Department: SECONDARY EDUCATION

ISSUE OF DUPLICATE PASS CERTIFICATE - AHSEC

()
(*Marked Fields are mandatory)
(*চিহ্নযু ক্ত তথযব োৰ োধযতোমূ লক)

Applicant’s Details (আব দনকোৰীৰ চ ৱৰণ)

*Applicant’s Name (আব দনকোৰীৰ নোম) Mr Mrs Miss

………………………………………..

*Mobile Number (ম োইল নম্বৰ ) ………………………………………..

Father's Name (চ঩তৃৰ নোম( ………………………………………..

Mother's Name (মোতৃৰ নোম( ………………………………………..

Mail Id ( ) ………………………………………..

Pan Number ( ) ………………………………………..

Aadhar card Number ( ) ………………………………………..

Address Details ( )

Address in Full

*State (ৰোজ্য) ………………………………………..

*District(চজ্লো) ………………………………………..

*Sub-Division (মহকুমো) ………………………………………..

*Circle Office(ৰোজ্হ িক্র) ………………………………………..

*Post Office(ডোকঘৰ) ………………………………………..

*Police Station(থোনো) ………………………………………..

*Village/Town(গোওঁ/নগৰ) ………………………………………..

*Pin Code(চ঩ন নং) ……………………………………….. (e.g 78xxxx)

Signature of the applicant

(আব দনকোৰীৰ িোক্ষৰ)
Department: SECONDARY EDUCATION

ISSUE OF DUPLICATE PASS CERTIFICATE - AHSEC

()
(*Marked Fields are mandatory)
(*চিহ্নযু ক্ত তথযব োৰ োধযতোমূ লক)
Candidate's Information ( )

Name of the H.S School/College ( )

Name of the Institution ( )
Name of Board/Council/University ( )
Examination passed ( )
Year of Exam ( )
Examination Roll no ( )
AHSEC Registration number ( )
Other details ()
What happened to the original document ( )
Challan no ( )
Bank draft no ( )

Supporting Documents (সংলগ্ন নচথ)

1. Application in the prescribed format duly countersigned by the Head of the Institute
along with copy of FIR in case of loss or theft
2. In case of partial damage of the original Certificate, the damaged Certificate should be
attached with the application
3. Photocopy of the Mark sheet duly attested
4. Photocopy of the Admit Card duly attested
5. Photocopy of Registration Certificate duly attested
6. A self-addressed stamped ( Registered / General as the case may be) envelope is to be
enclosed along with the application
7. Any Other Document
Signature of the applicant
(আব দনকোৰীৰ িোক্ষৰ)

------------------------------