Department: Secondary Education

ISSUE OF DUPLICATE MARK SHEET SEBA

()
(Marked Fields are mandatory)
(*চিহ্নযু ক্ত তথ্যববোৰ বোধ্যতোমূ লক)
Applicant’s Details (আবেদনকাৰীৰ বেৱৰণ)
*Applicant’s Name (আববদনকোৰীৰ নোম) ………………………………………..
*Applicant’s Gender ( ) Male Female
*Mobile Number (মবোইল নম্বৰ ) ………………………………………..
Father’s Name in full( ) ………………………………………..
Aadhar card Number ( ) ………………………………………..
Pan Number ( ) ………………………………………..
Mail Id ( ) ……………………………………….
Address Details ( )
Home Address in full (ঘ ) ………………………………………..
Correspondence Address ( )………………………………………..
*State (ৰোজ্য) ………………………………………..
*District(চজ্লো) ………………………………………..
*Sub-Division (মহকুমো) ………………………………………..
*Circle Office(ৰোজ্হ িক্র) ………………………………………..

Candidate Information (আবেদনকাৰীৰ বেৱৰণ)

Student name ( ) ………………………………………..
School name ( ) ………………………………………..
Principal name ( ) ………………………………………..
Name of the Examination ( ) ………………………………………..
Candidate Type(( )) Regular Private Compartmental
Roll no ( ) ………………………………………..
Year Of Examination ( ) ………………………………………..
Registration certificate no ( ) ………………………………………..
Total marks obtained ( ) ………………………………………..
Result( ) ………………………………………..
School from where appeared in the above examination
( ) ………………………………………..
Signature of the applicant
(আববদনকোৰীৰ িোক্ষৰ)
 ISSUE OF DUPLICATE MARK SHEET SEBA
()
(Marked Fields are mandatory)
(*চিহ্নযু ক্ত তথ্যববোৰ বোধ্যতোমূ লক)
Other Details ( )

Purpose of the document ( ) ………………………………………..

What happened to the original document ………………………………………..

( চ হ )

Challan no (চ ) ………………………………………..

Bank draft no ( ) ………………………………………..

Supporting Documents (সংলগ্ন নচথ্)

1. Recommendation letter from the Head of the Institute along with copy of FIR in case
of loss/theft
2. In case of partial damage of the original mark-sheet, the damaged marksheet should
be attached with the application
3. Photocopy of Admit Card duly attested
4. In Case of the document to be delivered on authority letter, applicant must attest the
signature of the person authorized
5. A self-addressed stamped ( Registered / General as the case may be) envelope is to be
enclosed alongwith the application form

Signature of the applicant

(আববদনকোৰীৰ িোক্ষৰ)
……………~………………