Application For Issue Of A Duplicate Ssc printable pdf download

Application For Issue Of A Duplicate Ssc

APPLICATION FOR ISSUE OF A DUPLICATE SSC

(X Class Record Book)

Note: - The application along with the required document should be sent to the Secretary to the Commissioner for

Government Examinations, Chapel Road, T.S., Hyderabad-500001 through the Headmaster where the candidate

last studied.

Name of the Applicant

( in BLOCK LETTERS )

Address of the Applicant

Father’s Name

Date of Birth

Place of Birth

School where the applicant last studied

Serial No. of original SSC

Number of times the applicant appeared for the SSC Public

Examinations with month and year of examination and

Registered No. assigned to each appearance (correct particulars

should be given)

Details circumstances under which the application for the

issue of Duplicate SSC is made. (Circumstances should be

clearly stated to be supported by documentary evidence, if

any, since the particulars of loss are to be furnished will

be published in the Gazette)

10.

Whether an affidavit regarding the loss of the original SSC

obtained from Junior Civil Judge or Notary.

Rs.250/-

11.

Whether the challan for

towards the fee for

obtaining a duplicate SSC is enclosed (Name of the

Govt. Treasury and No. and Date of the challan to be

0202 – Education, Sports, Arts and Culture

mentioned)

01 – General Education

102 – Secondary Education

12.

Head of Account

006 – Director of Government Examinations

800 – User Charges

25000303001 – DDO code

The challan should be obtained from SBI or

SBH

13.

Whether the SSC has at any time been suspended

or cancelled.

14.

Whether the candidate has at any time been debarred for

appearing for the SSC Public Examination due to

resorting to malpractice. If so, definite particulars may be

furnished.

15.

Marks of identification (as per the school record and

particulars entered in the original SSC)

DECLARATION

I solemnly declare that the particulars furnished above are true to the best of my knowledge and behalf.

PHOTO

Candidate’s Photo

Station :

attested by HM

Signature of the Candidate

Date :

Note :- The furnishing of inaccurate or false particulars will be entail of withholding of the Duplicate certificate and in

the case of false particulars, disciplinary action will be taken such as may be called for or deemed fit by the

Commissioner for Government Examination.

Application For Issue Of A Duplicate Ssc

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