Scribd Logo
Upload

Welcome to Scribd!

  • 132 views

    Application Form For Original Pass Certificate: Srimanta Sankaradeva University of Health Sciences

    Uploaded by

    Himangsu
    The document is an application form for an original pass certificate from Srimanta Sankaradeva University of Health Sciences. It requests information such as name, registration number, examination details, payment details, and postal address. The applicant must submit documents like registration certificate and mark sheets, and fees payment proof. The certificate will usually be sent to the institution from where the applicant passed, but can be sent by post or collected in person upon request.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd

    Application Form For Original Pass Certificate: Srimanta Sankaradeva University of Health Sciences

    Uploaded by

    Himangsu
    132 views2 pages
    The document is an application form for an original pass certificate from Srimanta Sankaradeva University of Health Sciences. It requests information such as name, registration number, examination details, payment details, and postal address. The applicant must submit documents like registration certificate and mark sheets, and fees payment proof. The certificate will usually be sent to the institution from where the applicant passed, but can be sent by post or collected in person upon request.

    Original Description:

    Application

    Original Title

    ApplicationForm OriginalPassCertificate

    Copyright

    © © All Rights Reserved

    Available Formats

    PDF, TXT or read online from Scribd

    Did you find this document useful?

    Is this content inappropriate?

    The document is an application form for an original pass certificate from Srimanta Sankaradeva University of Health Sciences. It requests information such as name, registration number, examination details, payment details, and postal address. The applicant must submit documents like registration certificate and mark sheets, and fees payment proof. The certificate will usually be sent to the institution from where the applicant passed, but can be sent by post or collected in person upon request.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    132 views2 pages

    Application Form For Original Pass Certificate: Srimanta Sankaradeva University of Health Sciences

    Uploaded by

    Himangsu
    The document is an application form for an original pass certificate from Srimanta Sankaradeva University of Health Sciences. It requests information such as name, registration number, examination details, payment details, and postal address. The applicant must submit documents like registration certificate and mark sheets, and fees payment proof. The certificate will usually be sent to the institution from where the applicant passed, but can be sent by post or collected in person upon request.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    of 2

    SRIMANTA SANKARADEVA UNIVERSITY OF HEALTH SCIENCES

    NARAKASUR HILLTOP, BHANGAGARH, GUWAHATI-32, ASSAM, INDIA


    Application Form for Original Pass Certificate

    1. Name of Examination :…............................................................................................................


    2. Name of applicant in full (in block letters) : .…..........................................................................................................
    3. Registration No. : …...........................................................................................................
    4. Father's name in full (in block letters) : …...........................................................................................................
    5. Mother's name in full (in block letters) : …...........................................................................................................
    6. Nationality : …...........................................................................................................
    7. Mobile No. : …...........................................................................................................
    8. Permanent Address : …...........................................................................................................
    …...........................................................................................................
    9. Present Address : …...........................................................................................................
    …...........................................................................................................
    10. Name of Institute studying at present : …...........................................................................................................
    11. Roll No. of last examination under the University : …..................................................................................................
    12. Details of Examinations appeared under the university :
    Name of Examination Year & Month Passed Subjects Failed Subjects
    of passing
    A
    B
    C
    D
    E

    13. Particulars of Certificate prayed:


    Name of Examination Year & Month Examination Roll No. Name of Institution from where passed
    of passing

    14. Details of payment of requisite fees:


    Amount of Fees paid Banker's Cheque No./ Name of Issuing Bank Date of Issue
    Bank Draft No.

    15. Postal Address to which Certificate is to be sent: ………………………………………………………………………….


    ………………………………………………………………………... ….
    …..…………………………………………………………………………
    DECLARATION BY THE APPLICANT
    I declare that the above entries in the form have been filled up in my own hand-writing and the entries made are correct as
    per my documents and to the best of my knowledge and belief. I agree that if any statement made above is proved to be false, I shall
    be liable for legal action for submitting false information and statements.

    Date : ….............................
    Place : …............................. Signature of the applicant in full

    RECOMMENDATION OF THE PRINCIPAL/HEAD OF INSTITUTION


    This is to certify that …………………………………………………… Registration No. ……………… of ……………
    Examination Roll No. …………….. a student of ……………………………………………. College passed the …………………….
    Examination held in …………………………… The Certificate may be issued to the applicant by the University.
    This certificate is to be signed by
    the Principal of the College in which
    the candidate has studied
    Signature of Principal/Head of Institution with Office Seal
    Date : …............................. …......................................................................................
    (Name of institute)
    -2-

    OFFICE NOTES & ORDERS

    Recommended Checked Examination record verified


    Certificate may be prepared Fees as shown have been paid

    Controller of Examinations Deputy Registrar Dealing Assistant

    1. The application must be complete in all respect for processing at the University. Incomplete
    application form shall not be processed.
    2. The applicant must enclose Photostat copies of the following documents, attested by Govt.
    Gazetted Officer or Principal/ Head of the Institution of the concerned Examination –
     Registration Certificate.
     All Mark Sheets/ Admit Cards of the concerned Examination
     Banker’s Cheque/ Bank Draft of requisite application fees drawn in favour of “Srimanta
    Sankaradeva University of Health Sciences” payable at GMC Branch, SBI Guwahati.
     Internship completion certificate (in case of M.B.B.S., B.D.S., B.A.M.S. and B.H.M.S.)
    3. The Certificate shall ordinarily be sent to the Principal/ Head of the Institution from where the
    applicant passed the concerned examination. However, the applicant, if desires, to obtain through
    Registered A/D post or by hand personally or through authorized person, he/she may apply in the
    form given below:

    Application for obtaining Certificate through Registered A/D post


    or by hand personally or through authorized person

    To,
    The Registrar,
    Srimanta Sankaradeva University of Health Sciences
    Guwahati-781032 (Assam)

    Subject: Delivery of Certificate through Registered A/D post or by hand personally or through
    authorized person.

    Sir,
    I may be allowed to receive my …………………………………….. Original Pass
    Certificate through Registered A/D post to my postal address as mentioned in Sl.15 of this application
    form/ by hand personally/ through authorized person whose signature is attested below. (Strike out
    whichever is not applicable). In this context I shall not hold the University responsible if the
    Certificate is lost/ misplaced/ delayed during transit.

    Specimen signature of the Applicant Signature of authorized person attested


    Name of the authorized person

    Specimen signature of the Applicant is attested -----------------------------------------------

    Principal/ Head of the Institution with Office Seal Signature of the Applicant

    Allowed

    Registrar
    Srimanta Sankaradeva University of Health Sciences
    Guwahati

    You might also like

    pFad - Phonifier reborn

    Pfad - The Proxy pFad of © 2024 Garber Painting. All rights reserved.

    Note: This service is not intended for secure transactions such as banking, social media, email, or purchasing. Use at your own risk. We assume no liability whatsoever for broken pages.


    Alternative Proxies:

    Alternative Proxy

    pFad Proxy

    pFad v3 Proxy

    pFad v4 Proxy