¹ −£ÜÔ°¶¾Ê˜¯—¸.
If the Original Certificate is irrecoverably lost, produce declaration of the candidate Attested by a Magistrate of the Judicial Department
under the seal of his court or by the Office Commanding in the case of Jawans, Deatailing the circumstances under which it was lost.
5. æÞ −ÜÈ°ý°¾Ý°œ¸ ¶‰“²¯“²‰à −¹¢ª°Å°È²µÊÃ°Þ ˜°µœ ‰²¦°Å²á ª°«šª°ª¥Äà œ§‰²Ò¶˜¯µ“¯Ô¹ ¶‰“¯¤
−ÜÈ°ý°¾Ý¸ −£ÜÔ°¾²‰¤²¹ ¶ª—¹.
If the Original Certificate is damaged, give details and enclose is remnants, if Remnants are not available give reasons.
6. −ÜÈ°ý°¾Ý¸ ª°¶š«Ì¸ ªÅ¸ ˜°¥°Å² ‰°È¯Ì ª°›Ì°Þ œ¬¸“µÔȰȲµÊÃ°Þ ¶À¶¤¯µ“¯Ô¹ ƒÐ»Ï †¹¡−°¤²µ“
²•±¬»Þ ›°‰¯¥£²á „¶š»¯‹ðµú −¯À»½˜ª²¹ ‰³“° „àµÔ“²Ì°¤°¥°¾—¹.
If the Original Certificate was irrecoverably lost in foreign country, produce affidavit of the Indian Emabssies Officer who has a judicial
power.
7. •»³¸¨°¶¾Ý¸ †−¸.†−¸.†Þ.−°.¡²¾¸ §¢°¾²Ò˜°œ¯¤° ¶À¶¤¯µ“¯Ô¹ PRD ¹‹±‰¥°Å ‡µ˜Ã°§²¹ š°œ½˜Ì°Þ
œÞ¶‰Ê ¥−»Ì°µú £¯˜´‰.
The prescribed notice to be published in any daily newspapers approved by PRD for obtaining the duplicate SSLC.
¶œ¯È±−¸
.............................ªÜ¬µÌ...................¥°èÜ œØ¥°§²á †µú †−¸.†−¸.†Þ.−°. ¡²¾¸ ª±µÊ“²¾¯Ï Ý¯Ì ª°›Ì°Þ
µµ‰¶£¯«¹ ªÒ ª°ª¥¹ ƒ˜°œ¯Þ ¦°¤°¾²Ò². ½−¸˜²˜ ¡²¾°µú •»³¸¨°¶¾Ý¸ ‰ÜÔ°œ¯¤° ¥±À¯‰Ù±¬—¦²µ“ µ−½‰È¦° £²Ï¯µ‰
œ°¤£¯œ²−¥—£²á ¶À œÞ‰²Ò˜°œ¸ ˜±¥²£¯œ°Å°¥°¾²Ò². ƒ˜°¶ÓÞ ‚¶À£²áªÜ ƒ· ¥−»¹ ªÒ¸ 15 š°ª−Ì°œ‰¹ µ−½‰È¦°,
¶¡¯Ü•¸ ˆ¯ý¸ ¡¸¨°‰¸ †‰¸−¯£°¶œ¬Ï−¸, ¥±À¯¢ªÏ, ³Ô²¥, ˜°¥²ªœÐ²¥¹ †Ò ª°§¯−Ì°Þ ¶¥Š¯£³§¹ ¥¯˜° œÞ¶‰Ê˜¯—¸.
¶¥²¹ ª°§¯−ª²¹
Notice
My SSLC Book bearing Reg. No................... year.................. has been irrecoverably lost. It is decided to submit an application for the
Duplicate SSLC Book before the Secretary to the Commissioner for Government Examinations (in the prescribed form) as per approved procedure.
Those who have any objection before the Secretary, Board of Public examinations, Pareeksha Bhavan, Poojappura, Thiruvananthapuram within 15
days from the date of this advertisement.
Name and Address
