BIHAR SCHOOL EXAMINATION BOARD

ONLINE APPLICATION FORM FOR COMPARTMENTAL-CUM-SPECIAL EXAMINATION, 2022

¼ijh{kk vkosnu dsoy अं ेजी ds cM+s v{kjksa ¼Block Letter½ म भरsa और येक श द कs chp एक बॉ स [kkyh j[ksa½
¼ijh{kk vkosnu i= ds lHkh fooj.k dsoy iath;u dkMZ ¼ Registration Card½ ds vuqlkj gh Hkjsa½
1. School Code 2. Registration No.- - -
3. School Name
(In English)
Colour
Photograph
4. Student's Name Size- 3.5 cm X 3.0 cm
(In English)

5. Father's Name
(In English)

Full Signature of Student

6. Gender (Please tick-√ ) Male Female Trans Gender
7. Caste Category
General EBC BC SC ST
(Please tick-√ )
8. Differently Abled
No. Yes Specify (if yes) 9. Visually Impaired Yes No
(Please tick-√ )
11.Aadhar No
10. Mobile No (Compulsory) (Not Compulsory)
12.Email-Id (Compulsory)
(If required, it may be changed
later on)
13. Student Category Regular Private Ex. Betterment Compart Single Sub.(Eng)
(Please tick-√ )
14. iwoZorhZ] dEikVZeUs Vy] ,dy fo"k; ¼vaxst
z h½ ,oa csVjesUV¼leqUur½ dksfV ds Nk=@Nk=k fuEufyf[kr fooj.k Hkjsa %
14.1. Roll Code 14.2. Roll No. 14.3. Prev. Exam Year
15. Nk=@Nk=k ijh{kk gsrq ikB~;Øekuqlkj fuEufyf[kr fo"k; dk p;u djsaA dEikVZeUs Vy dskfV ds Nk=@Nk=k vuqÙkh.kZ vf/kdÙke nks fo"k; ¼vaxst
z h
lfgr rhu fo"k;½ rFkk ,dy fo"k; ¼vaxsth½ ds Nk=@Nk=k ek= vaxst
z h fo"k; dk p;u djsa %
i. M.I.L.:
Hindi Urdu Bangla Maithili
(Please Tick -√)
ii. S.I.L. :
Sanskrit NLH (HIN) Arabic Persian Bhojpuri
(Please Tick -√)
iii. Compulsory:
(Please Tick -√) Mathematics Science Social Science English
For Visually
Impaired: Home Science (In lieu of Mathematics) Music (In lieu of Science)
iv. OPT. SUB.
(Please Write)

uksV % 1- fu;fer@Lora= dksfV ds iathd`r@vuqefr izkIr Nk=@Nk=k vius iath;u ds vuqlkj mi;qZDr dkWye dk fo"k; p;fur djsaxsA
2- ek/;fed ijh{kk] 2021 ds mÙkhZ.k Nk=@Nk=k csVjesUV¼leqUur½ ijh{kk ds fy, vius fdlh ,d ;k ,d ls vf/kd ;k lHkh mÙkhZ.k fo"k;@fo"k;ksa
dk p;u djsaxs rFkk dEikVZesUVy dksfV ds Nk=@Nk=k vius ek= vuqÙkh.kZ ,d ;k nks eq[; fo"k; ,oa vaxzsth fo"k; dk p;u djsaxsA
3- iwoZorhZ dksfV ds Nk=@Nk=k ds ijh{kk ds fo"k; muds iath;u dkMZ@iwoZ ijh{kk ds fo"k; ds vuqlkj gh gksxaAs

15.Address (Compulsory) :
(In English)

PIN:
ijh{kk vkosnu esa mi;qZDr vafdr fooj.k dk feyku
fo|ky; vfHkys[k@iath;u i=d ls dj fy;k x;k
esjs }kjk ijh{kk vkosnu esa Hkjk x;k lHkh fooj.k lgh gSA
gS tks lgh gS] ijh{kk vkosnu Lohdkj fd;k tk
ldrk gSA

Signature of Student in Hindi Signature of Student in English Signature of Parent /Guardian Signature of Principal & Seal
uksV % dkWye ua0 &09 n`f"V ckf/kr oSls fo|kfFkZ;ksa ds fy, gS] ftudk ijh{kk dk fo"k; xf.kr ds cnys x`g&foKku ,oa foKku ds cnys laxhr gksxkA