DOWNLOADED FORM
Received
Fee of Rs. ………….….
(Rupees …………..……...... ……………………..……...)
Signature of the Cashier
Date…………………
ASSAM UNIVERSITY : SILCHAR
APPLICATION FOR DUPLICATE MARKSHEET
(See overleaf for Rules)
TO
THE CONTROLLER OF EXAMINATIONS
ASSAM UNIVERSITY, SILCHAR.
Through the Principal/Head of the Department of …………………………………………………...
Sir,
I have the honour to request you kindly to issue the Duplicate Mark-sheet in my favour. I appeared / passed the ….. ……………………………………………………………………………… Examination in the year …………………….. with Roll ……………… No. …………………………. from ……………………………………………………………… College / Department* and was placed in …………………………….. Division / Class in ………………………………….. (Major / Honours) ………………………………………………………….. subject(s) with Assam University Registration No. …………………………………………… of 19 ……………… 20 ………………….
The Original Mark-sheet was lost / destroyed / stolen / deformed on ……………………………………………………. The above mentioned mark-sheet is urgently needed for the purpose of …………………………………………………….
I further affirm that I have carefully read the instructions overleaf and accordingly submitted all relevant documents / papers along with the application. I understand that if any of above statement is found to be incorrect my application is liable to be rejected.
The prescribed fees of . …………… (Rupees …………………………………………………………….................. ...........................…………………… ) only paid vide DD/Cash Receipt No. ………………………... dated …………………….
Address Your’s faithfully
Name ………………………………………
C/o …………………………………………
Vill/Town/Lane No. ………………………. Signature of the applicant
P.O. ……………………………… PIN Code dated
* Department means PG/UG department of A.U.S.
RECOMMENDATION OF THE HEAD OF THE INSTITUTION
Certified that Shri / Smti ………………………………………………………………………….. is / was a bonafide student of this college/deptt. The candidate may be allowed to obtain a Duplicate Mark-sheet from the University as prayed for.
Forwarded to the Controller of Examinations Signature of the Principal / HOD ……….………………………….
(Seal)
OFFICE NOTES & ORDERS
Police Report,
Fee Receipt, Examination records verified and found correct / incorrect
Document verified
Duplicate Mark sheet
may be / may not be prepared
Mark sheet may be
signed & issued
Deputy Registrar/Asstt. Registrar (Exam)
Dealing Asstt.
Section Officer
C.O.E.
RULES FOR OBTAINING DUPLICATE MARKSHEET
1. Issue of Duplicate Mark sheet may be considered if the original mark sheet is lost by theft/burning or otherwise destroyed. In that case, this prescribed application completed in every respect should be accompanied by (A) FIR (copy of the information lodged with the police) or a certified extract from the Police Diary containing the entry of the information lodged, with the seal of the police officer and the police station. In the Police Report also (1) the name of the holder of the mark sheet (2) Roll No. (3) Year of Passing (4) the College/Department from which he/she passed the Examination must be mentioned. Police Report should contain the G.D.E. No. & Date (of the Police Station) (B) A Newspaper clipping having information regarding loss of the mark sheets (C) Affidavit duly sworn before an Executive / Judicial Magistrate by the applicant himself.
2. Duplicate Mark sheet also may be issued, when original mark sheet is defaced or mutilated or partially burnt/damaged. Such mark sheet should surrender to this office giving convincing ground, along with the application and necessary fees.
3. The application form duly filled in and countersigned, should be submitted to this office together with the prescribed fees and necessary documents mentioned in Rules 1(A) (B) & (C) or 2 above. Besides this, the applicant shall be required to enclose with the application duly attested Photostat copy of the Mark sheet of the concerned Examination. Attestation should be done by the Head of the Institution / HOD / respective Dean (as the case may be) of Assam University.
4. All prescribed fees (as under) should be sent by Crossed Bank Draft payable in the name Finance Officer, Assam University, Silchar.
Amount of fees payable is 100/- (Rupees one hundred) only.
5. Generally the Mark sheet will be handed over to the applicant when his/her specimen signatures are attested in the form given below.
6. If desired, candidate may enclose self-addressed stamped envelope of size 11// x 5// for delivery by Post.
NOTE : UNIVERSITY HAS THE RIGHT TO REJECT THE APPLICATION IF THE REASONS FOR DUPLICATE MARKSHEET IS NOT SATISFACTORY TO THE OPINION OF THE UNIVERSITY AUTHORITY.
__________________________
Name of the applicant in full
Address :
Specimen Signatures of the applicant to be attested by the Head of the Institution / HOD / respective Dean of Assam University.
Specimen Signatures
1.________________________
2.________________________
3.________________________
Signature attested
Principal/Head of the
Institution / Head of the Department
with office seal
Allowed
C.O.E./Deputy Registrar (E)
2012-06-07