CERTIFICATE AUTHENTICATION CENTRE

Department of NORKA
Government of Kerala
APPLICATION FOR AUTHENTICATION OF ORIGINAL EDUCATIONAL CERTIFICATES

NOTE: 1. Registration Fee to be remitted to NORKA-ROOTS is Rs.500. Attestation Fee Payable to Govt. of Kerala is Rs.50 and to UAE Embassy is Rs.1500 per certificate. 2. This form should be filled in CAPITAL LETTERS only. 3. Furnishing Wrong Information or Fake Documents for attestation is Punishable Offence. PART I 1. Name of the Certificate Holder 2. Sex 3. Religion 4. Caste 5. Nationality 6. Date of Birth of Qualification Holder 7. Passport Number 8. Name of Father/Mother 9. Present Full Postal Address : : : : : : : : :

10. Permanent Full Postal Address of the Qualification Holder

11. Phone No. with STD Code 12. Email Address (if any) 13. Present Occupation 14. Name(s) of countries you have worked earlier

: : : :

15. Your highest education qualification 16. If you have already got visa, Country

: : Visa No:

Sl No.

Name of the certificate

Year

Marks Obtained

Total Marks

Register Number

Name of the University/Board/ Council/Institution

Attestation Required from MEA UAE

1 2 3 4 5 6

PART II (For Persons presenting application on behalf of certificate holder) 1. Name 2. Relationship with Qualification Holder 3. Postal Address : : :

4. Passport/Electoral Card/Ration Card No

PART III Undertaking I solemnly declare that the documents presented for authentication are original and genuine and the information given by me above are true to the best of my knowledge and belief. If the documents submitted by me are found to be fake or information furnished by me false, I am responsible for the same and action may be taken against me as is considered necessary.

Place : Date :

Name of the Certificate Holder/Representative: