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Domicile Proforma A-I

This document is a domicile certificate for residents of West Bengal who have lived in the state continuously for at least the last 10 years as of December 30, 2014. The certificate verifies the name, parents, address, and place of residence in West Bengal of the applicant. It must be issued by an authorized person other than the head of the institution where the applicant attended or will attend Class 12 exams.

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Jayanti Neogi Sardar
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440 views1 page

Domicile Proforma A-I

This document is a domicile certificate for residents of West Bengal who have lived in the state continuously for at least the last 10 years as of December 30, 2014. The certificate verifies the name, parents, address, and place of residence in West Bengal of the applicant. It must be issued by an authorized person other than the head of the institution where the applicant attended or will attend Class 12 exams.

Uploaded by

Jayanti Neogi Sardar
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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PROFORMA-A-I

Applicable for candidates residing in the State of West Bengal continuously at least for last ten (10) years as
on 30.12.2014
To be issued by authorized persons other than Head of the Institution from which the candidate appeared/due to
appear in 10+2 or equivalent examination.

Domicile Certificate: Type-A-I


Certified that ___________________________________________________________ son / daughter
of ___________________________________________ is a resident/permanent resident of West
Bengal at Village/House No. ________________
Street ______________________________________________________________________________
Post Office _____________________________ Police Station ________________________________
in the District of ____________________________________________ under Assembly Constituency
__________________________________________________ and has been living in the State of West
Bengal continuously / uninterruptedly at least for the last ten (10) years as on 30-12-2014.
Note:
Paste passport size
photograph of
applicant in this
box

Photograph to be attested by the certifying authority.

Signature of Certifying Authority ________________________________________________________________


Designation with Official Seal __________________________________________________________________
Full Name of Certifying Authority _______________________________________________________________
Office Address __________________________________________________________________________
Office Phone No. _________________ Mobile No:_________________(optional)
ID No: ______________________________(optional)
Note: The Certifying Authority may please preserve the duplicate copy of the Certificate in his/her Office
provided by the candidate

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