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Get and Sign Madhyamik Certificate Form
Midnapore,
Burdwan. Payment should be
made in cash or through
e-collection challan
OFFICE USE ONLY (NOT FOR APPLICANT)
Candidate’s Name : ……………………………………………..
(In Block Letters)
Father’s Name : …………………………………………………
Roll No./Regn.No………………………… Year ………………
Date of birth ……………………………Index No…………….
Division/Over all Grade/Result………………………….…..
Part No…………………….. Cert. No…………………………..
As per D/R
Verified
In case of loss/theft of original certificate Police General Diary No………………
Date………………… / enclosed...
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