POLYTECHNIC ADMISSIONS

ANNEXURE – XIV
CHARACTER CERTIFICATE
Certified that Mr./Miss/Mrs._______________________________________________________ Son/daughter of
Shri__________________________________________ has been a bonafide student of this institution during the
period_____________________________________He/She appeared in the _________________Examination of
the institution/Board held in ________________________under Roll No. __________________________ and
*passed obtaining _________________________________Marks out of __________________________ marks
or *failed / *placed under compartment in the subject of ________________
_______________________.
1. Academic Distinction, if any____________________________________
2. Co-curricular activities, if any ___________________________________
3. Brief particulars of disciplinary action by Institution/Board including punishment such as
Expulsion, warning, Fined for violation of hostel rules. UMC/disqualification etc., if any
_____________________________________________________________.
4. General Conduct during stay in the institution: Good/Satisfaction/Unsatisfactory
5. He/She bears good/bad Character.
No._____________________
Signature
Principal (with office seal)
Date: ____________________
_____________________________________________________________________
*Strike out whichever is not applicable
ANNEXURE –XV
CERTIFICATE FOR THE EX-EMPLOYEES OF INDIAN DEFENCE SERVICES
Certified that Number __________________________________ Rank ____________________________Name
___________________________ S/o or D/o _________________________________________ Father/ Mother
of ________________________ Resident of Village _______________________________________ Post Office
________________________ Tehsil ________________________________________________________ Distt.
_________________________________ belonging to the State of Haryana as per his/her service record at the
time of entry into service, had served in the Army / Air Force / Navy (Name of the Para-Military Force) from
___________________ to _______________________________ and subsequently discharged/retired from the
service on ____________________ as per his/her service record at the time of entry into service the home
address given is ______________________________________________ (Distt. ________________) Haryana.
Signature
Place ________________________ Officer Commanding/
Competent Authority
Date ________________________ (with Official Seal)
_____________________________________________________________________
(Strike out whichever is not applicable)
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