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Annexure-XI<br />
CHARACTER CERTIFICATE<br />
Name of the Department/College/School………………………….Session…………………Certified that<br />
Mr./Miss/Mrs………………………………………son/daughter of Shri…………………..……………………<br />
has been a bonafide student of this Department/College during the period………………………………….He/She<br />
appeared in the ……………………. Examination of the University/Board held in ……………………..under Roll<br />
No………………and *passed obtaining………………........marks out of ………………..marks or *failed/*placed<br />
under compartment in the subject of …………………………..<br />
1. Academic Distinction, if any………………………………….<br />
2. Co-curricular activities, if any………………………………...<br />
3. Brief particulars of disciplinary action by College/Department/University (including punishments such as<br />
expulsion, warning, fined for violation of College/Department/Hostel rules, UMC/ Disqualification etc., if<br />
any……………… ………………<br />
4. General Conduct during stay in the Institution: Good/Satisfactory/Unsatisfactory.<br />
Dated:……………<br />
Signature of the Principal/<br />
Chairperson of the Dept.<br />
(with office seal)<br />
________________________________________________________________________________________<br />
*Strike out whichever is not applicable.<br />
-------------------------------------------------------------------------------------------------------------------------------------<br />
Annexure-XII<br />
HARYANA GOVERNMENT<br />
Photo of<br />
Certificate Sr.No.______________ /Year______________ Tehsil____________.<br />
applicant to<br />
be attested<br />
by the issuing<br />
SCHEDULED CASTE CERTIFICATE<br />
authority<br />
This is to certify that Shri/Smt./Kumari_______________ son/daughter of Shri______________resident of<br />
Village/Town_____________________Tehsil_______________ Distt.____________ of the State/Union<br />
Territory___________________ belongs to the _____________Caste/Tribe, which is recognised as a Schedule Caste/Schedule<br />
Tribe under the Constitution (Scheduled Caste) Order, 1950.<br />
Signature with seal of issuing Authority<br />
Dated : _________<br />
Place : _________<br />
Issuing Authority:<br />
Full Name …………………………….<br />
Designation …………………………...<br />
Address with Telephone No. with code …………….<br />
Tehsildar-cum Executive Magistrate,<br />
Naib Tehsildar-cum Executive Magistrate,<br />
Head of Department in case of Govt. employees<br />
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