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14 APPLICATION FORM FOR Duplicate CERTIFICATE

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472 views3 pages

14 APPLICATION FORM FOR Duplicate CERTIFICATE

Uploaded by

Suresh Babu
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Download as PDF, TXT or read online on Scribd
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KALASALINGAM Anand Nagar, Krishnankoil – 626 126

Srivilliputtur (via), Virudhunagar (DT)


Academy of Research and Education Tamilnadu, INDIA.
Ph: 04563-289300
DEEMED TO BE UNIVERSITY
Estd.U/S 3 of UGC Act 1956, Accredited by NAAC with “A” Grade
e-mail : coe@klu.ac.in
www.kalasalingam.ac.in │1800 425 7884 │1800 425 9395

OFFICE OF THE CONTROLLER OF EXAMINATIONS

APPLICATION FOR ISSUE OF DUPLICATE CERTIFICATE

(Please tick: - Degree Certificate / Grade Cards/Provisional certificate / Consolidated Grade Card)
1. Name of the Student …

2. Register Number …

3. Sex …

4. (a) If applying for duplicate Grade Card,


fill in the Month and Year of
Exam for which grade card is
required. …

(b) If applying for duplicate degree certificate,


fill the …
i. Month and Year in which qualified for
the degree …
ii. Date of convocation in which
the degree was conferred …

(c) If applying for duplicate provisional


Certificate / consolidated grade
card fill in the Month & Year of
last appearance in which qualified
for the degree. …

5. Circumstances under which the certificate


was lost. …

6. Whether the prescribed affidavit has been


enclosed with the application …

Place:

Date: Signature of the Candidate


Please attach Cash Receipt No.

FOR OFFICE USE ONLY


Certificate issued on: Prepared by:
Signature:
Amount Paid : Fees Paid Date :

Signature of the Clerk issued: Controller of Examinations


INSTRUCTIONS

1. Duplicate certificate will be issued only when it is lost or destroyed irrevocably.

2. Application should be made only by the candidate in the prescribed format and should be
submitted to the Controller of Examinations directly. Application received on behalf of the
candidate will not be accepted.

3. The following documents should be enclosed along with the application.

(a) an affidavit detailing the circumstances under which the original certificate was lost.
(b) Xerox copy of the grade card / Certificate for which duplicate is required (if available)
(c) Cash Paid Receipt in original.

In addition to the above, candidates applying for the Duplicate Degree Certificate should
enclose:

(d ) Non traceable certificate from Police.


(e ) Copy of ‘Notification’ issued in a news paper for loss of certificate.

4. Application should be complete in every respect. Failure to furnish correct details may cause
delay in the issue of the certificate.

5. The fee for the issue of various certificate is as follows:

(a) Grade Cards -- Rs. 500/- per Grade Card


(b) Provisional Certificate -- Rs. 500/- up to convocation. No PC
will be issued after the Convocation.
(c) Consolidated Grade Card -- Rs. 500/-
(d) Degree Certificate -- Rs. 3000/-

6. The fee should be paid by Cash in the Cash Section.

7. Fees once paid will not be refunded nor adjusted for any other certificate under any circumstances.
8. Duplicate Certificate is to be surrendered to the University immediately if the Original Certificate
is recovered.
AFFIDAVIT TO BE FILED FOR ISSUE OF DUPLICATE CERTIFICATE

Affidavit of Thiru / Selvi……………………………………………………………………………………

1. I…………………………………………………………………………………..……. Son / Daughter of

………………………………………………………………………………….aged…….. ……………Years,

an old student / student of KALASALINGAM UNIVERSITY with Register number ………………..

And residing at……………………………..………………………………………………………………….

……..……………………………………………………………………………………………………………..

Do hereby solemnly and sincerely state as follows.

2. My (i) * Grade Cards issued relating to the Examinations held during ………………

(ii) * Degree certificate issued at the Convocation held on…………………………………

(iii) * Provisional Certificate / Consolidated Grade Cards issued by the


Kalasalingam University has irrevocably been lost / destroyed.

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

4. I will return immediately the duplicate certificate(s) 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.

Place :
Date : Signature of the Candidate

Solemnly affirmed

at ………………………………………(place)

this …………………..day of ………….. 200….

and his / her signature is affixed in my presence. Head of the Department

 delete which is not applicable.

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