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    of 2

    MAHARASHTRA STATE BOARD OF SECONDARY & HIGHER SECONDARY EDUCATION, PUNE 411 004

    APPLICATION FORM TEMPLATE FOR H.S.C. EXAMINATION OF FEB-MAR/JUL-AUG 20……

    1a Index No 3 2 0 1 0 0 3 1b UDISE No 2 7 2 3 0 5 0 0 6 0 5

    1c Student saral ID - -

    b Centre No
    2a Appl.Sr.No

    CANDIDATE’S
    3a Last name
    PHOTO

    Surname

    3b Candidate’s Name

    3c Middle/Father’s
    Name

    CANDIDATE’S SIGNATURE

    3d Mother’s Name

    4 Residential Address _________________________________________________


    __________________________________________________ Pincode___________
    5 Mobile No 
    6 Date of Birth 7 Aadhaar No

    8 Stream 1) Science 2) Arts 3) Commerce

    9 Gender
    1) Male 2) Female
    Minority
    10 0) Hindu & other
    Religion Non-Minority 1) Muslim 2) Christian 3)Buddhist 4) Sikh 5) Parsi 6) Jain 7) Jew

    01) SC 02) ST 03) VJ(A) 04) NT(B) 05) NT(C) 06) NT(D)
    11 Category 07) OBC 08) SBC 09) OPEN 10) SEBC 11) EWS

    12 Divyang 00) No Handicapped 01 TO 22 ) If Divyang Candidate

    Medium of 1) English
    13
    Instruction

    A 1) Fresh 2) Repeater
    B 1) Regular 2) Private 3) Isolated 4) Class Improvement
    Type of
    14
    Candidate C 1) Exempted 2) Non-Exempted
    4) General
    D 2) Bifocal (CS/EL) 3) IT
    E Whether foreigner 1) Yes 2) No
    15 Subject Details

    Lan *Exempted Subject Information


    Subjects g of
    Sr. Ans (Previously Passed Subjects in which candidate wish to claim exemption
    No. cod
    Name Code Seat No Month Year Marks Obt
    e

    1 English 0 1 Feb O Jul O


    Co
    m

    2
    Subj
    Feb O Jul O

    3 Feb O Jul O

    4 Feb O Jul O

    5
    Opt.
    Feb O Jul O
    Subj

    6 Feb O Jul O

    7 Feb O Jul O

    8 Physical Education 3 0 Feb O Jul O


    Co
    m

    9
    Subj
    Environment Education 3 1 Feb O Jul O

    NOTE: Please write 9 in case of exemption in column ‘Lang of Ans code’ and provide information in column under ‘Exempted Subject
    Information’
    \\

    16 Total No. of Exemption Claimed

    17 a) Amount of Fees Being paid by candidate as per College Notice ___________


    b) Subjects Combina on men oned in the College No ce for this fee amount_____________

    1)Feb
    18 Enrollment Certificate No(Private Candidate) Year Enrollment No
    O

    19 Exam Seat. No. Month Year Name of board / Jr. College


    Previous
    SSC Mar O Jul O
    Examination
    19 Total No.
    of Mar O Jul O
    Exemption
    Claimed XIth

    Passing Details

    Seat No
    20 Last Exam Seat No.(For Repeaters Only) 1)Feb/Mar. O 2) Jul O Year

    21 Whether S.S.C. Examination passed from Maharashtra State Board of Secondary & Higher Secondary Education, Pune

    1) Yes O 2) No O

    22 If answer to 21 is Yes (other Board), then


    whether Eligibility Certificate issued by Divisional board ? 1) Yes O 2) No O
    If Yes, then Certificate No.

    22

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