Must furnished in Triplicate
To For Office use only:
The Centre-in-Charge Date : ____/_____/20______
(Name & Address of your YCTC) Application (in original)
________________________________ forwarded to the
________________________________ District Youth Officer
_________________________________
________________________________
District for approval and
further proceedings.
Sub.: Application to obtain a DUPLICATE Transcript.
Respected Sir,
With due respect I beg to state that I have LOST / DAMAGE my Transcript of ___________________________________
__________________________________________ __________________
Siganture of the Centre-in-Charge
Course on ____/_____/20______, the Intimation (in ORIGINAL) to the Date: __________________________
_______________________________________Police Station about the
LOST / DAMAGE of the said Certificate is duly furnished herewith.
Received Approval / Refusal
Please issue a DUPLICATE TRANSCRIPT on my favour.
from the DYO ____________
I do confirming that I will bear the required Charges (if any) for the same.
Please take necessary steps infavour. On ____________________
Thanking You.
Proceed for necessary steps
Yours faithfully,
on ____________________
(Full Signature of the Student)
DUPLICATE Transcript
Name of the Student: ________________________________________ Received by
Registration No. ____________________________________________
Course ____________________________________________ FULL Signature of
the Student
Session ____________________________________________
On _____________
Contact Phone Nos. (Land Line) __________________________________
Mobile__________________________ ___________
Informed to Student on
Enclosed: 1) Police Report in ORGINAL
1)___________________
Photocopies of the followings:
2) Student ID CARD 2)___________________
3) Transcript/Certificate of all relevant courses
3)___________________