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Department: SECONDARY EDUCATION

ISSUE OF MIGRATION CERTIFICATE - SEBA


(Marked Fields are mandatory)
(*চিহ্নযু ক্ত তথ্যব োৰ োধ্যতোমূ লক)
Applicant’s Details (আবেদনকাৰীৰ বেৱৰণ)
*Applicant’s Name (আব দনকোৰীৰ নোম) ………………………………………..
*Applicant Gender ( ) Male Female
*Mobile Number ( ম োইল নম্বৰ ) ………………………………………..
Mail Id ( ) ………………………………………..
Pan Number ( ) ………………………………………..
Aadhar card Number ( ) ………………………………………..
Address Details ( )
Address ( ) ………………………….
*State (ৰোজ্য) ………………………….
*District(চজ্লো) ………………………….
*Sub-Division (মহকুমো) …………………………..
*Circle Office(ৰোজ্হ িক্র) ………………………….
Post Office(ডোকঘৰ) …………………………..
Police Station(থ্োনো) …………………………..
Village/Town(গোওঁ/নগৰ) …………………………..
Pin Code(চিন নং) ………………………….. (e.g 78xxxx)
Information Of The School/College ( / )
School/College name ( / ) …………………………..
Principal name ( ) …………………………..
School/College District ( / ) …………………………..
Information Of The Student ( ) …………………………..
Student name ( ) …………………………..
Name of Examination ( ) …………………………..
year (বছৰ ) …………………………..
Result ( ) …………………………..
Examination type ( ) …………………………..
Total marks obtained ( ) …………………………..
Father name in full ( ) …………………………..
Purpose of the document ( ) …………………………..
What happened to the original document …………………………..

Signature of the applicant


(আব দনকোৰীৰ িোক্ষৰ)
Department: SECONDARY EDUCATION
ISSUE OF MIGRATION CERTIFICATE - SEBA
(Marked Fields are mandatory)
(*চিহ্নযু ক্ত তথ্যব োৰ োধ্যতোমূ লক)

Challan Information ( )
Challan no ( ) …………………………..
Bank draft no ( ) …………………………..

Supporting Documents (সংলগ্ন নচথ্)


1. The prescribed form along-with the Registration card in original is to be surrendered
along-with the recommendation of the Head of the Institute. ()
2. A self-addressed stamped ( Registered / General as the case may be) envelope. ( )
to be enclosed along with the application.( )
3. Any Other Document.( )
Signature of the applicant
(আব দনকোৰীৰ িোক্ষৰ)
……………~………………