PUNJAB EXAMINATION COMMISSION

Sr. # _____

Private Student Registration Form for Exam 2015

Grade 5
Instructions:
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Form must be filled in BLOCK letters.

The form must be submitted at any cluster center in Punjab within due date.
In case of fake/unverified entry, strict action will be initiated against applicant.
The cluster center officials must verify the form after checking applicants credentials.
Attested copy of CNIC of parent/guardian must be attached with this form.
Copy of birth certificate/form B is also required for registration.
Please attach two attested photographs of applicant.

Student Information:

To be filled by Student/Parents

Father Name:
Father/ Guardian CNIC #
Student Name:

Student Date of Birth:

Student Gender:

Male

Female

Medium of Instruction:

Urdu

English

Islamiyat

Ethics

Select One Subject:

photograph here.

Postal Address: ____________________________________________________________________________________

_________________ Tehsil: ___________________ District: ________________ Contact # ____________________

I hereby acknowledge that all information given above is true/correct and in case of fake information,
I shall be held personally responsible.
Student Signature: _________________ Father/Guardian Signature: _______________

Date: ____/____/______

Form Verification

This Form must be verified by Head of the high school/Govt. Officer/Lumberdar.

Name:
________________________
CNIC # ____________________________
Mobile #
________________________
Office# ____________________________
It is certified that information given in this form is correct to the best of my knowledge.
Signature:

________________________

Stamp: ____________________________
For official Use Only
Date: ___/___/______

Computer Generated Form No. ______

Cluster center (CTSC) name: ______________________________________
(Write name of Cluster center where registered)

Name of Receiving officer: ___________________ Signature with stamp: ___________________

(Who received this form)

---------------------------------------------------------------Receipt:
It is certified that the registration form (Computer Generated Form No. _____) containing Private Student information for
Grade 5 registration has been verified and received on ___/___/_____ with complete information.
Name of Receiving Officer: _____________
Designation:

_____________

Signature: ___________
Stamp:

___________