GAP Certificate Format

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GAP Certificate

I, Mr./Ms. ____________________________________________, Registration. No. _________________, Roll No.


______________________________, Son/Daughter of Mr./Mrs. ________________________________________ do
hereby solemnly state & affirm as under:-

1. That I have passed _______________ class in the year _________________ from


______________________________________________ School/College/Institute/University.
2. I got admission in _____________________________________________(Name of the Institute/University) in the
Year _________________ in the Department of ______________________________________ to pursue
_______________________ Programme of _______________________ Years (Duration of course).

3. I declared that during the GAP Year/s of _________________ to __________________ ,


(tick any one)
(a) I did not take admission in any educational institute/college/school/university to pursue further studies after
passing ______________________ (Last qualifying examination).
(b) I took admission in an educational institute/college/school/university namely
_________________________________________________________________________ to pursue
_____________________________________________ course after passing qualifying exam from
___________________ to _______________________ and did not avail any Government
Scholarship/Financial Assistance.

(c) I took admission in an educational institute/college/school/university namely


_________________________________________________________________________ to pursue
_____________________________________________ course after passing qualifying exam from
___________________ to _______________________ and availed Government Scholarship/Financial
Assistance from ___________________________________________ (Department) for an amount of Rs.
_______________________ .

4. All above information furnished by me are true and genuine.

_______________________________ _____________________________
(Name of the Student) (Name of the Parent)

_______________________________ _____________________________
(Signature of the Student) (Signature of the Parent)

Date:- _____/________/_______ Date:- _____/________/_______

Verification:-
Verified that the contents of the above said declaration supported by the document(s) submitted on
________________ by the student are true and correct to the best of my knowledge and belief and nothing has
been concealed or misrepresented therein.
Date:- _____/________/_______

Place: __________________________ _____________________________________


Signature of Head of the Institution (with Stamp)

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