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(wj nj) --------

SSLC nj ma brKiw gfhf

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Application for Enrollment to Practical Training Classes for the SSLC

Public Examination to be held in the academic year 2015 2016
(This form should be submitted in Duplicate to the respective
District Educational Office)
Affix here a

1
2

Name of the Applicant

:
recent Passport
Fathers Name/Mothers
:
size Photo
Name/Guardians Name
3 Sex
;
4 Date of Birth
:
5 Age as on 01.04.2016
:
`6 Permanent Residential
:
Address
7 Address for Communication :
8 Educational Qualification
:
9 Medium chosen for Practical :
classes
10 State whether Physically
:
challenged. If, so mention
the nature of physical
challenge
11 Fee Particulars Amount
:
Rs.125/- by cash
12 Contact Phone Number
:
13 Whether Self Addressed
:
cover with Postal stamp for
Rs.5/- enclosed
I do hereby declare that the particulars given above are true and to the best of my
knowledge.
Signature of the Parent/Guardian

Signature of the Student

Place:
Date:
For office use only
Name of Practical Class Centre Alloted:
Seat Assistant

Superintendent
DEO
Receipt
Received Rs.125/-(Rupees One Hundred and twenty five only) from --------- D.O.B. ------------by cash towards SSLC March 2016 Science Practical training fees.
Signature with office seal