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Photograph
of Amanuensis
Application Form for Appointment of Amanuensis

PROGRAMME………………………………………………………………………
A. Details of Student:
1. Name of Student……………………………. 2. Father’s Name………………………………..
3. Enrollment No……………….…… 4. Roll No. ……………………... 5. Examination………………...
6. Ailment/ Injury which caused incapacity to write examination……………………………………………
7. Details of Medical Certificate in support of claim……………………………………………………………
B. The details of Proposed Amanuensis are given below:-
8. Name in Capital letters……………………………………………………………………....................
9. Father’s Name………………………………………………………………………………….................
10. Permanent Address………………………………………………………………………………………
11. Qualifications:
Examination passed (a)……………….(b)Div……………(c) Year…………………
Subject (s)………………………………………………………………………………
12. Date of Birth……………………………….
13. Profession………………………………….
14. Handwriting specimen of Amanuensis in (A) English
(B) Hindi
C. I agree to act as amanuensis for Mr/ Ms. ……………….…….. a student of ……………… Programme.
Signature of Amanuensis
(Signature of Student)
Address
…………………………………………………………
Recommendations of Head of Institution/ Deptt.
Phone No.…………………………………

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Photograph
of Amanuensis
To,
…………………..
…………………..

Dear Sir/ Madam

As per recommendation on the application of Sri…………………………………………………….
S/o ……………………………. Enrollment No. ………..……………Roll No. ...………………………
Programme ……………………. for Examination …………………………... the proposed amanuensis
named below is allowed.
Name (Amanuensis) ……………………………………………………………………………………………
Father’s Name……………………………………………………………………………………………………
English
Specimen Handwriting in
Hindi

(Signature of Amanuensis)
Controller of Examinations