Application For DPC For SSC (APOSS)

ANDHRAPADESH OPEN SCHOOL SOCIETY, GUNTUR
APPLICATION FOR ISSUE OF DUPLICATE SSC (APOSS) PASS

CERTIFICATE/MIGRATON CUM TRANSFER CERTIFICATE
1. Name of the applicant (in block letters)
2. Address of the applicant
3. Father’s Name
4. Mother’s Name
5. Name & address of the School/College

through which the applicant admitted
for the SSC (APOSS) course
6. Details of the SSC (APOSS)
Public Examination appeared
Month & Year of appearance
Hall Ticket No
Admission No.
7. Reasons under which the application for issue of
duplicate * SSC (APOSS) pass Certificate / *
Migration cum Transfer Certificate is made
8. Whether the damaged Original SSC (APOSS) Pass
Certificate/Migration cum Transfer Certificate are
available and enclosed
9. IF LOST:
a) Whether police enquiry certificate is enclosed to
the effect that the pass certificate/Migration cum
Transfer Certificate lost is beyond recovery
b) Whether an affidavit on Judicial Stamp Paper
worth Rs. 100/-, regarding the loss of the Original
SSC, APOSS Pass Certificate/Migration cum
Transfer Certificate beyond recovery attested by
First Class Magistrate/Notary is attached
10. Whether Original D.D for Rs.1000/- for Duplicate Pass Certificate and Rs. 500/- for Duplicate
Migration cum Transfer Certificate drawn in favour of Director, APOSS, payable at Guntur are
enclosed. If so, furnish the following details
Details D.D for Rs. 1000/- towards DPC D.D for Rs. 500/- towards DMC
Amount of Rs.
Bank Name
Branch Place
D.D. No. & Date
Note: * When both Original Pass Certificate and Migration cum Transfer Certificate are lost,
the loss of both the certificates should be mentioned in the Police Certificate.
Page-2
DECLARATION
1. I,…………………………………………………………do hereby declare that the original pass
certificate/Migration cum Transfer Certificate bearing Regd.
No………………………………of SSC (APOSS) April/May, Oct/Nov………………..is
neither suspended nor cancelled by the competent authority.
2. I solemnly declare that the particulars furnished above are true to the best of my
knowledge and belief.
SIGNATURE/SEAL OF SIGNATURE OF THE CANDIDATE

THE AI COORDINATOR
NOTE: The furnishing of inaccurate or false particulars will entail, besides withholding of
the duplicate SSC(APOSS) Pass certificate/Migration cum Transfer Certificate such
disciplinary action as may be called for or deemed fit by the Director SSC (APOSS),
Guntur.
IDENTIFICATION CERTIFICATE
I, Certify that the above particulars furnished by the candidate have been verified
and found correct with reference to records of the college and the applicant
Sri/Smt….…………………………………………….is the same person to whom the original SSC
(APOSS) Pass Certificate/Migration cum Transfer Certificate was issued and that the
issue of the duplicate/s to the candidate is recommended. The attested passport size
photograph of the candidate is enclosed.
Passport size
Photo
attested by
AI
Coordinator
Signature of the Principal/Head Master/

AI Coordinator with seal
Station:
Date:
Page-3
The Following Certificates should be sent along with application without fail:
1. Original police Enquiry Certificate to effect that the SSC (APOSS) Pass Certificate cum
memorandum of marks /Migration cum Transfer Certificate lost is beyond recovery and
the enquiries have been made to trace the Original Certificate but in vain.
2. An affidavit on non- judicial stamp paper/special adhesive stamp worth of Rs.100/-
attested by First class Magistrate / Notary (as per proforma).
3. D.D for Rs.1000/- for duplicate Pass Certificate and Rs. 500/- for duplicate Migration
cum Transfer Certificate drawn in favour of Director, A.P. Open School Society payable
at Guntur.
NOTE: If the spoiled SSC (APOSS) Pass Certificate/Migration cum transfer Certificate or
in case pieces of it are available, they may be sent to this office along with the
application. In case, the damaged Original Certificate/s is enclosed, police Enquiry
Certificate and Notary Affidavit are not required.
4. One photo should be affixed on the Identification certificate duly attested by the AI
Coordinator/Head Master/Principal.
5. Xerox copy of Pass Certificate duly attested by the AI Coordinator/Head

Master/Principal
AFFIDAVIT (Proforma)
I,……………………………………………………..S/o,………………………………………D/o…………………
………………………aged…………………….Years
R/o…………………………………………occupation……………………..solemnly on oath and
affirmation declare as under.
1. That I have appeared for SSC (APOSS) Public Examination held in the month and
year of……………with Hall Ticket
……….Admn.No……………………through……………………College/AI.
2. That the original SSC (APOSS) Pass Certificate/Migration cum Transfer Certificate
issued to me by the A.P. Open School Society has been lost by me
while………………………………**…………………………………and in spite of my best efforts I
am unable to trace it and it is beyond recovery. In case, it is traced in future, I shall
submit it to the Director, A.P. Open School Society, Guntur for cancellation.
3. That I am in need of duplicate copy of the said SSC (APOSS) Pass
Certificate/Migration cum Transfer Certificate /s for which purpose I am hereby making
the declaration as required by the Director, A.P. Open School Society, Guntur.
Station: DEPONENT
Date:
**TO MENTION THE REASONS FOR THE LOSS

Application For DPC For SSC (APOSS)

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ANDHRAPADESH OPEN SCHOOL SOCIETY, GUNTUR

APPLICATION FOR ISSUE OF DUPLICATE SSC (APOSS) PASS

2. Address of the applicant

5. Name & address of the School/College

SIGNATURE/SEAL OF SIGNATURE OF THE CANDIDATE

Signature of the Principal/Head Master/

5. Xerox copy of Pass Certificate duly attested by the AI Coordinator/Head

**TO MENTION THE REASONS FOR THE LOSS

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