A Character Certificate (ಪಾತ್ರ ಪ್ರಮಾಣಪತ್ರ) is an official document attesting to an individual's moral conduct, reputation, and absence of a criminal record. In Karnataka, this document is frequently required for government job applications (KPSC/KPSC Group C/D), police verification, college admissions, and passport applications. A "High Quality" format ensures the document is legible, professionally formatted, and contains all necessary legal affirmations in both Kannada and English.
When searching for or generating a Character Certificate in Kannada, "High Quality" implies the following technical specifications:
To ensure your high-quality PDF holds legal value, the issuer must be from this list:
Many websites offering "Character Certificate Format in Kannada PDF High Quality" actually provide:
Always choose a source that provides a direct .pdf or .docx link, or create your own using the template above.
To obtain a high-quality PDF, it is best to download the form directly from a government portal (like the Karnataka Police or a State University website) or create one using professional software to ensure the Kannada script renders correctly without encoding errors. Always ensure the document is printed on A4 size paper and attested by a Gazetted Officer to be considered valid for official use.
A character certificate, often referred to as a ನಡತೆ ಪ್ರಮಾಣ ಪತ್ರ (Nadate Pramana Patra) in Kannada, is a crucial document for government employment, educational admissions, and professional licensing in Karnataka. It verifies an individual’s identity, moral integrity, and lack of criminal history. Common Character Certificate Formats in Kannada
Depending on the purpose, the format varies slightly to meet the requirements of different institutions.
Student Conduct Certificate: Used by educational institutions like NITK Surathkal to verify a student's behavior and academic standing.
Government Employment Format: A more formal version required for public sector jobs. It typically states the candidate has no "antecedents" that make them unsuitable for duty.
Gazetted Officer Format: Required for most official applications, this must be signed by a recognized government official who has known the applicant for a specific period (usually at least 6 months to a year). Standard Format Structure (Kannada/English)
A high-quality certificate should include the following key sections: CHARACTER CERTIFICATE
This is to certify that Shri / Kumari / Smt. …….…………………………………………………………, Son / Daughter of Shri .....................…………………………………. Pemiya Rishikesh Institute of Technology CHARACTER CERTIFICATE
Certified that I have known Mr./ Ms./ Dr. ________________________ Son/ Daughter of Shri ________________________ for the last ___ NITK Surathkal
Character Certificate Format by Gazetted Officer | PDF - Scribd
This character certificate verifies the identity and moral character of an individual named _________________, born on ___/___/___ Scribd
Header: "ನಡತೆ ಪ್ರಮಾಣ ಪತ್ರ" (Character Certificate).
Personal Identification: Full name of the applicant, father’s/husband’s name, and residential address.
Statement of Knowledge: The issuer certifies how long they have known the applicant (in years and months).
Character Affirmation: Explicitly stating the person bears a "good moral character" and is not related to the signer.
Purpose Clause: Mentioning why the certificate is being issued (e.g., "for higher education" or "job application").
Official Authentication: Signature, date, place, and the official seal of the issuing authority. Where to Find & Download Formats
For a "high-quality" PDF, you can access verified templates from official and community sources:
Official Institutional Templates: Many Karnataka-based institutions like the National Institute of Technology Karnataka (NITK) provide standard downloadable formats.
Government Portals: Specific state services, such as those under the Karnataka e-Suraksha, often have service-related character formats.
Community Document Platforms: Sites like Scribd host community-uploaded Kannada character certificate PDFs, though these should be verified for current official standards.
Tip: Always ensure the certificate is not more than 6 months old when submitting for admissions or government jobs, as older certificates may be rejected. CHARACTER CERTIFICATE
This is to certify that Shri / Kumari / Smt. …….…………………………………………………………, Son / Daughter of Shri .....................…………………………………. Pemiya Rishikesh Institute of Technology iipe - character certificate
Character Certificate Format in Kannada PDF: A High-Quality Guide
In India, a character certificate is an essential document that is required for various purposes, such as government job applications, police verification, and visa applications. The certificate serves as a testament to an individual's good character and behavior. In Karnataka, the certificate is issued in Kannada, and it is crucial to have a high-quality format to ensure its acceptance. In this article, we will provide a comprehensive guide on the character certificate format in Kannada PDF, focusing on high-quality standards.
What is a Character Certificate?
A character certificate, also known as a police character certificate, is a document that certifies an individual's character and behavior. It is usually issued by the local police station or the district magistrate's office. The certificate is a crucial document that is required for various purposes, such as:
Importance of Character Certificate Format in Kannada PDF
The character certificate format in Kannada PDF is essential for individuals residing in Karnataka. The certificate must be in Kannada, as it is the official language of the state. A high-quality format ensures that the certificate is accepted by government agencies, police departments, and other organizations.
Character Certificate Format in Kannada PDF: A Sample
Here is a sample character certificate format in Kannada PDF:
ಶೀರ್ಷಿಕೆ: ಪೊಲೀಸ್ ಪಾತ್ರ ಪ್ರಮಾಣ ಪತ್ರ character certificate format in kannada pdf high quality
ಪೊಲೀಸ್ ಠಾಣೆ: [ಪೊಲೀಸ್ ಠಾಣೆಯ ಹೆಸರು] ಜಿಲ್ಲೆ: [ಜಿಲ್ಲೆಯ ಹೆಸರು] ರಾಜ್ಯ: ಕರ್ನಾಟಕ
ದಿನಾಂಕ: [ದಿನಾಂಕ]
ಈ ಪಾತ್ರ ಪ್ರಮಾಣ ಪತ್ರವು [ಹೆಸರು] ಅವರಿಗೆ ನೀಡಲಾಗಿದೆ. ಇವರ ವಿಳಾಸ [ವಿಳಾಸ] ಎಂದು ತಿಳಿದುಬಂದಿದೆ.
ಇವರು ನಮ್ಮ ಠಾಣೆಯಲ್ಲಿ [ಅಪರಾಧ/ಇತರ] ಸಂಬಂಧದಲ್ಲಿ ವಿಚಾರಣೆಗೆ ಒಳಗಾಗಿದ್ದು, ಅವರ ಪಾತ್ರ ಉತ್ತಮವಾಗಿದೆ ಎಂದು ನಮಗೆ ತಿಳಿದುಬಂದಿದೆ.
ಆದ್ದರಿಂದ, ಈ ಪಾತ್ರ ಪ್ರಮಾಣ ಪತ್ರವನ್ನು ನೀಡಲಾಗಿದೆ.
ಪೊಲೀಸ್ ಅಧಿಕಾರಿ [ಪೊಲೀಸ್ ಅಧಿಕಾರಿಯ ಸಹಿ] [ಪೊಲೀಸ್ ಅಧಿಕಾರಿಯ ಹೆಸರು] [ಪೊಲೀಸ್ ಅಧಿಕಾರಿಯ ವಿನ್ಯಾಸ]
High-Quality Format Requirements
To ensure a high-quality character certificate format in Kannada PDF, the following requirements must be met:
How to Create a High-Quality Character Certificate Format in Kannada PDF
To create a high-quality character certificate format in Kannada PDF, you can follow these steps:
Conclusion
In conclusion, a character certificate format in Kannada PDF is an essential document that requires a high-quality format to ensure its acceptance. By following the guidelines and sample provided in this article, individuals can create a high-quality character certificate format in Kannada PDF. Remember to use a standard template, clear font, and accurate details to ensure the certificate's authenticity. Additionally, ensure that the certificate is signed and stamped by an authorized police officer or magistrate.
Download Character Certificate Format in Kannada PDF
You can download a sample character certificate format in Kannada PDF from the following link:
[Insert link to download]
Frequently Asked Questions (FAQs)
By following the guidelines and sample provided in this article, individuals can create a high-quality character certificate format in Kannada PDF.
What is a Character Certificate?
A character certificate is a document that certifies an individual's good character and moral standing. It is often required for various purposes such as employment, education, immigration, and other official purposes. The certificate is usually issued by a competent authority, such as a police officer, government official, or a gazetted officer.
Importance of Character Certificate
A character certificate is an essential document that serves as proof of an individual's good character and reputation. It is often required by:
Character Certificate Format in Kannada PDF
The character certificate format in Kannada PDF is a document that is issued by the authorities in the state of Karnataka, India. The certificate is usually issued in Kannada language and is available in PDF format.
Here is a sample character certificate format in Kannada PDF:
ಶಿರೋನಾಮೆ: ಪೊಲೀಸ್ ಇಲಾಖೆ, ಕರ್ನಾಟಕ ರಾಜ್ಯ
ವಿಷಯ: ಗುಣಪಟ್ಟಿ ಪ್ರಮಾಣಪತ್ರ
ಈ ಪ್ರಮಾಣಪತ್ರವು [ಹೆಸರು] ಪুত್ರ/ಪುತ್ರಿ [ತಂದೆಯ ಹೆಸರು] ರವರಿಗೆ ನೀಡಲಾಗಿದೆ. ಇವರು [ವಿಳಾಸ] ರಲ್ಲಿ ವಾಸಿಸುತ್ತಿದ್ದಾರೆ.
ನಾನು, [ಪೊಲೀಸ್ ಅಧಿಕಾರಿಯ ಹೆಸರು], ಪೊಲೀಸ್ ಇಲಾಖೆ, ಕರ್ನಾಟಕ ರಾಜ್ಯ, ಇವರ ಗುಣಪಟ್ಟಿಯನ್ನು ಪರಿಶೀಲಿಸಿದ್ದೇನೆ. ಇವರು ಉತ್ತಮ ಗುಣ ಹೊಂದಿದ್ದಾರೆ ಮತ್ತು ಯಾವುದೇ ಅಪರಾಧ ಚಟುವಟಿಕೆಯಲ್ಲಿ ಭಾಗಿಯಾಗಿಲ್ಲ ಎಂದು ನಾನು ಪ್ರಮಾಣ ಮಾಡುತ್ತೇನೆ.
ಈ ಪ್ರಮಾಣಪತ್ರವನ್ನು [ದಿನಾಂಕ] ರಂದು ನೀಡಲಾಗಿದೆ.
ಪೊಲೀಸ್ ಅಧಿಕಾರಿಯ ಸಹಿ: _____________________________
ಪೊಲೀಸ್ ಅಧಿಕಾರಿಯ ಹೆಸರು: _____________________________
ಪೊಲೀಸ್ ಇಲಾಖೆ, ಕರ್ನಾಟಕ ರಾಜ್ಯ
How to Obtain a Character Certificate in Kannada PDF
To obtain a character certificate in Kannada PDF, you need to follow these steps:
Benefits of Character Certificate in Kannada PDF
The character certificate in Kannada PDF has several benefits, including: Always choose a source that provides a direct
Conclusion
In conclusion, a character certificate is an essential document that serves as proof of an individual's good character and reputation. The character certificate format in Kannada PDF is a document that is issued by the authorities in the state of Karnataka, India. The certificate is usually issued in Kannada language and is available in PDF format. The certificate has several benefits, including easy to obtain, time-saving, authenticity, and wide acceptance.
High-Quality Character Certificate Format in Kannada PDF
To obtain a high-quality character certificate format in Kannada PDF, you can:
By following these steps, you can obtain a high-quality character certificate format in Kannada PDF that meets your requirements.
Once upon a time in a bustling town in Karnataka, a young graduate named Akash received a job offer from a prestigious government office. To finalize his appointment, he needed one crucial document: a Character Certificate (ನಡತೆ ಪ್ರಮಾಣ ಪತ್ರ).
Akash realized that a high-quality certificate isn’t just a piece of paper; it is a formal testament to one’s integrity. He set out to find the perfect format to ensure his transition into his career was seamless. 📝 The Essential Elements
For a Character Certificate to be valid and professional in Karnataka, Akash learned it must include:
Header: Clear title in Kannada (ನಡತೆ ಪ್ರಮಾಣ ಪತ್ರ). Identification: Full name and father’s name. Duration: How long the issuer has known the candidate. Declaration: A statement confirming good moral conduct.
Signature: Seal and sign from a Gazetted Officer or Principal. 🏛️ Standard Kannada Format
Here is the structure Akash used for his high-quality draft:
ನಡತೆ ಪ್ರಮಾಣ ಪತ್ರ (Character Certificate)
ಈ ಮೂಲಕ ದೃಢೀಕರಿಸುವುದೇನೆಂದರೆ, ಶ್ರೀ/ಶ್ರೀಮತಿ [ಹೆಸರು], ತಂದೆಯ ಹೆಸರು [ತಂದೆಯ ಹೆಸರು], ಇವರು ಕಳೆದ **[ವರ್ಷ/ತಿಂಗಳು]**ಗಳಿಂದ ನನಗೆ ವೈಯಕ್ತಿಕವಾಗಿ ಪರಿಚಯವಿದ್ದಾರೆ.
ನನಗೆ ತಿಳಿದ ಮಟ್ಟಿಗೆ ಇವರ ನಡತೆಯು ಉತ್ತಮವಾಗಿದೆ ಮತ್ತು ಇವರು ಸತ್ಚಾರಿತ್ರ್ಯವುಳ್ಳವರಾಗಿದ್ದಾರೆ. ಇವರ ಮುಂದಿನ ಭವಿಷ್ಯಕ್ಕೆ ಶುಭ ಹಾರೈಸುತ್ತೇನೆ. ಸ್ಥಳ:ದಿನಾಂಕ:
(ಸಹಿ ಮತ್ತು ಮೊಹರು)(ಅಧಿಕಾರಿಯ ಪದನಾಮ) 🚀 Tips for High-Quality PDFs
To ensure the document looked professional, Akash followed these steps:
Clear Fonts: He used standard Kannada fonts like Nudi or Baraha for readability.
Official Letterhead: He printed it on the official stationery of his college or a local Gazetted Officer.
PDF Conversion: He saved the file as a "High Quality" or "Press Quality" PDF to avoid pixelation of the Kannada script.
No Errors: He double-checked the spelling of names to avoid legal delays.
⭐ Key Takeaway: A well-formatted Character Certificate in Kannada acts as a bridge between your past achievements and future opportunities.
This article is structured for SEO, readability, and practical utility, focusing on users in Karnataka who need a formal document in the Kannada language.
If you’d like, I can:
You can find high-quality Character Certificate (ನಡತೆ ಪ್ರಮಾಣ ಪತ್ರ) formats in Kannada through several reliable resources. These certificates are typically required for job applications, school admissions, or official verifications. High-Quality Formats & Downloads Official Karnataka Government Portals : For standardized academic formats, the Department of School Education (Pre-University)
provides official document structures for students in Karnataka. Scribd Downloads
: You can access community-uploaded, high-quality Kannada character certificate templates on sites like Study & Conduct Formats
: For combined study and conduct certificates, resources like Scribd's Study Certificate Kannada Format are widely used for local school and college requirements. Standard Kannada Format Structure
A standard character certificate in Kannada typically includes:
: "ನಡತೆ ಪ್ರಮಾಣ ಪತ್ರ" (Character Certificate). Certification Statement
: "ಶ್ರೀ/ಕುಮಾರಿ [ಹೆಸರು] ಅವರು ಕಳೆದ [ವರ್ಷಗಳು] ವರ್ಷಗಳಿಂದ ನನಗೆ ವೈಯಕ್ತಿಕವಾಗಿ ಪರಿಚಯವಿದ್ದಾರೆ ಎಂದು ಧೃಡೀಕರಿಸುತ್ತೇನೆ." (I certify that Shri/Kumari [Name] is personally known to me for the last [Years] years). Moral Standing
: "ನನ್ನ ತಿಳುವಳಿಕೆಯಂತೆ ಅವರ ನಡತೆ ಮತ್ತು ಚಾರಿತ್ರ್ಯವು ಉತ್ತಮವಾಗಿದೆ." (To the best of my knowledge, their conduct and character are good).
: Mention why it’s being issued (e.g., for employment or education). Signature & Seal
: Must be signed by a Gazetted Officer, Principal, or relevant authority with their official stamp. Authorized Signatories
To be valid, the certificate must be signed by one of the following: Gazetted Officers of Central or State Government. Principals or Headmasters of recognized educational institutions. Sub-Divisional Magistrates or Tehsildars. draft of a letter to request this certificate from your college principal? CHARACTER CERTIFICATE
Searching for a high-quality Character Certificate Format in Kannada (ನಡತೆ ಪ್ರಮಾಣ ಪತ್ರ) is common for students seeking admissions or job seekers applying for government and private positions in Karnataka.
Below is a guide and a template you can use to create your own document or download as a reference. What is a Character Certificate? To obtain a high-quality PDF , it is
A character certificate is a legal document issued by a gazetted officer, school principal, or a person of repute to verify that an individual has no criminal record and possesses a good moral character. In Karnataka, this is often required for:
Government Job Applications: Especially for KPSC or police department recruitments.
School/College Admissions: Usually issued by the last institution attended.
Police Verification: Often required for driver licenses or specific employment roles. Character Certificate Template in Kannada
You can copy and adapt the following text into a Word document and save it as a high-quality PDF.
ನಡತೆ ಪ್ರಮಾಣ ಪತ್ರ (Character Certificate)
ಈ ಮೂಲಕ ಪ್ರಮಾಣೀಕರಿಸುವುದೇನೆಂದರೆ, ಶ್ರೀ/ಶ್ರೀಮತಿ/ಕುಮಾರಿ __________________________, ಇವರ ತಂದೆಯ ಹೆಸರು ಶ್ರೀ __________________________, ಇವರು ನನಗೆ ಕಳೆದ __________ ವರ್ಷಗಳಿಂದ ವೈಯಕ್ತಿಕವಾಗಿ ಪರಿಚಯವಿದ್ದಾರೆ.
ನನಗೆ ತಿಳಿದಿರುವ ಮಟ್ಟಿಗೆ ಇವರು ಉತ್ತಮ ನಡತೆ ಹಾಗೂ ಸದಾಚಾರವನ್ನು ಹೊಂದಿದ್ದಾರೆ. ಇವರ ವಿರುದ್ಧ ಯಾವುದೇ ಕ್ರಿಮಿನಲ್ ಪ್ರಕರಣಗಳು ದಾಖಲಾದ ಬಗ್ಗೆ ಅಥವಾ ಸರ್ಕಾರದ ವಿರುದ್ಧದ ಚಟುವಟಿಕೆಗಳಲ್ಲಿ ತೊಡಗಿಸಿಕೊಂಡ ಬಗ್ಗೆ ನನಗೆ ಯಾವುದೇ ಮಾಹಿತಿ ಇರುವುದಿಲ್ಲ. ಹಾಗೂ ಕಾರ್ಯದರ್ಶಿಗಳು
A character certificate, commonly known as ನಡತೆ ಪ್ರಮಾಣ ಪತ್ರ
(Nadate Pramana Patra) in Kannada, is a formal document verifying an individual’s conduct and behavior. High-quality formats for students, government employees, and general purposes can be found on platforms like DTE Karnataka High-Quality Kannada Character Certificate Formats
The following table summarizes common formats and their typical contents: Certificate Type Key Information Required Source Example School/College
Student Name, Father’s Name, Academic Years, Class studied Scribd School Format Gazetted Officer
Resident Name, Father's Name, Acquaintance Period (Years/Months), Purpose Scribd Gazetted Format Police Verification Identification proof, Residency proof, No criminal history Seva Sindhu Online
Standard Content in Kannada (ನಡತೆ ಪ್ರಮಾಣ ಪತ್ರದ ಸಾರಾಂಶ)
A high-quality Kannada character certificate typically includes these details:
: ನಡತೆ ಪ್ರಮಾಣ ಪತ್ರ (Character Certificate). Identification
: ಶ್ರೀ/ಶ್ರೀಮತಿ [ಹೆಸರು] ಇವರ ಮಗನಾದ/ಮಗಳಾದ ಶ್ರೀ [ತಂದೆ/ತಾಯಿಯ ಹೆಸರು] (Shri [Name], son/daughter of Shri [Parent Name]). Acquaintance Statement
: ಇವರು ನನಗೆ ಕಳೆದ [ವರ್ಷ/ತಿಂಗಳು]ಗಳಿಂದ ವೈಯಕ್ತಿಕವಾಗಿ ತಿಳಿದಿರುತ್ತಾರೆ (Known to me for the last [years/months]). Character Declaration
: ಇವರು ನನಗೆ ತಿಳಿದ ಮಟ್ಟಿಗೆ ಉತ್ತಮ ನಡತೆ ಹಾಗೂ ಸಶ್ಚಾರಿತ್ರ್ಯವನ್ನು ಹೊಂದಿದ್ದಾರೆ (To the best of my knowledge, they bear a good moral character). Verification
: ಇವರು ಸರ್ಕಾರಿ ಉದ್ಯೋಗಕ್ಕೆ ಸೇರಲು ಅರ್ಹರಾಗಿದ್ದಾರೆಂದು ಈ ಮೂಲಕ ಪ್ರಮಾಣೀಕರಿಸುತ್ತೇನೆ (I certify they are suitable for government service). Who Can Sign Your Character Certificate?
Official certificates often require the signature and seal of authorized persons such as: Gazetted Officers (Central or State). School Principals or Headmasters where you last studied. Tehsildars or Sub-Divisional Magistrates. Post Masters or Block Development Officers (BDO). Ensure the certificate is not older than
from the date of submission for academic or job applications. Do you need a specific template for a school admission or a government job application?
ನಡತೆ ಪ್ರಮಾಣ ಪತ್ರ (ಗಣ್ಯವ್ಯಕ್ತಿಗಳಿಂದ) | PDF - Scribd
Here’s a ready-to-use high-quality character certificate format in Kannada, designed to be copied into a Word/Google Docs file and saved as a PDF.
Heading (Top, Bold, Large Font): ಪಾತ್ರ ಪ್ರಮಾಣಪತ್ರ
(Character Certificate)
Body:
ಪ್ರಮಾಣಪತ್ರದ ಸಂಖ್ಯೆ: [ಸಂಖ್ಯೆಯನ್ನು ನಮೂದಿಸಿ]
ದಿನಾಂಕ: [ದಿನಾಂಕವನ್ನು ನಮೂದಿಸಿ]
ಪ್ರತಿ:
ಇದರ ಮೂಲಕ, [ಸಂಸ್ಥೆಯ/ವ್ಯಕ್ತಿಯ ಹೆಸರು], [ಸ್ಥಳ/ವಿಳಾಸ] ಅವರು ಪ್ರಮಾಣೀಕರಿಸುತ್ತಾರೆ,
ಶ್ರೀ/ಶ್ರೀಮತಿ/ಕುಮಾರಿ [ಪೂರ್ಣ ಹೆಸರು], [ತಂದೆ/ಪತಿಯ ಹೆಸರು], ಅವರು [ದಿನಾಂಕದಿಂದ] ರಿಂದ [ದಿನಾಂಕದವರೆಗೆ] ಅವಧಿಯಲ್ಲಿ [ಸಂಸ್ಥೆಯ/ಕಾಲೇಜಿನ/ಶಾಲೆಯ/ಗ್ರಾಮದ] ನಮ್ಮೊಂದಿಗೆ [ವಿದ್ಯಾರ್ಥಿ/ನೌಕರ/ಸದಸ್ಯ/ನಿವಾಸಿ] ಆಗಿ ಸಂಪರ್ಕ ಹೊಂದಿದ್ದರು.
ಈ ಅವಧಿಯಲ್ಲಿ ಅವರ ಪಾತ್ರ, ನಡತೆ ಮತ್ತು ವರ್ತನೆ ಉತ್ತಮವಾಗಿತ್ತು ಎಂದು ನಾವು ಪ್ರಮಾಣೀಕರಿಸುತ್ತೇವೆ. ಅವರು ಪ್ರಾಮಾಣಿಕ, ಶಿಸ್ತುಬದ್ಧ, ಜವಾಬ್ದಾರಿಯುತ ಮತ್ತು ಸದಾಚಾರ ಸಂಪನ್ನರಾಗಿದ್ದಾರೆ. ಅವರ ವಿರುದ್ಧ ಯಾವುದೇ ಶಿಸ್ತಿನ ಕ್ರಮ ಅಥವಾ ದೂರು ದಾಖಲಾಗಿಲ್ಲ.
ಈ ಪ್ರಮಾಣಪತ್ರವನ್ನು ಅವರ ಮುಂದಿನ ಶೈಕ್ಷಣಿಕ/ಉದ್ಯೋಗ/ಕಾನೂನು ಅಗತ್ಯಗಳಿಗಾಗಿ ನೀಡಲಾಗಿದೆ.
ವಿಶೇಷ ಟಿಪ್ಪಣಿ (ಐಚ್ಛಿಕ):
[ಯಾವುದೇ ನಿರ್ದಿಷ್ಟ ಗುಣಗಳನ್ನು ನಮೂದಿಸಲು – ಉದಾ: ಸತ್ಯಸಂಧ, ಸಹಕಾರಿ, ನಾಯಕತ್ವ ಗುಣ]
ಸ್ಥಳ: [ಊರಿನ ಹೆಸರು]
ದಿನಾಂಕ: [ದಿನಾಂಕ]
ಸಹಿ ಮತ್ತು ಮುದ್ರೆ
[ಅಧಿಕಾರಿಯ ಹೆಸರು]
[ಹುದ್ದೆ]
[ಸಂಸ್ಥೆಯ ಹೆಸರು ಮತ್ತು ಮುದ್ರೆ]