Application for Duplicate Hall Ticket


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ST. XAVIER’S TECHNICAL INSTITUTE, MAHIM
Government Aided Autonomous Minority Institute, Approved by A.I.C.T.E. New Delhi Mahim Causeway, Mumbai. Pin – 400 016
Phone: 24455937, 24454559; 24451961, 24460359 Fax: +91(22)2445 4482 E-mail: [email protected]
Application for Duplicate Hall Ticket
Date: ______________________ To, The Principal / Controller of Examination
Subject: To issue Duplicate Hall Ticket.
Sir / Madam, I the undersigned kindly request you to issue me the Duplicate Hall Ticket of Semester ______________ of Regular and / or Backlog of Summer / Winter _____________. Name of the candidate: ___________________________________________________________________________________
SPN: _____________________ Contact Number: _____________________ Programme :____________________________
Address of the candidate: ___________________________________________________________________________________________________________________ ___________________________________________________________________________________________________________________
Photocopy of documents to be submitted with application:
1. Examination fees receipt
Leaving certificate
Yours faithfully, Sign:

Name of candidate / applicant: For office use only
To Accounts office Kindly accept the amount of Rs.*____________ /-

Principal/ Controller of examination

Received Rs. __________________/- against receipt no. ___________

Date: __________________________

Signature of Cashier / Accountant

*Duplicate Hall ticket Rs. 100/-

ST. XAVIER’S TECHNICAL INSTITUTE, MAHIM
Government Aided Autonomous Minority Institute, Approved by A.I.C.T.E. New Delhi Mahim Causeway, Mumbai. Pin – 400 016
Phone: 24455937, 24454559; 24451961, 24460359 Fax: +91(22)2445 4482 E-mail: [email protected]
Application for Duplicate Marksheet / Diploma Certificate / Provisional Certificate
Date: ______________________ To, The Principal / Controller of Examination

Subject: To issue Duplicate Marksheet / Diploma Certificate / Provisional Certificate.

Sir / Madam,
I the undersigned kindly request you to issue me the Duplicate Marksheet of Semester One / Semester Two / Semester Three / Semester Four / Semester Five / Semester Six / Diploma Certificate / Provisional Certificate.
Name of the candidate: ___________________________________________________________________________________

SPN:

_____________________Programme:______________Year

of

passing:

____________

Contact Number: _____________________

Address of the candidate: ___________________________________________________________________________________________________________________ ___________________________________________________________________________________________________________________

Photocopy of documents to be submitted with application:
1. All semesters mark sheets (which ever available) 2. Leaving certificate 3. Diploma passing certificate 4. Police station report original copy (only for issuance of Duplicate documents) 5. Affidavit on Rs. 100/- stamp paper (only for issuance of Duplicate documents)
Yours faithfully, Sign:

Name of candidate/ applicant: For office use only
To Accounts office Kindly accept the amount of Rs.*____________ /- (mark sheets) /- + Rs*. __________ /- (Diploma Certificate) + Rs. *___________/- (Provisional Certificate) Total amount Rs. ___________________________________

Principal/ Controller of examination Received Rs. __________________/- against receipt no. ___________

Date: __________________________
*Duplicate Marksheet Rs. 200/* Provisional Certificate Rs.100/-

Signature of Cashier / Accountant
*Duplicate Diploma certificate Rs.500/-

ST. XAVIER’S TECHNICAL INSTITUTE, MAHIM
Government Aided Autonomous Minority Institute, Approved by A.I.C.T.E. New Delhi Mahim Causeway, Mumbai. Pin – 400 016
Phone: 24455937, 24454559; 24451961, 24460359 Fax: +91(22)2445 4482 E-mail: [email protected]

Application for Name correction on Marksheet / Diploma Certificate
Date: ______________________ To, The Principal / Controller of Examination
Subject: To correct the name on Marksheet / Diploma Certificate.
Sir / Madam, I the undersigned kindly request you to correct my name on the Marksheet of Semester One / Semester Two / Semester Three / Semester Four / Semester Five / Semester Six / Provisional Certificate / Diploma Certificate. Printed Name of the candidate:_______________________________________________________________________________ Name as per SSC Marksheet:__________________________________________________________________________________ Name as per HSC Marksheet (if applicable):_________________________________________________________________ SPN: _____________________ Year of passing: __________________________ Contact Number: _____________________ Programme:_______________________________________ Address of the candidate: ___________________________________________________________________________________________________________________

Photocopy of documents to be submitted with application:
1. All semesters mark sheets (which ever available) 2. Leaving certificate 3. Diploma passing certificate 4. Copy of SSC mark sheet 5. Copy of HSC mark sheet

Original document on which name has to be corrected:

Semester 1

Semester 2

Semester 3

Semester 4

Semester 6

Provisional Certificate

Diploma Certificate

Yours faithfully, Sign:

Semester 5

Name of candidate / applicant: For office use only
To Accounts office Kindly accept the amount of Rs.____________ /- (mark sheets) /- + Rs. __________ /- (Diploma Certificate) Total amount Rs. ___________________________________

Principal/ Controller of examination

Received Rs. __________________/- against receipt no. ___________

Date: __________________________

Signature of Cashier / Accountant

*Corrected Marksheet Rs. 200/- * Corrected Diploma certificate Rs.500/- * Corrected Provisional

Certificate Rs.100/-

ST. XAVIER’S TECHNICAL INSTITUTE, MAHIM
Government Aided Autonomous Minority Institute, Approved by A.I.C.T.E. New Delhi Mahim Causeway, Mumbai. Pin – 400 016
Phone: 24455937, 24454559; 24451961, 24460359 Fax: +91(22)2445 4482 E-mail: [email protected]
Application for Transcript
Date: ______________________ To, The Principal / Controller of Examination,
Subject: To issue transcript set/s.
Sir / Madam, I the undersigned kindly request you to issue me _____________ number/s of transcript/s and / or Name of the candidate: ___________________________________________________________________________________
SPN: _____________________ Year of passing: __________________________ Contact Number: _____________________
Programme:_______________________________________
Address of the candidate: ___________________________________________________________________________________________________________________ ___________________________________________________________________________________________________________________
Photocopy of documents to be submitted with application: 1. All semesters mark sheets 2. Leaving certificate 3. Diploma passing certificate
Yours faithfully, Sign:

Name of candidate / applicant:

For office use only To Accounts office Kindly accept the amount of Rs.*_________________________ /- + postage charge Rs. ________________/Total amount Rs. ___________________________________

Principal/ Controller of examination

Received Rs. __________________/- against receipt no. ___________

Date: __________________________

Signature of Cashier / Accountant

*Two Copies Rs. 1500/-

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Application for Duplicate Hall Ticket