Residential (Domicile) Certificate

Candidates domiciled in West Bengal must produce Residential (Domicile) Certificates signed by
competent authority (refer to Information Brochure) in prescribed proforma as given in Annexure I.
If the candidate is residing in West Bengal continuously for the last ten years as on 31.12.2013,
he/she should use either Proforma type-A OR Proforma type-B.
If the candidate is not residing in West Bengal but whose parent(s) is/are permanent resident(s) of
West Bengal having their permanent home address within the state, he/she should use Proforma
type-C.
Candidates seeking admission to Govt. Colleges have to show their Residential certificates during
counselling.
 ANNEXURE – I
Proforma for Residential Certificate
Applicable for candidates residing in the State of West Bengal continuously at least for last
ten (10) years as on 31.12.2013

Residential Certificate: Type-A

To be issued by authorized persons other than Head of the Institution from which the candidate
appeared/due to appear in ‘10+2’ or equivalent examination.

Certified that _________________________________________________________________ son / daughter of

_______________________________________________ is a resident/permanent resident of West Bengal at

Village/House No. ________________ Street ______________________________________________________

________________ Post Office _____________________________ Police Station __________________________

in the District of _______________________ under Assembly Constituency ___________________________

and has been living in West Bengal continuously at least for the last ten years as on 31-12-2013.

Note:
 Photograph to be attested by the certifying
Paste passport authority.
size photograph  Candidates must submit the same photograph,
of applicant in as used in the Application Form. The same
this box photograph should be used during his/her
admission through this system

Signature of Certifying Authority ________________________________________________________________

Designation with Official Seal ___________________________________________________________________

Full Name of Certifying Authority _______________________________________________________________

Office Address _________________________________________________________________________________

_________________________________________________________________________________

Office Phone No. ____________________________________

Note: The Certifying Authority may please preserve the duplicate copy of the Certificate in his/her
Office provided by the candidate
 Proforma for Residential Certificate
Applicable for candidates residing in the State of West Bengal continuously at least for last
ten (10) years as on 31.12.2013

Residential Certificate: Type-B

To be issued by the Head of the Institution from which the candidate appeared/due to appear in
‘10+2’ or equivalent examination.

Certified that _________________________________________________________________ son / daughter of

________________________________________________________ has passed the ‘10+2’ Examination in the

year_______ / will appear in the Final ‘10+2’ Examination in 2014 from this Institution. It is also

certified that the student is a resident / permanent resident of West Bengal at Village/House No.

_____________________________ Street _____________________________________________________________

Post Office ___________________________ Police Station ____________________________ in the District of

___________________________________ under Assembly Constituency_______________________________

and has been living in West Bengal continuously at least for the last ten (10) years as on 31-12-

2013.

Note:
 Photograph to be attested by the certifying
Paste passport authority.
size photograph  Candidates must submit the same photograph,
of applicant in as used in the Application Form. The same
this box photograph should be used during his/her
admission through this system

Signature of Certifying Authority ________________________________________________________________

Designation with Official Seal ___________________________________________________________________

Full Name of Certifying Authority _______________________________________________________________

Office Address _________________________________________________________________________________

_________________________________________________________________________________

Office Phone No. ____________________________________

Note: The Certifying Authority may please preserve the duplicate copy of the Certificate in his/her
Office provided by the candidate
 Proforma for Residential Certificate
Applicable for candidates not residing in the State of West Bengal but whose parent(s) is(are)
permanent resident(s) of West Bengal having their permanent home address within the State.

Residential Certificate: Type-C

To be issued by authorized persons other than Head of the Institution from which the candidate
appeared/due to appear in ‘10+2’ or equivalent examination.

Certified that ___________________________________________________________________Father/Mother of

______________________________________________________(the applicant) is/are permanent resident(s)

of West Bengal at Village/House No. __________________ Street ____________________________________

__________________________________ Post Office __________________ Police Station ___________________

in the District of ______________________ under Assembly Constituency ___________________________

Note:
Paste passport Paste passport  Photograph to be attested by the
size photograph size photograph of certifying authority.
of applicant in Father/Mother of  Candidates must submit the same
this box applicant photograph, as used in the Application
Form. The same photograph should be
used during his/her admission through
this system

Signature of Certifying Authority ________________________________________________________________

Designation with Official Seal ___________________________________________________________________

Full Name of Certifying Authority _______________________________________________________________

Office Address _________________________________________________________________________________

_________________________________________________________________________________

Office Phone No. ____________________________________

Note: The Certifying Authority may please preserve the duplicate copy of the Certificate in his/her
Office provided by the candidate