H.S.C Board Form.pdf

## MAHARASHTRA STATE BOARD OF SECONDARY & HIGHER SECONDARY EDUCATION, PUNE 411 004 APPLICATION FORM TEMPLATE FOR H.S.C. EXAMINATION OF FEB-MAR/JUL-AUG 20 | 1a | Index No | 1b | UDISE No | 1c | Student saral ID | |---|---|---|---|---|---| | 2a | Appl.Sr.No | b | Centre No | | 3a | Last name/Surname...

## MAHARASHTRA STATE BOARD OF SECONDARY & HIGHER SECONDARY EDUCATION, PUNE 411 004 APPLICATION FORM TEMPLATE FOR H.S.C. EXAMINATION OF FEB-MAR/JUL-AUG 20 | 1a | Index No | 1b | UDISE No | 1c | Student saral ID | |---|---|---|---|---|---| | 2a | Appl.Sr.No | b | Centre No | | 3a | Last name/Surname | 3b | Candidate's Name | 3c | Middle/Father's Name | 3d | Mother's Name | | 4 | Residential Address | 5 | Mobile No | 6 | Date Of Birth DDMMYYY | 7 | Aadhar No | | 8 | Stream | 1) Science | 2) Arts | 3) Commerce | 4) HSC Vocational | 5) Technology Science | | 9 | Gender | 1) Male | 2) Female | 3) Trans Gender | | 10 | Minority Religion | 0) Hindu & other Non-Minority | 1) Muslim | 2) Christian | 3) Buddhist | 4) Sikh | 5) Parsi | 6) Jain | 7) Jew | | 11 | Category | 01) sc | 02) ST | 03) VJ(A) | 04) NT(B) | 05) NT(C) | 06) NT(D) | 07) OBC | 08) SBC | 09) OPEN | 10) SEBC | 11) EWS | | 12 | Divyang | 00) No Handicapped | 01 TO 22) If Divyang Candidate | | 13 | Medium of Instruction | 1) English | 2) Marathi | 3) Gujarati | 4) Kannada | 5) Urdu | 6) Sindhi Arabic | 7) Sindhi Devnagari | 8) Hindi | | 14 | Type of Candidate | A 1) Fresh | 2) Repeater | | | | B 1) Regular | 2) Private | 3) Isolated | 4) Class Improvement | | | | C 1) Exempted | 2) Non Exempted | | | | D 1) Agriculture | 2) Bifocal | 3) IT | 4) General | 5) Home Science | | | | E Whether foreigner | 1) Yes | 2) No | | Sr. No. | Subjects | Code | Lang of Ans Code | Seat No | Year | Month | Marks Obt | |---|---|---|---|---|---|---|---| | 1 | Co English | 01 | | | | Feb O | | | | | | | | | Jul | | | 2 | | | | | | Feb O | | | | | | | | Jul | | 3 | | | | | | Feb O | | | | | | | | Jul | | 4 | | | | | | Feb O | | | | | | | | Jul | | 5 | Opt Subj | | | | | Feb O | | | | | | | | Jul | | 6 | | | | | | Feb O | | | | | | | | Jul | | 7 | | | | | | Feb O | | | | | | | | Jul | | 8 | Co Phy | | | | | Feb O | | | | | | | | Jul | | 9 | Environment Education | 30 | 31 | | | Feb O | | | | | | | | Jul | **NOTE:** 1) Please write 9 in case of exemption in column 'Lang of Ans code' and provide information in column under 'Exempted Subject Information'. ## MAHARASHTRA STATE BOARD OF SECONDARY & HIGHER SECONDARY EDUCATION, PUNE 411 004 APPLICATION FOR ADMISSION TO H.S.C. EXAMINATION OF FEB-MAR/JUL-AUG 20...... | 16 | Total No. of Exemption Claimed | 17 | Enrollment Certificate No(Private Candidate) | | | |---|---|---|---|---| | | | | | 1)Feb | Year | | | | 18 | Exam | | | | | Seat. No. | | | | Previous Examination | | | | | Month | Year | | | SSC | | | | | Mar O | Jul O | | | | XIth | | | | | Mar O | Jul O | | | 19 | Last Exam Seat No. (For Repeaters Only) | 1) Feb O | 2) Jul O | Year | Seat No | | | | 20 | Whether S.S.C. Examination passed from Maharashtra State Board of Secondary & Higher Secondary Education, Pune | Yes O | No O | | | | | | 21 | Whether Eligibility Certificate issued by Divisional board ? | 1) Yes O | 2) No O | Certificate No. | | | | **Details for reimbursement of fees to students of drought prone areas.** * A) Revenue Circle And Village * B) Account No of Student/parent * C) IFSC CODE * D) Account Holder * 1) Own O * 2) Father O * 3) Mother O * 3) Other Parent O **NOTE:** Colleges should submit following documents to the board as per candidate type: | **CANDIDATE TYPE** | **DOCUMENTS TO BE SUBMITTED TO BOARD** | |---|---| | 1) REPEATER CANDIDATE | Photocopies of statement of mark of all previous examination/s | | 2) ISOLATED CANDIDATE | Photocopies of statement of mark of all previous examination/s | | 3) CLASS IMPROVEMENT CANDIDATE | Photocopies of statement of mark of all previous examination/s | | 4) PRIVATE CANDIDATE | Photocopy of enrollment certificate | | 5) OTHER STATE BOARD'S CANDIDATE | Photocopy of eligibility certificate | **23 Undertaking by Candidate/Head of Institution** (१) मी खाली सही करणार उच्च माध्यमिक शालान्त प्रमाणपत्र परीक्षा फेब्रुवारी / जुलै २०..... प्रवेश अर्ज करीत आहे. मंडळाने वेळोवेळी निर्गमित केलेले सर्व नियम आणि सुचनांचे पालन करण्यास माझी सहमती आहे. शासनाने मान्य केलेल्या मंडळाच्या परीक्षा व त्यासंबंधीच्या विषययोजना याची मला माहिती आहे आणि मी चुकीची विषययोजना निवडली असेल तर त्या विषयांची संपादणूक रद्द करण्यासंबंधीचा मंडळाचा निर्णय माझेवर बंधनकारक असेल. (२) उमेदवारासाठीच्या सूचनांचे पत्र मला प्राप्त झाले असून ते माझ्यावर बंधनकारक राहील. (3) संस्था प्रमुखांकडून मला परीक्षा शुल्काची पोहोच पावती प्राप्त झाली आहे. (४) मी यापुर्वी कधीही महाराष्ट्र राज्य माध्यमिक व उच्च माध्यमिक शिक्षण मंडळाने घेतलेली उच्च माध्यमिक शालान्त प्रमाणपत्र परीक्षा किंवा इतर कोणतेही वैधानिक मंडळ यांची इतर कोणतीही समतुल्य परीक्षा (श्रेणी सुधार/तुरळक विषय घेवून प्रविष्ट विद्यार्थ्यांव्यतिरीक्त) उत्तीर्ण झालेली/झालेलो नाही. (5) मंडळामार्फत फेब्रुवारी - मार्च/जुलै/ऑगस्ट २०.... मध्ये घेण्यात येणाऱ्या परीक्षेचे माझे संपूर्ण शुल्क (विलंब, अतिविलंब इ. सह) मंडळाकडे जमा झाल्याशिवाय माझा निकाल जाहीर केला जाणार नाही याची मला पूर्ण जाणीव आहे. **Place** **Date:** **Signature of Candidate** (i) I hereby certify that the information given by the candidate has been verified by me and is found to be correct. (ii) I certify that a receipt of EXAMINATION FORM and FORM FEE along with the INSTRUCTIONS TO THE CANDIDATE have been given to the candidate. (iii) I certify that the candidate is eligible to appear for H.S.C. exam as per Boards regulations. **Signature and Seal of the Head of the Institution**