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Department: SECONDARY EDUCATION

ISSUE OF MIGRATION CERTIFICATE - AHSEC


(Marked Fields are mandatory)
(*চিহ্নযু ক্ত তথ্যব োৰ োধ্যতোমূ লক)

Applicant’s Details (আবেদনকাৰীৰ বেৱৰণ)


*Applicant’s Name (আব দনকোৰীৰ নোম) ………………………………………..
*Applicant’s Gender ( ) Male Female
*Mobile Number ( ম োইল নম্বৰ ) ………………………………………..
Father's name in full ( ) ………………………………………..
Mail Id ( ) ………………………………………..
Pan Number ( ) ………………………………………..
Aadhar card Number ( ) ………………………………………..

Address Details ( )
Address ( ) ………………………….
*State (ৰোজ্য) ………………………….
*District(চজ্লো) ………………………….
*Sub-Division (মহকুমো) …………………………..
*Circle Office(ৰোজ্হ িক্র) ………………………….
Post Office(ডোকঘৰ) …………………………..
Police Station(থ্োনো) …………………………..
Village/Town(গোওঁ/নগৰ) …………………………..
Pin Code(চিন নং) ………………………….. (e.g 78xxxx)

Information Of The School ( )


Last Studied School Name ( ) …………………………..
Institution Name (outside Assam) ( ) …………………………..
Current Institute (or intended) ( ) …………………………..
Current Course ( ) …………………………..
Current Class ( ) …………………………..
Current Roll Number ( ) …………………………..

Signature of the applicant


(আব দনকোৰীৰ িোক্ষৰ)
Department: SECONDARY EDUCATION
ISSUE OF MIGRATION CERTIFICATE - AHSEC
(Marked Fields are mandatory)
(*চিহ্নযু ক্ত তথ্যব োৰ োধ্যতোমূ লক)

Information Of The Student ( )


AHSEC Registration Certificate Number * …………………………..
(AHSEC ) …………………………..
Examination Passed ( ) …………………………..
Examination Roll Number ( ) …………………………..
Year of Passing ( ) …………………………..
Name Of Board / University ( / ) …………………………..
Division (Class) ( ( )) …………………………..
Cause for Obtaining Migration Certificate ( ) …………………………..
Original Registration Certificate Number ( ) …………………………..
Address ( ) …………………………..…………………………..…………………..

Challan Information ( )
Amount Paid …………………………..
Challan no ( ) …………………………..
Bank draft no ( ) …………………………..

Supporting Documents (সংলগ্ন নচথ্)


1. The prescribed filled up form ( )
2. Recommendation of the Head of the Institute ( )
3. Registration card in Original ( )
4. Any Other Document.( )
Signature of the applicant
(আব দনকোৰীৰ িোক্ষৰ)
……………~………………

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