Professional Documents
Culture Documents
(To be filled in by the candidate in his / her own hand writing legibly)
I, solemnly declare that the facts mentioned in the application are correct.
GENERAL INSTRUCTION
1. The Board reserves the right to accept or reject any application for the issue of DUPLICATE PACCA
CERTIFICATE.
2. A Duplicate Pacca Certificate will be issued only in case of loss/damage or destruction of the Original
Certificate.
3. FOLLOWING DOCUMENTS SHOULD BE ATTACHED WITH THIS APPLICATION FORM:
(I) An affidavit sworn in before a First Class Magistrate or Civil Judge stating the reasons for the loss,
damage or destruction of the original certificate.
(II) A Certificate from Class 1 Gazetted Officer certifying that he/she has personal knowledge about the loss
of certificate.
(III) Certificate A (printed on other side of this form) must be signed by the Principal / Head Master / Head
Mistress of the College/School from which the candidate has appeared in the Examination.
(IV) The original Challan through which the prescribed fee of Rs: __________ has been deposited.
(V) Photocopy of Marks Certificate of the examination for which the Duplicate Pacca Certificate is applied.
(VI) Photocopy of Computerized National Identity Card/Form B.
4. In case of damage to the certificate remaining portions of the certificate are to be attached with the application.
5. Application should be made by the candidate himself / herself. Application made by anyone else on behalf of
the candidate shall not be entertained.
6. Recent photograph of the applicant dully attested by the Head of Institution.
7. The Duplicate Pacca Certificate will be issued to the concerned candidate only.
CERTIFICATE A
(To be signed by the concerned Head Master / Head Mistress / Principal)
I hereby certify from my personal knowledge and on the basis of School / College record, that
who have passed the SSC / HSC Annual / Supplementary Examination in _______
and that the particulars filled in by him / her in the form are correct.
PHOTOGRAPH
ATTESTED BY
HEAD OF
INSTITUTION
CERTIFICATE