Application Form Secondary-(FRESH) EXAM.

MARCH-2024

Personal Information
Registration Number : HOS10-12496971 District : FARIDABAD
Student's Name : KUSUM Father's Name MAHESH
Photograph
:
Mother's Name : DURGA Date of Birth : 10/10/1999
Gender : FEMALE Category BC-B
Differently Abled : SELECT Area of URBAN
Residence :
Aadhar Card No : 277484869483 Class 10
Certificate Issue Authority govt.of NCT of Issue Date Signature
Name(Birth Proof) : delhi 21/2/2018
Medium of Study : HINDI

Corresponding Address
Add. Line 1: NACHAULI
Add. Line 2: NEAR SACHIWALYE Add. Line 3:
State : HARYANA District FARIDABAD
Pincode : 121002 Mobile : 8447881030
Email Address : VEER2003TIWARI@GMAIL.COM Telephone No :

Subject Details
Subject 1 : HINDI Subject 2 : ENGLISH
Subject 3 : MATHEMATICS Subject 4 : SOCIAL SCIENCE
Subject 5 : SCIENCE & Optional Subject : HOME SCIENCE
TECHNOLOGY
Center Detail
Center Name : FARIDABAD Center Tehsil : FARIDABAD

Payment Details
Payment Status : SUCCESS Merchant Trans_ID : 150337491
Transaction Amount : 1550.00 Transaction ID : 11000192775169
Transaction Date: 10/11/2023
Declaration
It is certified that the information given on the form is correct and has been checked by me.

Note: Candidates are advised to submit self attested hard copy of application, along with proof
of Original copy of Date of Birth Certificate/School Leaving Certificate/Matric Fail
Certificate/Photocopy of Middle Pass/Fail Certificates sent to Asstt. Secretary (Haryana Open
School), Board of School Education Haryana, Bhiwani-127021 by post or in person within 07
days of application submission.
 paste your
passport size
Student's Signature
photograph
here

For Office Use Only

It is certified that the information given in the application form has

been sertinized/check.

Eligible/Not Eligible:........................
Reason for not being eligible:................
D.E.Op./Clerk Assistant Superintendent