APPLICATION FOR ISSUE OF A DUPLICATE COPY OF VOCATIONAL HIGHER SECONDARY CERTIFICATE/MARK LIST WITH ELIGIBILITY CERTIFICATE 1. Name of the applicant in : block letters with full permanent address. 2. Name of Parent /Guardian : 3. Date of birth : 4. If the Original Certificate/ : Marklist is damaged/ Lost, give details. (a) Certificate: Reg. No. Month and Year Course Name of Centre (b) Marklist with eligibility Certificate: Reg. No. Month and Year Course Name of Centre 5. Circumstances under which a : duplicate certificate is required. a) If the original Certificate is irrecoverably lost whether declaration of the candidate attested by a 1st Class Magistrate of the judicial department under the seal of the Court or by the Officer Commanding in the case of Jawans describing the circumstances under which it was irrecoverably lost submitted along with the application. b) If the original certificate is damaged Whether details of damage furnished and remnants of damaged certificate / marklist enclosed. 6. }} : : Whether the applicant had applied for a duplicate copy of the certificate / marklist earlier. If so, state the details. 7. Details regarding remittance of fees for duplicate Certificate/ Marklist a) Amount : b) Chalan number and date of remittance : c) Name of treasury: Place: Date: Signature of the Applicant DECLARATION I, ...................................................................................... hereby declare that the facts stated above are true and correct and the original certificate/ marklist will not be misused and that if it is recovered hereafter, it will be surrendered to the Secretary, Board of Vocational higher Secondary Examinations, Kerala. Place: Date: Signature of the Applicant CERTIFICATE The details furnished by the applicant have been carefully verified with this office records and found correct and true, and certified that the original certificate/ marklist issued to the applicant is irrecoverably lost/damaged. Hence I recommend that a duplicate Vocational Higher Secondary Certificate/Marklist may be issued to the applicant. Place: Date: Signature of the Head of the Institution. Name and Designation. OFFICE SEAL 2 Instructions: 1) Application for duplicate copy of certificate should be complete in all respects and all the required documents should be attached with each application. Remnants of marklist or certificate if any should be placed in cover and attached with the application duly noting the same on the cover. 2) The rate of fees for issue of duplicate certificate/ marklist with eligibility certificate is Rs.100/ each. 3) The amount should be remitted into a government treasury in the name of the applicant under the Head of account 0202-01-102-93 VHS Examination Fees. 4) Application should accompany an affidavit in the prescribed format typed in stamped paper worth Rs. 50/- and attested by a I Class Judicial Magistrate. 5) Application should be routed through the Head of the Institution. 3 FORMAT OF AFFIDAVIT I, ...................................................... son/daughter of ......................................................... aged ...................years ............................................................................................................. (Full address) do hereby affirm and state as follows: 1. That I was a student in the .......................................................................................... (Name of School with place) for the Vocational Higher Secondary Course (Subject) ...................................................... during the academic years ........................................ 2. That I have appeared for the I year/ II Year Examination in ........................................... ...............................................vide Reg. No. ..................................................... and passed in ............................................. class. 3. That the Vocational Higher Secondary Certificate/ marklist with eligibility certificate Sl No ............................. Dated .................................... issued (Certificate) Sl. No .................................. dated ................................. issued (Marklist) by the Secretary, BVHSE, Thiruvananthapuram has been irrecoverably lost/ damaged leaving no remnants of it due to ....................................................................................... (State circumstances) 4. That I have not misused the said Vocational Higher Secondary Certificate/ marklist for any purpose, 5. That I will not misuse the said certificate/ marklist and the nobody will be allowed to do so and, 6. That the said certificate/ marklist would be surrendered to the Secretary, Board of Vocational Higher Secondary Examinations if it is recovered hereafter. All the facts stated above are true and correct to the best of my knowledge and belief. Place: Date: Signature of the Applicant 4
