FORM - B
GOVERNMENT OF GOA
BOARD OF TECHNICAL EDUCATION
Alto, Porvorim - Goa
APPLICATION FOR ELIGIBILITY CERTIFICATE
1. Name of the candidates_____________________________________________
2. Address of the candidates____________________________________________
____________________________________________
____________________________________________
3. Telephone:__________________________________________________________
4. Examination passed_______________________ 5. Year of passing________
6. Board from which qualifying Examination passed_____________________
________________________________________________________________________
7. Course & Institute for which Admission is sought ____________________
_____________________________________________________________________
8. Copies of documents: (Original should be produced for verification)
Sr
No
Certificates Attached Verified
a Mark sheet of qualifying Examination
b Certificate of qualifying Examinations
c School leaving certificate from last school attended.
d Migration certificate from the Board from which qualifying Examination is passed
Date: Signature of the Applicant
FOR OFFICE PURPOSE ONLY
Details of payment of
Rs.100/-
Receipt No.
Date:
Cashier
Provisional/Final Eligibility Certificate
issued On:
Signature: