Scribd Logo
Upload

Welcome to Scribd!

  • 12 TH

    Uploaded by

    lalit
    9 views2 pages
    1. This document is an application form for a secondary school certificate examination in 2017. It requests the candidate to fill in personal details like name, father's name, date of birth, address, educational qualifications etc. 2. The form asks for information like gender, category, subjects to be chosen from the list, bank account details and income details to check eligibility for reservation/fee concession. 3. The candidate is warned that providing any false information could lead to cancellation of their examination form and results. The principal of the institution has to certify that the candidate fulfils the eligibility criteria to appear for the examination.

    Original Description:

    DETAIL

    Original Title

    12th

    Copyright

    © © All Rights Reserved

    Available Formats

    PDF, TXT or read online from Scribd

    Did you find this document useful?

    Is this content inappropriate?

    Report this Document
    1. This document is an application form for a secondary school certificate examination in 2017. It requests the candidate to fill in personal details like name, father's name, date of birth, address, educational qualifications etc. 2. The form asks for information like gender, category, subjects to be chosen from the list, bank account details and income details to check eligibility for reservation/fee concession. 3. The candidate is warned that providing any false information could lead to cancellation of their examination form and results. The principal of the institution has to certify that the candidate fulfils the eligibility criteria to appear for the examination.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Flag for inappropriate content
    Download as pdf or txt
    9 views2 pages

    12 TH

    Uploaded by

    lalit
    1. This document is an application form for a secondary school certificate examination in 2017. It requests the candidate to fill in personal details like name, father's name, date of birth, address, educational qualifications etc. 2. The form asks for information like gender, category, subjects to be chosen from the list, bank account details and income details to check eligibility for reservation/fee concession. 3. The candidate is warned that providing any false information could lead to cancellation of their examination form and results. The principal of the institution has to certify that the candidate fulfils the eligibility criteria to appear for the examination.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Flag for inappropriate content
    Download as pdf or txt
    of 2

    ek/;fed f'k{kk e.

    My] e/;ns ' k] Hkks i ky


    vkosnu i= gk;j lsd.Mjh lfVZfQdsV ijh{kk 2017
    lacaf/kr dksM uEcj gh [kkus esa Hkfj;s
    1 vkos n d
    dk iz d kj fu;fer&1 Lok/;k;h&2 fu;fer12oha Qs y &3 Lok/;k;h 12oha Qs y &4
    Js . kh lq / kkj fu;fer&5 Js . kh lq / kkj Lok/;k;h &6 vfrfjDr fo"k;&11
    ;fn Nk= us=ghu] ewd&cf/kj gS rks mldk izdkj & us = ghu ewd&cf/kj
    e/;iz n s ' k ds ewyfuoklh gk@ugh
    D;k vgZdkjh ijh{kk vU; cksMZ ls mRrh.kZ dh gS] ;fn gk rks cksMZ ,oa o"kZ dh tkudkjh vafdr djsaA o"kZ
    jksy uEcj cksMZ dk uke ifj.kke
    Js . kh
    .............................................................................................................................................................................................................................................................................
    3 vkosnd dk iwjk uke FULL NAME OF CANDIDATE

    4 firk dk iwjk uke FULL NAME OF FATHER

    5 ekrk dk iwjk uke FULL NAME OF MOTHER

    6 tUe frfFk
    va d ks a es a D D M M 1 9 Y Y tUe frfFk
    2 ftyk dks M fodkl [k.M dks M kkyk@vxz " ks . k la L Fkk dks M ukeka d u dks M

    ftys dk uke fodkl [k.M dk uke


    ek/;e
    fgUnh -1
    10oha dk jks y ua - o"kZ & vaxzsth -2
    mnwZ -3
    ds o y ek/;fed f'k{kk e.My] e-iz - ls vuq kh.kZ ] Js . kh lq / kkj vFkok vfrfjDr fo"k; ds Nk= dk vuq eka d &
    12oha dk jks y ua - o"kZ &
    lacaf/kr dksM ckWDl esa HkjsaA
    7 Hkk "k"kkk ,oa Mk;oflZQkbZM xzqi ds fo"k; fo"k;
    Hkk"k fo"k; dksM lwph vuqlkj gh Hkjs xzqi dksM xzqi uke

    Fke Hkk"kk fof'k"V &&&&&&&&&&& Fke fo"k; &&&&&&&&&&&&&&&&&&&&&


    f}rh; Hkk"kk lkekU; &&&&&&&&&&& f}rh; fo"k; &&&&&&&&&&&&&&&&&&&&&
    r`rh; fo"k; &&&&&&&&&&&&&&&&&&&&
    vfrfjDr fo"k; &&&&&&&&&&&&&&&&&&&&

    fo'ks"k Vhi %& us=ghu ewd&cf/kj ,oa LikfLVd lsjsfczy ikYlh ekufld :i ls fodykax oxZ ds fo|kfFkZ;ksa dks fof'k"V Hkk"kk ls NwV jgsxhA
    fo|kFkhZ fgUnh lkekU; vFkok vaxzsth lkekU; esa ls dksbZ ,d Hkk"kk dk p;u ikB~;ekuqlkj dj ldrs gSA
    8 i= Ooogkj dk irk &

    House No. : ijh{kkFkhZ dk


    uohure uke]
    Colony : fnukad
    a ;qDr
    fMftVy QksVks
    Town :

    Block :
    District :

    Phone No. : Pin:


    dkye ds vanj Nk= ds gLrk{kj
    Vhi%& Lok/;k;h ijh{kkFkhZ ftuds ikl fdlh Hkh cksMZ }kjk tkjh ukekadu ugha gS rFkk os cksMZ dh ijh{kk esa izFke ckj Lok/;k;h ijh{kkFkhZ ds :i
    esa 'kkfey gks jgs gSa] os xzkg;rk@ukekadu 'kqYd ijh{kk 'kqYd ds lkFk online tek djsaxsA
    9 Nk= dk vU; fooj.k %&

    fya x tkfr
    fcUnq - 11 ls 17 rd ds izdj.kksa esa l{ke vf/kdkjh
    ckyd -1 vuqlwfpr tkfr -1 fiNM+k oxZ-3
    ckfydk }kjk lR;kfir izek.k&i= layXu djuk vko';d gSA
    -2 vuqlwfpr tutkfr-2 lkekU; -4

    10- D;k vki e.My }kjk ekU;rk izkIr f'k{k.k laLFkkvksa ds lsok fuo`k f'k{kdksa ,oa jk"Vifr }kjk iqjLr e/;izns'k ds f'k{kdksa ds iq=@
    iqf=;ksa ds ijh{kkFkhZ gS \ gk ugha

    11- D;k vki e.My ds vf/kdkjh@deZpkfj;ksa ds iq=@iqf=;ka ijh{kkFkhZ gS \ gk ugha

    12- vki e.My }kjk ekU;rk izkIr f'k{k.k laLFkkvksa esa dk;Zjr~ f'k{kd@f'k{kdkvksa dh iq=@iqf=;ka ijh{kkFkhZ gS \ gk ugha

    13- D;k vki ,slh efgyk ijh{kkFkhZ gSA ftuds vfHkHkkodksa dh lHkh lzksrksa ls okf"kZd vk; :- 15]000@& ls vf/kd ugha gS \
    dsoy efgyk ijh{kkFkhZ ds fy, gk ugha
    14- D;k vkids ifjokj dh leLr lzksrkas ls okf"kZd vk; :- 1]00]000@& ,d yk[k ls vf/kd ugha gS \
    dsoy SC Nk=ksa ds fy, gk ugha
    15- D;k vkids ifjokj ds leLr lzksrkas ls okf"kZd vk; :- 1]08]000@& ,d yk[k vkB gtkj ls vf/kd ugha gS \
    dsoy ST Nk=ksa ds fy, gk ugha
    16- 'kkyk dh izos'k lwph esa ijh{kkFkhZ dk ljy ekad dsoy fu;fer ijh{kkFkhZvksa ds fy,

    17- layXu nLrkost dsoy vgZdkjh ijh{kk vU; cksMZ ls mRrh.kZ Nk=ksa ds fy,
    v LFkkukUrj.k izek.k i=A
    c izotZu izek.k&i=A
    c d{kk 11oha dh vadlwphA

    18.Bank A/c No. IFSC Code

    19. SSMID Aadhar No.

    ijh{kkFkhZ dh ?kks " k.kk


    esjs }kjk nh xbZ mijksDr tkudkjh lR; gS ;fn blesa fdlh izdkj dh vlR; tkudkjh ikbZ xbZ rks esjk ijh{kk vkosnu ,oa
    ijh{kk ifj.kke dHkh Hkh fujLr fd;k tk ldrk gSA

    ijh{kkFkhZ ds gLrk{kj

    izkpk;Z@vxzs"k.k laLFkk izkpk;Z dk izek.khdj.k


    esSa lacaf/kr nLrkostksa dh tkp mijkar izekf.kr djrk gw fd Nk= ijh{kk esa izfo"V gksus gsrq fu/kkZfjr ekin.M iw.kZ
    djrk gSA

    fnukad

    laLFkk ekad laLFkk dk uke gLrk{kj ineq n z k lfgr

    You might also like