FORM - E
GOVERNMENT OF GOA
BOARD OF TECHNICAL EDUCATION
Alto, Porvorim - Goa
APPLICATION FOR ISSUE OF PROVISIONAL PASSING CERTIFICATE
1. Name of the Student: _______________________________________________
2. Address: ___________________________________________________________
3. Telephone No.: __________________
4. Institute where the student was studying: __________________________
____________________________________________________________________
5. Diploma Programme undergone: _________________________________
6. Enrol. No.: ________________
7. Month & year of Diploma completed:
8. Last Exam appeared: _______________
9. Copies of document ( Original to be produce for verification):
a) Mark sheet of diploma programme.
Date: Signature of the candidate
FOR OFFICE PURPOSE ONLY
Details of payment of Fees
Rs. 100/-
Receipt No:
Date:
Cashier
Transcript issued
On:
Signature: