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Application Form TC & Conduct Certificate

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M E S COLLEGE MARAMPALLY

Marampally P.O Aluva 683 105


NAAC Re accredited with A+ Grade (Score 3.38 )
Application for TC and Conduct Certificate
1 Name in full ( Block letters )

2 Studied Programme

3 Year of study Roll No. Admission No. Date of admission


4 Date of birth
5 Reason for leaving Course completed Discontinued
6 Date of relieving/discondinuing
7 Whether exam registered Registered Not registered
8 If registered Reg.No. Semesters
9 Whether exam appeared Yes No Semesters
10 Whether passed/completed the course Passed/not passed Completed/not completed
Communication address with PO & PIN Mobile/ Phone No.

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e mail ID
I do hereby declare that all the facts mentioned in this application are true and correct.

Place : Date: Signature of the applicant:


FOR DEPARTMENTS USE ONLY
Name of departments Details of dues Name & Signature of HOD/Tutor/Clerk/Asst
1 Library
2 Lab …………………..
3 Lab …………………..
4 Sports
5 NCC
6 NSS
7 Department
8 Hostel
9 College Bus
10 Office
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Remarks & Recommendation of HOD
Name and signature
NB: All identity cards should be returned to the office at the time of TC issued.
OFFICE USE ONLY
Verified by Name…………………………………………. Signature………………………….
Signature of HA Signature of Superintendent
Signature of Principal
TC No…………………… Date……………………….. Date of issue………………. Signature of Clerk……………….

Received TC, Conduct certificate , …………………………………………………………………………………………...


Name & signature of applicant with date……………………………………………………..…., ……………………………

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