Government Polytechnic College, Punalur

GOVERNMENT POLYTECHNIC COLLEGE, ADOOR

APPLICATION FOR ISSUE OF SSLC BOOK / ITI Certificate

Adm.No. 1. Name of student :

2. Semester &Branch :

3. Year of Study : 20…… - 20……

4. Purpose :

5. Date of return of SSLC Book :

Place: Adoor Date: Name & Signature of the student ………………………………………………………………………………………………… *6. Dues, if any Name of Depts. DUES- Name &Signature of staff YES/NO (i) Library (ii) Fees (iii) Laboratory (iv) Sports (iv) Department ………………………………………………………………………………………………… *7. SSLC book may be issued on my guarantee.

**Signature, Name & Designation of the Guaranteer ………………………………………………………………………………………………….. 8. Remarks of Head of Section:

9. Order of Principal : Principal FOR OFFICE USE ONLY SSLC issue date:

Returned on: (C1)Academic Section Clerk *Col. 6 and 7 must be completed and compulsory. ** For Evening Diploma Programme, an undertaking of Guaranteer is compulsory