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fcgkj eqDr fo|ky;h f'k{k.k ,oa ijh{kk cksMZ] iVuk

BIHAR BOARD OF OPEN SCHOOLING AND EXAMINATION, PATNA

ek;fed@mPp ek;fed izos'k vkosnu&i=k & 2012-13

iQkWeZ la[;k
Form No.

vkosnu&i=k Hkjus ls igys funsZ'kksa dks vo'; i<+s

ewy izfr (eq[;ky;)

iQksVks
Photo

gLrk{kj

dk;kZy; mi;ksx gsrw

1- v;;u dsUnz gsrq izR;k;u dksM
'kqYd dk fooj.k & cSad MkWV @euhvkMZj@vkbZ-ih-vks-@uxn
jkf'k
jlhn la[;k
fnukad
v;;u dsUnz izR;k;u dksM & dafMdk 22 ds vk/kj ij Hkjk tkuk gSA*

gLrk{kj izHkkjh fc- eq- fo- f'k- ,oa i- cksMZ

1- fo|kFkhZ dk iwjk uke fgUnh esa/Full Name of the Candidate in Hindi

fo|kFkhZ dk iwjk uke vaxzsth esa/Full Name of the Candidate in English in CAPITAL Letters

2. firk@ifr dk iwjk uke vaxzsth esa/Full Name of the Father/Husband in CAPITAL Letters

3. ekrk dk iwjk uke vaxzsth esa/Full Name of the Mother in CAPITAL Letters

4. Ik=k&O;ogkj ds fy, irk/Postal Address in CAPITAL Letters

iz[k.M@Block
ftyk@District
fiu Pin
5. jk"Vh;rk@ Nationality*

jkT;@ State
nwjHkk"k

6. fyax@Gender*

7. tUefrfFk@ Date of Birth (dd-mm-yyyy)

8. oxZ@Category *
9. oafpr oxZ@Disadvantaged Group*
10. fodykaxrk@Disabled*
11. vkosnu dk ikB~;e@Course Applied for*
12. v;;u dk ek;e@Medium of Study*
13. iw.kZ ;ksX;rk@Previous Qualification*
14. fo"k;ksa dk pquko (U;wure 5 rFkk vf/dre 7 rkfydk&1 ns[ksa) iathdj.k ds ikpksa fo"k; vfuok;Z gSaA
Choose Subjects (Minimum 5 and Maximum 7, See Table-1)*

vfrfjDr fo"k; Additional Subject

1.

2.

3.

5.

6.

7.

4.

uksV % vkaf'kd@nksgjk ukekadu ds fo|kFkhZ vf/dre pkj fo"k;ksa esa gh iath;u djok ldrs gSaA
15. ek;fed ijh{kk/Xth Board Exam*
mkhZ.k gksus dk o"kZ Year of Passing
Name of the Board
16. 'kgjh@xzkeh.k@ Urban/Rural*
17. jkstxkj@Empolyment*

dsoy sfMV LFkkukarj.k (Vh-vks-lh-) fo|kfFkZ;ksa ds fy,

18. fcgkj fo|ky; ijh{kk lfefr @ jk"Vh; eqDr fo|ky;h f'k{kk laLFkku@ lhch,lbZ@vkbZlh,lbZ@ vU; jkT;ksa ds eqDr
fo|ky; @vU; jkT;ksa ds vkSipkfjd cksMZ@ fcgkj eqDr fo|ky;h f'k{k.k ,oa ijh{kk cksMZ*

fcgkj eqDr fo|ky;h f'k{k.k ,oa ijh{kk cksMZ ds l=k 2012&13 ds

fy,A(d) iath;u dk o"kZ@Year of Registration
([k) jksy uEcj@ Roll No.
(x) vuqkh.kZ gksus dk o"kZ@ Year of Failing
* vafdr dkWye ds fy, ifjf'k"V esa fn, x, funsZ'kksa dks ns[k dj gh HkjsaA

(?k) Vh-vks-lh- cksMZ dk dksM@ Code of the

T.O.C. Board
19. mkh.kZ fd, x, fo"k;ksa dk fooj.k ftudk sfMV LFkkukUrj.k djuk gks/Details of Subjects Passed for which
transfer of credit is opted (l=k&2006&07) ds iathr vuqkh.kZ fo|kfFkZ;ksa ds iqu% izos'k gsrq vf/dre pkj fo"k;
,oa vU; ds fy, vf/dre nks fo"k;)*

ijh{kk dk o"kZ fo"k;

fo"k; dksM

izkIrkad Marks

Year of Exam Subject(s)

Subjects Code

Theory

1.

....................

...................

.....................

2.

....................

...................

.....................

3.

....................

...................

.....................

4.

....................

...................

.....................

Sl. No.

Practical

Total

uksV %
1. vU; jkT;ksa ds vkSipkfjd f'k{kk cksM]Z lh-ch-,l-bZ-] vkbZ-lh-,l-bZ-] ,u-vkbZ-vks-,l- ,oa vU; jkT;ksa ds eqDr fo|ky;ksa ds

ikap o"kZ ds vuqkh.kZ fo|kfFkZ;ksa dks vf/dre nks mkh.kZ fo"k;ksa esa gh Vh-vks-lh- dk ykHk izkIr gks ldrk gSA
2. vU; jkT;ksa ds eqDr fo|ky;h esa iathd`r fo|kFkhZ tks ikp o"kZ esa mkh.kZ ugha gq;s gSa ,oa iqu% izos'k ysuk pkgrs gSa]
mUgsa vf/dre pkj mkh.kZ fo"k;ksa esa Vh-vks-lh- dk ykHk izkIr gks ldrk gSA
20. vkaf'kd iath;u gsrq mkh.kZ dk o"kZ ,oa cksMZ vuqekad/Year of passing and Roll No. of the board for the
Partial Registration **

ftlesa vkaf'kd izos'k

vuqekad
mkh.kZ dk o"kZ
21. o"kZ 2013 dh ijh{kk esa cSBus ds fo"k; (Subject in which you desire to appear in the Examination) vfrfjDr
fo"k; (Additional Subjects.*
1.

2.

3.

5.

6.

7.

4.

22. v;;u dsUnzkas dk p;u & viuh lqfo/kuqlkj] izkFkfedrk ds vk/kj ij ikp v;;u dsUnzksa ds uke ?kVrs e esa fy[ksa &*

-l1
2
3
4
5

v;;u ds dsUnz@laLFkk dk uke

iz[k.M dk uke

ftyk dk uke

iQkWeZ la[;k
Form No.

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fo|kFkhZ dh uke

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