Candidate Name:RICHARD RAJAN (1124235)

Note: (1) Candidate should furnish the 'Course Certificate' given below as proof of subjects studied.

(2) B.Sc holders should attach copy of relevant degree/mark list (all parts) in addition to the certificate of Higher Secondary
or equivalent examination.

(3) Candidates already passed the qualifying examination should attach the copy of their mark lists to prove academic eligibilty, instead of course certificate.

COURSE CERTIFICATE
(To be issued by the Head of School/Institution where the applicant has completed or is
completing his/her studies in Standard XII or equivalent/Diploma in Engineering)
(Candidates who have passed the Plus Two/equivalent examination can attach
the self-attested copy of the marksheet/pass certificate to prove academic eligibility)
CERTIFIED that Shri/Smt /Kum.........................................................................................., an applicant for Admission to the
Professional Degree Courses Kerala 2014, who is the son/daughter of Shri./Smt.........................................................................
of .....................................................................................................................................................................................................
...............................................................................................................................................................................................(address)
*(a) is/was a student of Standard XII/equivalent during the year....................................................................................................with
subjects as * (i) PHYSICS (ii) CHEMISTRY (iii) MATHEMATICS (iv) BIOLOGY (v) ...................................................................
(vi).........................................................................and second language as..........................................................................................

*(b)is/was a student of Three Year Diploma in Engineering

The date of birth of candidate as per school record is.............................................................................

Signature of the Head of the Institution:.....................
Name :.....................
Designation :.....................
Name of Institution :.....................
District :.....................
Place :
Date :

(Office Seal)

* Strike out whichever is not applicable.

IT Services: NIC Kerala

Date:16/01/2014