Professional Documents
Culture Documents
Candidate'S Photo: D D M M Y Y Y Y
Candidate'S Photo: D D M M Y Y Y Y
1a Index No 1b UDISE No
1c Student saral ID - -
2a Appl..No b Centre No.
Last name/
3a
Surname
Candidate’s
3b
Name CANDIDATE’S
Middle/Father’s PHOTO
3c
Name
3d Mother’s Name
Residential
4
Address
Pin Code
5 Mobile No
CANDIDATE’S SIGNATURE
Place of
6
Birth
15 Subject Details
Lang *Exempted Subject Information
Sr. Subjects of
No. Ans
(Previously Passed Subjects in which candidate wish to claim exemption
Name Code code Seat No Month Year Marks Obt
st Jul
1 1 Language Mar O O
nd Jul
2 2 Language / NSQF Sub. Mar O O
rd Jul
3 3 Language Mar O O
Jul
4 Mathematics Mar O O
Jul
5 Science & Technology Mar O O
Jul
6 Social Sciences / NSQF Sub. Mar O O
Jul
7 Grade Sub (for Handicapped) Mar O O
J1 /J5 /J9 /K1 /K5 /L7 /M3 /M6
/M7
NOTE: 1) Please write 9 in case of exemption in column ‘Lang of Ans code’ and provide information in column under
‘Exempted Subject Information’
2) The handicap candidate offering special subject/s from the GRADE SUBJECTS group can only write their
code in the respective box and no need to circle corresponding BUBBLE (O) for the subject
16 Total No. of Exemption Claimed
PDBEDP/APPLICATIONS/HAPPL_M18_SSC.PDF
MAHARASHTRA STATE BOARD OF SECONDARY & HIGHER SECONDARY EDUCATION, PUNE 411 004
APPLICATION FOR ADMISSION TO S.S.C. EXAMINATION OF FEB-MAR/JUL-AUG 20……
Whether student going to apply for Sports, N. C. C. Scout/Guide, Art (classical art/folk art /drawing)
17
concession marks? िव�ाथ� क्रीडा, एन. सी. सी., �ाऊट/गाईड, कला (शा�ीय कला/लोककला /िचत्रकला) 1) Yes 2) No
सवलतीचे गुण िमळव�ासाठी अज� करणार आहे का ?
1)Mar
18 Enrollment Certificate No(Private Candidate) Year Enrollment No
O
Seat No
19 Last Exam Seat No. 1)Mar O 2)Jul O Year
NOTE : Schools 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
21 Undertaking by Candidate/Head of Institution (१) मी खाली सही करणार माध्यिमक शालान्त �माणप� परीक्षा
(i) I the undersigned hereby apply for the admission to the माचर्/जुलै २०..... �वेश अजर् करीत आहे. मंडळाने वेळोवेळी िनगर्िमत
SSC EXAM March/July 20…… I agree to abide by the के लेले सवर् िनयम आिण सुचनांचे पालन करण्यास माझी सहमती आहे.
regulations and all instructions issued by the Board time to
शासनाने मान्य के लेल्या मंडळाच्या परीक्षा व त्यासंबंधीच्या
time. I am aware of the scheme of subject combination and
examination of the Board approved by the Government and िवषययोजना याची मला मािहती आहे आिण मी चुक�ची िवषययोजना
I agree to abide by the decision of the Board to treated िनवडली असेल तर त्या िवषयांची संपादणूक र� करण्यासंबंधीचा
the performance of the subject as cancelled if wrong मंडळाचा िनणर्य माझेवर बंधनकारक असेल. ( २) उमेदवारासाठीच्या
combination of subjects if offered. (ii) I have received a सूचनांचे प� मला �ा� झाले असून ते माझ्यावर बंधनकारक राहील.
copy of the INSTRUCTIONS TO THE CANDIDATE and (३) संस्था �मुखांकडू न मला परीक्षा शुल्काची पोहोच पावती �ा�
undertake to abide by them (iii) I have received a receipt of
झाली आहे. ( ४) मी यापुव� कधीही महारा� राज्य माध्यिमक व उ�
the EXAMINATION FEE from the Head of the Institution.
(iv) I HAVE NOT PASSED S.S.C. Examination conducted माध्यिमक िशक्षण मंडळाने घेतलेली माध्यिमक शालान्त �माणप�
by the Maharashtra State Board of Secondary & higher परीक्षा �कवा इतर कोणतेही वैधािनक मंडळ यांची इतर कोणतीही
Secondary Education or any other equivalent Examination समतुल्य परीक्षा ( �ेणी सुधार/तुरळक िवषय घेवून प्रिव�
(other than those appearing for Isolated Subject/class िव�ा�ा��ितरी�) उ�ीणर् झालेली/झालेलो नाही. (5) मंडळामाफर् त
Improvement) of any statutory Board. (v) I am fully aware माचर्/जुलै/ऑगस्ट २०..... मध्ये घेण्यात येणाऱ्या परीक्षेचे माझे संपूणर्
that… along with unless and until the full fees (late and
शुल्क (िवलंब, अितिवलंब इ. सह) मंडळाकडे जमा झाल्यािशवाय माझा
additional late fees) paid by me, for the examination to be
held in February-March/July-August 20…… is actually िनकाल जाहीर के ला जाणार नाही याची मला पूणर् जाणीव आहे.
received by the Board. My result will not be declared.
Signature and Seal of the Head of the Institution मुख्याध्यापकाची स्वाक्षरी व शाळे चा िश�ा
PDBEDP/APPLICATIONS/HAPPL_M18_SSC.PDF
MAHARASHTRA STATE BOARD OF SECONDARY & HIGHER SECONDARY EDUCATION, PUNE 411 004
APPLICATION FOR ADMISSION TO S.S.C. EXAMINATION OF FEB-MAR/JUL-AUG 20……
PDBEDP/APPLICATIONS/HAPPL_M18_SSC.PDF