KHYBER PAKHTUNKHWA BOARD OF TECHNICAL EDUCATION
PLOT # 22, SECTOR B-1, PHASE – 5, HAYATABAD, PESHAWAR
APPLICATION FORM FOR DUPLICATE/TRIPLICATE
CERTIFICATE/DIPLOMA
PLEASE READ THE INSTRUCTIONS OVERLEAF BEFORE FILLING THE FORM
1.
APPLICANT’S NAME (In Block Letters) ________________________________________________
2.
FATHER’S NAME (In Block Letters) ___________________________________________________
3.
DATE OF BIRTH __________________________________________________________________
4.
NAME OF CERTIFICATE/DIPLOMA REQUIRED ________________________________________
on face side by
5.
NAME OF EXAMINATION PASSED __________________________________________________
the Principal
6.
REGISTRATION NO. ______________________________________________________________
7.
DATE OF BIRTH _______________________
Please paste
a passport size
photograph attested
(FEMALES EXEMPTED)
8.
ROLL NUMBER _______________________
9. YEAR OF PASSING
10. SESSION/TERM
(ANNUAL/SUPPLY/1st/2nd)
______________________
11. INSTITUTION FROM WHICH APPEARED _________________________________________________________________________
12. AMOUNT OF FEE PAID RS. _____________ BANK DRAFT/RECEIPT NO. _______________________ DATE _________________
13. POSTAL ADDRESS
House No. __________________________ Mohalla/Village __________________________________
Post Office __________________________ Tehsil/District ___________________________________
I solemnly declare that the facts mentioned in the application form are correct.
SIGNATURE OF APPLICANT______________________________________________________ DATE __________________________
CERTIFICATE OF THE CONCERNED PRINCIPAL
I hereby certify on the basis of the College/Institution record that Mr/Miss ____________________________________________________
son/daughter of _____________________________________________, whose particulars are given in this form is the same person who
passed the ___________________ examination under the Roll Number _________________ in the year _________________ from
_______________________________________________________ College/Institution and the particulars filled in by him/her are correct.
We have no objection if the above Certificate/Diploma is issued direct to him/her.
SIGNATURE OF PRINCIPAL _________________________________ OFFICIAL STAMP _____________________________________
NOTE: Affidavit to be filled in as (to be sworn in before a Civil Judge/Judicial Magistrate (for civil persons) or CO (for military personals)
personally by the applicant).
I hereby state on solemn affirmation that I ______________________________________ son/daughter of __________________________
______________________ have lost my original Certificate/Diploma bearing Serial Number _____________ in the following circumstances:
_______________________________________________________________________________________________________________
Nothing has been concealed and I shall be bound for any legal action if my statement proved to be incorrect.
SIGNATURE OF APPLICANT ___________________________________
WITNESS NO. 1
NAME _____________________________________________ ID CARD NO. ________________________________ SIGNATURE __________________
WITNESS NO. 2
NAME _____________________________________________ ID CARD NO. ________________________________ SIGNATURE __________________
SIGNATURE OF CIVIL JUDGE/JUDICIAL MAGISTRATE _____________________________ COURT STAMP ___________________________
SIGNATURE OF CO (In Case Of Military Personals) ________________________________ OFFICIAL STAMP __________________________
INSTRUCTIONS
1. No other person is authorized to apply on behalf of applicant.
2. The form should be filled by the candidate in his own handwriting legibly.
3. Duplicate/Triplicate copy of the Certificate/Diploma will only be issued if the Board is satisfied that the Original one has
been lost.
4. Overleaf certificate of the concerned principal is to be signed by the principal of the Institution/College through which
the candidate appeared and passed.
5. Affidavit is to be signed by a Civil Judge/Judicial Magistrate (for civil persons) or CO (for military personals).
6. Applicant must paste a recent passport size photograph (Male Candidates Only) duly attested on face side by the
concerned principal at the space shown in the form.
7. Fee for DUPLICATE certificate is Rs. 660/-. (Attach the bank draft/receipt in original)
8. Fee for TRIPLICATE certificate is Rs. 900/-. (Attach the bank draft/receipt in original)
9. Prescribed fee may be sent through the Bank Draft in the name of Secretary, Khyber Pakhtunkhwa Board of Technical
Education Peshawar or Bank Receipt of National Bank of Pakistan, Phase-5, Hayatabad Branch, Peshawar.
10. Press cuttings from two leading local newspapers should also be attached with the form regarding the loss of
Original/Duplicate Certificate with complete particulars i.e. Serial Number of Certificate, Roll Number, Session and
Date of Birth.
11. Original FIR entered with the Local Police Station, to be attached with the form.
12. Photocopy of the National Identity Card also to be attached with the form.
13. A Certificate/Diploma shall ordinarily be issued within a week of the receipt of the application form and fee. In urgent
situations, these shall be issued within 48 hours on receipt of double the fee prescribed.
14. Separate affidavit on Rs.10/- stamp paper duly signed by the student and attested by the Oath Commissioner.