PROFORMA-B Applicable for candidates not residing in the State of West Bengal but whose parent(s) is(are) permanent resident(s) of West Bengal having their permanent home address within the State. To be issued by authorized persons other than Head of the Institution from which the candidate appeared/due to appear in ‘10+2’ or equivalent examination. Domicile Certificate: Type-B Certified that ___________________________________________________________________Father/Mother of ___________________________________________________________(the applicant) is/are permanent resident of West Bengal at Village/House No. _____________________________ Street ____________________________ ____________________________ Post Office __________________________ Police Station _________________ ____________________________ in the District of _____________________________________ under Assembly Constituency________________________________________________________________________________ __ Paste passport size photograph of applicant in this box Paste passport size photograph of Father/Mother of applicant Note: Photograph to be attested by the certifying authority. Signature of Certifying Authority ________________________________________________________________ Designation with Official Seal __________________________________________________________________ Full Name of Certifying Authority _______________________________________________________________ Office Address _______________________________________________________________________________ Office Phone No. _________________ Mobile No:_________________(optional) ID No: ______________________________(optional) Note: The Certifying Authority may please preserve the duplicate copy of the Certificate in his/her Office provided by the candidate
Posted on: Fri, 02 Jan 2015 18:15:23 +0000
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