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KERALA COMPUTER SAKSHARATHA MISSION An ISO 9001:2000 Certified Board of examination Application Form for certificate

(to be filled in by the candidates in BLOCK letters) 1. KCSM Reg. no 2. Name of Applicant 3. Course Selected 4. Name & Place of the Centre 5. Duration From To 7. Marks Obtained

Photograph 6x4cms

Subjects 1 3 5 7 9 11

Marks

Subjects 2 4 6 8 10 12

Marks

Declaration I........................................................................................... hereby declare that the particulars furnished above are true to the best of my knowledge and belief. Date......../........./............ Place.............................. Center Seal Signature of applicant Signature of authority

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