<p> GOVERNMENT POLYTECHNIC COLLEGE, ADOOR</p><p>APPLICATION FOR ISSUE OF SSLC BOOK / ITI Certificate</p><p>Adm.No. 1. Name of student :</p><p>2. Semester &Branch :</p><p>3. Year of Study : 20…… - 20……</p><p>4. Purpose :</p><p>5. Date of return of SSLC Book :</p><p>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.</p><p>**Signature, Name & Designation of the Guaranteer ………………………………………………………………………………………………….. 8. Remarks of Head of Section:</p><p>9. Order of Principal : Principal FOR OFFICE USE ONLY SSLC issue date:</p><p>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</p>