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Central Office : The Deputy Secretary,
West Bengal Council of H.S. Education North Bengal Regional Office
Vidyasagar Bhavan W.B Council of H.S. Education
9/2, Block DJ,Sector-11 Rahul Sankrityayan Bhavan
Salt Lake, Kolkata-700091 P.O. - North Bengal University
Dist - Darjeeling,
Kolkata Regional Office : The Deputy Secretary,
[Link] of H.S. Education Burdwan Regional Office
Bikash Bhavan W.B Council of H.S. Education
North Block (2nd Floor) Nazrul Bhavan (behind LIC Office)
Salt Lake, Kolkata-700091 5, Ichlabad (Jalkal Math),
P.O. Sripally, Dist : Bardhaman
The Deputy Secretary,
Midnapore Regional Office
W.B Council of H.S. Education
Jack paul Bhavan,
Raja [Link] Road,Nanur Chawak
[Link], Dist : Paschim Medinipore

Police Diary No ................................................

Date ....................................................
(In case of lost or stolen)
Signature of the [Link] P.S.

Subject : APPLICATION FOR ISSUE OF DUPLICATE / PASS CERTIFICATE

Sir,
I beg to apply for issuing a Duplication Certification in my favour for the
foiiowing Examination as the orginal one has been Lost/ Stolen/ Damaged (in case of
FOR VERIFICATION
Stolen/Lost. Police Diary is to be enclosed and in case of Damaged, the Damaged
NOTE BY COUNCIL’S Certificate is to be attached.)
OFFICE ONLY
1. Name in full :
(In Block Letters)

2. Son/Daughter/Ward of :
(In Block Letters)

3. Full Address :
(for Correspondence)

4. Name & Address of :

Insititution form where
appeared

5. Higher Secondary Examination, year .....................................

6. Streem :
(General/ Vocational/ External)

7. Registration No. with year :

8. Roll & No. :

9. Passed in .................................................................................. Division

10. Fees of Rs. 80/- (Ordinary)/ Rs. 90/- (Urgent) Shall be paid for issue of Duplicate
Certificate. Such fees shall be deposite by cash/ bank draft drawn in favour of
Result verified ‘W. B. Council of H.S. Education’.
Yours faithfully,

............................................................
Full Signature of the Candidate
Date
Forwarded to the Secretary for necessary action,
The above statement is true to the best of my knoledge and belife.
Date

Signature of the of the Institution with

Office Selt

N. B.: The certificate will be sent to the Head of the Institution who will deliver the same to the applicant on proper
identification and report the matter to the Council.
Delivery of Duplicate Certificate : Between 12 noon to 2 P.M.
Urgent: within 10 clear working days.
Ordinary: within 30 clear working days.
P.T.O.
N.B. : (1) Application Form filled in wrongly will be rejected without any referances to the applicant.
(2) Document applied for remaining unclaimed beyond six monthes from the date of receipt will be
destroyed. Fees submitted for the purpose shall not be re funded even in the cases of rejected
forms.
(3) In case of personal delivery, letter of authority (specimen below) from the Institution should be
product at the time of delivery.
(4) In case of postal delivery, current postal charge (Registration) shall be paid separately in the
precribed manner mentioned at SL. No. 10 of the application.

SPECIMEN OF LETTER OFAUTHORITY

To
The Deputy Secretary (KRO/BRO/MRO/NBRO)
W.B. Council of H. S. Education

Sub : Delivery of Duplicate Certificate

Dear Sir,
I do hereby authorise Shri/Smt....................................................................................................
................................................... bearing Roll ..................................... No ...........................................
at the Higher Secondary Examination.............................................................to receive his/her Duplicate
Certificate.

The Signature of Shri/Smt ........................................................................................................

is attested below by me.

Date.......................................
Yours faithfully,

Signature of Shri/Smt..................................... ...........................................................

ATTESTED (Signature of the Head of the Institution
with Office seal)

Code number of the Instituion

(Signature of the Head of the Institution

with Office Seal)