Anna University - Application for Change of Photograph in Certificates

 

ANNEXURE

                                           ANNA UNIVERSITY :: CHENNAI – 25

OFFICE OF THE CONTROLLER OF EXAMINATIONS

Phone: +91-044-22357244, 22357295, 22357296

Click the below link

Application for change of photograph in certificates

 

APPLICATION FOR CHANGE OF PHOTOGRAPH IN CERTIFICATES

(Please fill complete form in capital letters)

 

Name of the Student………………………………………………….…………………...……………………..

Register No.………………………..………                      Gender: MALE / FEMALE/TRANSGENDER

Father’s Name…………………………………………………………….…………………………………….

College Code/Name…………………………………………………………………..………………………...

Programme and Branch Name………………………………………………………………………………...

Month and Year of Passing …………..……………..….……………………………………………………...

Passing Division (as mentioned in Degree) ……………………………………………………………………

Contact No. (Landline) ……………………………… (Mobile No.)…………………………………… ……

E- Mail ID ……………………………………………………..................................................................……..

Aadhaar Number……………………………….…….... Ration Card No……………………………………

Voter ID No…………………………………….…….... PAN No…………………………………………..

 

 

Photograph to be Changed in	Semester
Statement of Grades/Marks	I	II	III	IV	V	VI	VII	VIII	IX	X
Make a tick mark in which photo to be changed

 

Give the details, if the photograph is to be changed in Consolidated Statement of Grades/Marks or/and Degree Certificate:

 

Month and Year of issue of Consolidated Statement of Grades/Marks with Serial No.………………………

 

Month and Year of award of Degree (as mentioned in Degree) ………………..

 

 

Degree Serial No.…………………..

 

 

 

Date ………….	Signature of the Candidate
Date ………….	Signature of the Principal with Name and Seal

Sworn Affidavit:-

Photograph of the candidate executing the affidavit

(Sample copy of Affidavit to be sworn before an Oath Commissioner/ Judicial First Class Magistrate) AFFIDAVIT

 

 

 

 

I,                                                                                           Son / Daughter of                                                      major in age (state here profession / occupation) resident of (Full Address in which you are residing) do hereby solemnly affirm and state on oath as under:

1.        That I was a (State the Programme and Branch) student of (State the Name of the College), an affiliated college under Anna University, Chennai with Register No.                                                             . I appeared for all the examinations and successfully completed my degree in (Month and Year of award of Degree as mentioned in Degree Certificate).

2.        I state that the photograph printed in my Statement of Marks / Grades , Consolidated Statement of Marks/Grades / Degree Certificate is/are not mine, and the wrong photograph printed in the said certificate(s) was/were noticed by me now and the reason for not reporting the same in time are mentioned below:

(a)                                                                                                                                                                                                       

(b)                                                                                                                                                                                                       

3.        I now declare that the photograph I produced herewith for the process is mine and I am fully responsible for the change of photo in the Statement of Marks/ Grades, Consolidated Statement of Marks/Grades / Degree Certificate and also liable for any legal action to be initiated, if any wrong claim is made by me.

4.        That I am swearing this affidavit in order to produce the same before the Controller of Examinations, Anna University for obtaining the Statement of Marks/ Grades, Consolidated Statement of Marks/Grades / Degree Certificate with my photograph.

VERIFICATION

I, (full name                                                    S/o                                                              ) on solemn affirmation and oath state that all the facts stated in paragraphs 1 to 4 are correct to the best of my knowledge and belief and nothing is false or concealed. The contents being true I swear this affidavit.

 

Solemnly affirmed at                                on           day of               20

 

Before Me

Name of the Deponent

 

 

Fees	Statement of Grades/Marks	Consolidated Statement of Grades/Marks	Degree Certificate
	Rs.1000/- (per semester)	Rs.2000/-	Rs.3000/-

 

Enclosures:-

1.     Original Statement of Marks/ Grades, Consolidated Statement of Marks/Grades / Degree Certificate.

2.     Forwarding letter from college concerned stating the reason for the delay in reporting for the change of photograph.

3.     Photocopy of all Statement of Grade/Mark sheet(s), Consolidate Grade/Mark Sheet, Provisional degree certificate and Degree Certificate duly self-attested and attested by the Principal of the College.

4.     Demand Draft/Challan should be in favour of “The Controller of Examinations, Anna University, Chennai”

payable at Chennai.

5.     One Passport Size color photograph, preferably with blue background.

6.     Photocopy of mark sheets of class X and class XII.

7.     Photocopy of personal ID (Aadhaar Card, PAN Card, Ration Card and Voter ID Card).

8.     Sworn affidavit executed in Rs.100/- stamp paper.

Note:-

1.     All documents should be properly legible, otherwise change of photograph cannot be made.

2.     In case of any wrong information provided in the form, candidate will be fully responsible for the same and University may take appropriate action against him.