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Biv. Eddrdtary'
 FORM NO. I (H. S. C.)

FORU OF',DECLARATION TO BE MADE BY THE JUNIOR COLTEGE

(To be used for change'in Name of the H. S. Certificate when the Name of Candidate
' is not ul.ordirrg to the Ceneral Register of tte lr. College)

, Principal ofthe Jr. Co,llege

1) That lhave beenPrincipal ofthe Jr. College

, since20

2) Tha,t I haveverifidd the coltrege gerleral register and found tliat the.entry ofthe name of the candidate

as recorded therein is andnot

as, inqorrectly showE in the
candidete's applicatiorr for admissior,'l'to drell- S, C. Examination and in thell. S- Certificate ofthe
said candidate bearing Seat No " oftheH. S. C- Exanrinationof
Feb. / March / July /Oct. 20

-.
3) Thatthe saidenfy hasnot, totheb.estofnny knowledgeandbelief, been erased altered orqorrected
since it was originally made.

4) Thar an incorrect date ofbirth was recorded in the applicatio n of the said candidate for admission to

the H. S. C. Examinatio.n of Feb. / M#ch I Jrily / Oct 20- , . by Cterical mistake as stated
below

5) I thecandidatepassedtheH. S. C. ExaminationofFeb. /March/July / Ad.20 at

Seat No. and his i her H. S. Certificate is enclosed herewith for correction.

6) ' IndexNo.ofJr. College:

Signafure:
-
Principal

Copnter Signature :

Place: Dy. Director of Education,

Date: : PuneDivision.Pune
-
FORM NO. 1 (S. S. C.)

FORM OF DECLARAIION TO BE MADE BY THE HEAD OF THE SCHOOL

(To be used for change in Name of the S. S. Certificate when Name of Candidate
is not according to the General Register)

Head Master ofthe school

do hereby declares and says as fotrlops :

l) ThatlhavebeenHeadMaster/FleadMistressofthe
, sinoe20l

2) . Thatlhave examined that school register and have found.that the original entryrofthe candidbte" as,

recordedtherein is and,not

as incorrectly shown in gardi'date"s application for, admissiot* to, tlie,

Eiamination and S. S. Certificate ofthe said candidatebeming SeatNo.

ofthe S. S. C. Examination ofMarch/Julv/Qct.20

3) That the said entry has not, to the best ofmyknowledge and belief, been erased, altered or c.errsctedi

since it was originally made.

4) Thar an incorrect name was recorded in the application of the said candidate frr admission of.the
. .S. S. C. ExarninationofMarch/JulylOct.20 . byClericalmistake as statedbetro.w-
.
\

.,. l,

5) The said candidatepassed ofthe S. S. C. Examination ofMarch/July/Oct. at SeatNo. ,'

and S. S. Ce; iificate is enclosed herewith for correction.

6) IndexNo.oftheHighSchool:

Place

Date: Signature:

Hpad Master i H. Mistress

School

Countersignedby
Education Offrcer,

Pune / Ahme dnagar I Solapur

 FORMNO.2 (S. S. c.)

FORM sS DECLA RATTON'TO tsE nnamnmy THs rymAD QF THS SCHOOT

/T h, : used for c,harye in Date of Birft of S. S. C. Certificate)
\ ^b

Hea{ilMaster / HeadAlGstres so f
dohebby declares andaays as follows :

1) That I hsv,e beenHdfu'{aster / Headh&isffess of,the

, since20
l

2) ffimt I hrytersxamined1.*wt school register,and have found that the date of birth of the candidate
as recordedtherein is dayof
offhe year (In figure ).

3) That the said e-ntry has not, to the best of my knowledge and belief; been erased, altered or corrected

since :it was originally made,

4) Thar an'incorrect tdate ofbirth was recorded in the application ofthe said candidate for admission to

the S' S' C. Examination ofMarch I July lOct.20 by Clerical mistake as stated below

-5) Thesaidcandidatepassedofthes.S.C.ExaminationofMarch/July/Oct.20 under

Seathlo. and S. S. Certificate is enclosedherewith forcorrection.

6) IndexNo. ofthe l{igh School :

(Head Master I Head Mistress)

Piace: School:

Date: Countersigned:

(Education Offrcer)

Pune /Ahmednagar / Solapur