69, Anna Salai, Guindy, Chennai

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1 THE TAMILNADU DR.M.G.R. MEDICAL UNIVERSITY 69, Anna Salai, Guindy, Chennai From To The Controller of Examinations i/c. The Dean/Principal of all Affiliated Institutions The Tamil Nadu Dr.MGR Medical University of this University in the Flood affected Districts Guindy, Chennai of CHENNAI, TIRUVALLUR, KANCHIPURAM and CUDDALORE. Letter No. Ex. XI(1)/59968/2015 Dated: Sir/Madam, Sub: Affiliated Institutions of The Tamil Nadu Dr.MGR Medical University in the Flood affected Districts of CHENNAI, TIRUVALLUR, KANCHIPURAM and CUDDALORE Loss or Damage of Certificates due to floods Conduct of special camps to receive Applications from affected students Issue of Duplicate Educational Certificates (Degree, Provisional certificates and Statement of Marks) Reg. Ref: G.O. Ms. No.366 Health & Family Welfare (ME) Department, dated As part of the flood relief measures, the Government of Tamil Nadu vide G.O. cited has issued orders to conduct special camps to receive applications from the students for the issue of Duplicate Educational Certificates (Degree, Provisional certificates and Statement of Marks) in the flood affected districts of CHENNAI, TIRUVALLUR, KANCHIPURAM and CUDDALORE for a period of two weeks from to Hence, the Dean / Principal of all the Affiliated Institutions of this University in the Flood affected Districts of CHENNAI, TIRUVALLUR, KANCHIPURAM and CUDDALORE are requested to conduct special camps to reach out to the affected students and receive applications for the issue of Duplicate educational certificates in lieu of loss or damaged ones in the recent flood. This will be done at free of cost and no charges shall be collected from the students. Sample application form to be issued to the students is enclosed herewith. The original filled application received from the student is to be retained in the Institution itself and one copy of filled application to be given to the student as acknowledgement and the scanned copy of the original filled application to be sent to the Controller of Examinations in-charge through Duplicate certificates will be sent to the respective Colleges within one week from the date of receipt of application. The Deans/Principals of the Institutions are requested to strictly adhere to the above and extend their full cooperation, so as to execute the task on time. Encl: Application Format. Sd/ xxxxxx CONTROLLER OF EXAMINAIONS i/c.

2 OFFICE OF THE CONTROLLER OF EXAMINATIONS, THE TAMIL NADU Dr.M.G.R. MEDICAL UNIVERSITY, GUINDY, CHENNAI APPLICATION FOR ISSUE OF DUPLICATE EDUCATIONAL CERTIFICATES (DEGREE CERTIFICATE) (Special Camps to those who lost their Original Certificates in Flood in Chennai, Tiruvallur, Kanchipuram and Cuddalore Districts) 1. Name of the Candidate (in English) (As per Record) Affix Candidate Passport Size Photo 2. Name of the Candidate (in Tamil) 3. Father s Name 4. Register Number 5. Name of the College / Centre Code 6. Name of the Degree / Course (The Photo copy of the Degree Certificate if available enclose the same) 7. Branch Studied 8. Month & Year of Passing 9. Present Address 10. Phone No. / Mobile No. UNDERTAKING BY THE CANDIDATE Information furnished by me in this application is correct to the best of my knowledge. Original Certificates for which Educational Certificates are requested were lost in the flood. Signature of the Applicant CERTIFICATE BY THE HEAD OF THE INSTITUTION Certified that the information furnished above is verified with the records available at this institution and the application is recommended for issue of Educational Certificates. Institution Seal Signature of the Principal with Designation Seal The form has to be prepared triplicate / One copy to be given as acknowledgement to student / One scanned copy to be sent to COE Office through / Original to be retained at the institution itself.

3 OFFICE OF THE CONTROLLER OF EXAMINATIONS, THE TAMIL NADU Dr.M.G.R.MEDICAL UNIVERSITY, GUINDY, CHENNAI APPLICATION FOR ISSUE OF DUPLICATE STATEMENT OF MARKS / PROVISIONAL CERTIFICATE (Special Camps to those who lost their Original Certificates in Flood in Chennai, Tiruvallur, Kanchipuram and Cuddalore Districts) Affix Candidate Passport Size Photo 1. Name of the Candidate (in English) (As per Record) 2. Name of the Candidate (in Tamil) 3. Father s Name 4. Register Number 5. Name of the College / Centre Code 6. Name of the Degree / Course (The Photo copy of the Degree Certificate if available enclose the same) 7. Branch Studied 8. Month & Year of each Appearance (s) Provisional Certificate Mark Sheet Month & Year of Passing Sl.No. Month & Year 9. Present Address 10. Phone No. / Mobile No. UNDERTAKING BY THE CANDIDATE Information furnished by me in this application is correct to the best of my knowledge. Original Certificates for which Statement of Marks are requested were lost in the flood. Signature of the Applicant CERTIFICATE BY THE HEAD OF THE INSTITUTION Certified that the information furnished above is verified with the records available at this institution and the application is recommended for issue of Statement of Marks. Institution Seal Signature of the Principal with Designation Seal The form has to be prepared triplicate / One copy to be given as acknowledgement to student / One scanned copy to be sent to COE Office through / Original to be retained at the institution itself.

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