FORM - C
GOVERNMENT OF GOA
BOARD OF TECHNICAL EDUCATION
Alto, Porvorim - Goa
APPLICATION FOR MIGRATION CERTIFICATE
1. Name of the Student: _______________________________________________
2. Address: ___________________________________________________________
3. Telephone No.: __________________
4. Institute where the student was studying: __________________________
____________________________________________________________________
5. Diploma Programme undergone: _________________________________
Enrol. No.: ________________
7. Whether Diploma is completed : yes/No
8. If yes Month & Year of Diploma Completion: _______________
9. Last Exam appeared: ______________
10. Copies of documents (originals to be produced for Verification)
S.
N
Documents Attached Verified
a Final mark sheet of the Diploma Programme
b Leaving Certificate from the institute the students was studying
Dated: Signature of the candidate
FOR OFFICE PURPOSE ONLY
Details of payment of Rs.100/-
Receipt No.
Date:
Cashier
Diploma Complete/incomplete
Migration Certificate issued
On:
Signature: