Eis0114 : 0120-4089800

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C)c-i Tbc 9. : 18001809393

Phone: 11120--4(i89800

NATIONAL INSTITUTE OF OPEN SCHOOLING

(Formerly, National Open School — NOS)

Government of India

Toll Free No. 18001809393

7-24-25, **,9c .zpilei \44-41, 44Z7-62, -111, DWI *all -1414

A-24-25, Institutional Area, NH-24, Sector-62, NOIDA, Distt. Gautam Buddha Nagar (U.P.)

fi-r : va-49/3mir-Eft 1,44-11u1141/3t-+-91 mchi to 14-uut q A TTft tul

Subject : Application Form for Obtaining Migration Certificate/Provisional Certificate/Duplicate Certificate/Duplicate Marks Statement etc.

I. 3111114 n 11/Roll No.

fi4sf_A1 9-ff •Wf 9T4 33PJ11

Name of the student (in 13lock letters)

fi-rcil/I1F01

Father's/Mother's Name

144-uut n41 °Fr 9P1 "1

Name orcertilicate Required

5. 1f 3t T TTI 31TT qTi

Name and Year of Exam

(). 14f1MT 1*.u1lTi/Result

7. : fi rV-131/1 c,h -r-1101-1

qcb 7_;TEM TR-.741

qc-t.) 'WI .971

Mode of Payment : Cash/Bank Draft/Bank ChaIlan

11.D. No. Amount Date Bank

(PftFT ';'4* 4-FR -(TrI74 ITT1 NPOt *214R, rtR51/ Cc-ri IN it t--4 C+1-11 )

N.B. Hank Draft Must be drawn in favour of Secretary, NIOS , payable at Delhi/NOIDA.

IRV/Address (in HI,OCK letters)

f9 i cb1..f (Pin Code)

1:L9419/Place:

frTvIT zTi -r:11",tRiSil.n,nature of the Student

ici.e4ch fff-4";iT/Important Notes

aTT4-1-9.11-1- 174 -4 1:1-0. F-1471):t-ucfart "LT4: /Read the Instructions carefully before filling the form

I. mc-;4=1, Ar-fTutTrl 1X4171 ctAl Use separate form for each certificate.

-1=rfu l L1 .71 7=r-tr' -surd. 117 TR -f4IVR A 1 54tift gR1 '717?-1 TitzT -c-01 Theapplication for duplicate passing certificate must be accompanied with an affidavit executed in front of a 1st class Magistrate in theformat given below.

4-jc-f dr-li Ala -to ct;) ARJ 4, ,71 ,4 cl F-1 z214-) 1 fg9Th3f-dffffq *ltRT'qT,(414/-1T-..=h1 aftz A Titd: Tit Triplicate copy of the passing certificate shall not be issued unless the Director (Evaluation) is

further satisfied that duplicate copy has been actually lost/destroyed.

#174101cf: q Jf 3T1T 3T14- 'tfq * alteTT{ AT LIVE p ie S1 1-11 1 ,-1?1 t TEO * e4IC 4(11 ,I Ile documentsapplied for will ordinarily he issued after two weeks (excludin g holidays) from the date of receipt of the application form and fee,provided the application is found complete in all respects.

Ifs 3-TT4.A+-If Wt--4 *11C (-11-1 1:09 `1-ft7 ricif *, 91' +il u l ,-1->t 3 #TIlltuT TIC 1:1731

rctiT •31Ri lf 3TT-479' # 4119 •FTIA.cbt FOI 3fR -F-4uRAI ki -am 3-TR4. ,-r tiTTTIIn case the document is not collected by the applicant within three months from the date of depositing the fee, it nvill he sent b y-ordinary post at the address given. In case the addrress is not given, the documents will he cancelled and the student will have to applyafresh.- ITT.Trum- 4,,Acrf 141?-71f17T/ -,-,r4c1( TTIF74f1TW '4.1- T mt 1 cflo'ls 1 74thT i-q[ 3111-14

f4E11211 Wi siti TIT 3.17zfrEft atra-q-9.9 041 Migration Certificate and Provisional Certificate can be issued to thosewho have paSSed the Sec./Sr. Sec. Examination. The failed candidates should not apply for Migration or Provisional Certificates.TA ql-If u l LN t*--T11 Ift 4)14---t-TR 14 3-1 1-Rli 3 ,s4 :31 5 q,11. ci ch Tizn-q 3-f-Tim**t 'frjfiT4* MIS ,s1R1Rift slid: 10 , !34 ,;f. 31[R-79 4 .N1 ,5 041 71=IT All CertilkatesWill be delivered on the production ofreceipt of payment with Enrolment No between 3.00 P.M. to 5.00 P.M. on working days. The fee can be deposited between 10.00A.M. to 4.00 P.M. on all working days. -- •

* , friv fff7-411(ct Na-)R Fees' prescribed for various certificates are as follows:

I. s(4-11 u 141 TER1 q icf/Duplicatc copy of Certificate : Rs. 100.00

3R-2417-ft ii-if u r4,1/Provisional Certificate : Rs. 100.001;1q7i 514-11,314,(/Migration Certificate : Rs. 100.00

4. 3ilicilic14b1 TAfff/Duplicatc copy of the Statement of Marks .Rs. I 00.003i)s1 : c+11 '31"T-dif@Wf3 so-u u 1 14,1 /On Demand Examination MarkSheet & other documents Rs. 100.00

6. - 1'T ( gRT -,-.41i)/Postal Charges : (iTthedocumetts is required by Regd. post) : Rs.40.00

arT-2-rfzi/ sii-n u f47fim ciA-1 Afcf qt-cf 1;17ff WC4 200 T. 2-TT 3T*ff NI7f

48 'Eft .* 3Tq7 cli(T k q f %TWIT ThNote : The prescribed fee for the issue of urgent provisional certificate/Migration Certificate and Duplicate Marksheet is Rs. 200/

- and these documents will be issued within-48 hours from the date of receipt of application.

9 10.00 t., 4R 1114( 'TT -51 24-14 OftH1 I gio tic4lf4cf ,-4151faro 2f7if 1 FA-5 iirt miftut4,1';rfff*fo ch-if*) gRi (WriqrTff/(-1c-q 1F-Icr AR,fri l orm of Affidavit

to be executed on Non-judicial Stamp Paper of Rs. I 0.00 duly attested by the first class magistrate (For Candidate applying forduplicate copy of qualifying certificate) The affidavit attested by oath Commissioner/Notary is not acceptable.

2i-1 2T TiTEPTIT WT-d-T Trtq ria-q?T fTur A-FzIR (

(1q174 1T49 Ict.11c1 41. ) Llt P-Jf 9/-1,44-%1( S141uf-.-7. ANT *I31c1-(-1 TR A lft =11 AilchR1 # tOff:

Son/Daughter of declare on oath that my certificate of having passed the Exam. of May/Nov. from National Insitute ofOpen Schooling, (FormerlyNational Open School) Delhi, has been lost/destroyed and certify that the fact stated above is true to the best of my knowledge and belief.

ollsto-fii.)/Roll No. fd-fIT4 7:MW/Signature of the Student

kif- /Date Trdi/Address.

9/Place

#1Tt : 1P-114 &uft 4i•Tie./Court Seal : Sworn before me I st Class Magistrate.