Annexure-4
Application for Correction in Exam Certificate/Marksheet (Surname/Name/Father's Name/Date of
Birth)
To,
Deputy Secretary (Examination)
Student Service Center,
Gujarat Secondary and Higher Secondary Education Board,
Gandhinagar.
Subject: Request for correction in Surname/Name/Father’s Name/Date of Birth in the Examination
Certificate/Marksheet.
Correction In:-
School Index No.: - Seat No.: -
Exam Year: -
1. Candidate's Name (in English):-
2. Candidate's Address:
-
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--
--
-
3. Correction Required:
Through Principal of: - High School
Receipt No.: ____________________ Date: ____________________
I am submitting the required documents and forms for correction in Surname/Name/Father’s
Name/Date of Birth as mentioned above. The correction from - to is verified according to our
school’s General Register of Std. 10/12 and is hereby recommended.
Principal’s Signature and Seal
For more details call us on our Helpline number - 079 23252104 OR Write us an email at
gsebeservice@gmail.com between 10:30 AM to 05:30 PM.
Annexure-4(A)
Declaration Form to be Filled and Submitted by School Principal for Correction in
Certificate/Marksheet
School Index No.: -
I, the undersigned, ________________________________________________________, hereby
declare as the Head of the School and make the following statement:
(1) I, ___________________________________________________________, have been
working as the Head of -High School since the month of ______________________ 20_________.
(2) I have checked the General Register of the school, where the student was enrolled from Std. 8
to Std. 12. The student, Master/Miss - is registered at Serial No. ________________ with the
following details:
(a) Correction details (in English): ____________________________________________ are
entered in the General Register from Std. 10/12.
(b) His/Her Date of Birth (in figures, in English): ______________________ (Only for SSC)
(3) I hereby certify that no unauthorized changes have been made in the General Register.
(4) The student appeared in the SSC/HSC examination held in March/October/July - with Seat
No. - from the examination center ______________________ and has been
____________________.
(5) The examination certificates/marksheets were received by the school on date:
_________________.
(X Please mention clearly the type of correction to be made in English.)
Principal's Signature, Seal, and Date:
School Name: ________________________________
Full Address:
________________________________
________________________________
________________________________
For Office Use Only
Based on the documents submitted by the student and the recommendation of the school
principal, the correction is:
? Approved ? Not Approved
Clerk's Signature: Asst. Secretary: Deputy Secretary (Examination):
_______________________ _______________________ _______________________
Annexure-4(B)
For Correction in Std. 10 Marksheet/Certificate Only
G.R. No.:
Full Name: -
Caste with Sub-
caste:
Place of Birth:
Date of Birth:
Last School
Attended:
Date of Admission:
Standard/Class
Admitted:
Exam Seat No.: - Progress: Conduct: Date of:
Standard From: D.C. No.: Year & Month of Passing: -
I certify that I have verified the Surname, Father’s Name, and Date of Birth from the School
General Register.
Signature of the Principal
Date: ______________________
With Rubber Stamp
Signature of the District Education Officer
__________________________ District
Date: ______________________
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