Applicable for candidates residing in the State of West Bengal continuously at least for last ten (10) years as on 30.12.2014 To be issued by the Head of the Institution from which the candidate appeared/due to appear in ‘10+2’ or equivalent examination. Domicile Certificate: Type-A-II Certified that ___________________________________________________________ son / daughter of _______________________________________________ has passed the ‘10+2’ Examination in the year______ / will appear in the Final ‘10+2’ Examination in 2015 from this Institution. It is also certified that the student is a resident/permanent resident of West Bengal at Village/House No. _______________________________ Street_______________________________________________________________________________ Post Office _____________________________ Police Station ________________________________ in the District of ____________________________________________under Assembly Constituency ____________________________________________ and has been living in the State of West Bengal continuously / uninterruptedly at least for the last ten (10) years as on 30-12-2014. Paste passport size photograph of applicant in this box Note: Photograph to be attested by the certifying authority. Signature of Certifying Authority ________________________________________________________________ Designation with Official Seal __________________________________________________________________ Full Name of Certifying Authority _______________________________________________________________ Office Phone No. _________________ Mobile No:_________________(optional) ID No: ______________________________(optional) Note: The Certifying Authority may please preserve the duplicate copy of the Certificate in his/her Office provided by the candidate
Posted on: Fri, 02 Jan 2015 18:14:37 +0000
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