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Form No.

5731

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Roll No.

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CENTRAL BOARD OF SECONDARY EDUCATION, DELHI

For Olfice Use

Regional Ofiice, Todarmal Marg, Ajmer (Raj.)305 030

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Apolication Form For Private Candidate (Class Xll)-2015
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REno THE
tFie INSTRUCTIONS
rNrsrRUcroNS CAREFULLY
cAREFULLy BEFORE
B
FILLING THE FORM
For
Otfice
USE
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Receipt No
Passporl size pholograph duly
attested by lhe pincipal oI
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CBSE affiliated school lo b

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aftixed by candidale

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Signature of Cashier

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lmprovement

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Additional Subject
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Compartment
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OONOTSTAPLE

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C)/ )andidate's Name

previous senior school certificate Exam.

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Atl.itd PholocoDies ol allclass XllMark sheets ol pr.vious year{s)'nu5l be allachdd

in Full (lN BLOCK LETTERS

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/ Fatheis

Name in Full
LETTERS

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Disabiliiy

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olfered and medium olexamination code {Please See Inslruction)

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Marks Obtained

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Please fiovide previous year's practical Marks

Subject Code and Name

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Pin code

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be
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Note: Prac Fees is also requiredto
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exam. Fees @ Rs.40 Per Subiecl

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Full Signature ot the Candidate (in running hand)

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To be certified by ihe Principal of Affiliated School with CBSE, Delhi

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I certify that the candidate bears a good moral character and he / she has signed on this appllcation form,

photo and Admit Card in my.presence.

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The admission fee of the candidate is being remitted by Crossed Bank Drafl in favour of Secretary cBSE
Payable at AJMER (Raj.)

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I certiry

that.........

........... who appeared from

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.....................with

RollNo. ................... atthe Senior School Certificate Exam. March ............. and his/ her Resu1twas................

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I certify that he

/ she is appearing for Compartment / lmprovement of his / her performance in subject (s) /

Additional Subject and has not pursued higher studies after passing the examination.
5.

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No.

lf disqualified from appearing at any Examination, Roll

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Board i

University

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......Year.......................Name of

]IqFlrqrd signature of Principal

( fu{rtrq qt qt6{ stamp of the school)

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Date

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CENTRAL BOARD OF SECONDARY EDUCATION, DELHI

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Regional Office, Todarmat Marg, Ajmer (Raj.)305 030

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ALLINDIASENIORSCHOOLCERTIFTCATEEXAMINATION-2O15

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ADM|SS|ON CARD FOR pRtvATE CANDTDATE (CLASS X
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(All entries except Name of the centre and Roll No. should be filled in by the candidate in his/her own handwriting)

sr{frqi*. ( sid d ) Rol No. (tn figures)

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Roll No. (ln Words)

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category - Futt Subject

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Passport Size Photograph

to be affixed by the
candidate duly signed by
him / her and
countersigned by the
Principal of the CBSE
affiliated School.

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compartmenr
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Addt.

Mother's Name

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Father's / Guardian's Name

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Category of Physically Challenged Student

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Name of Centre (For office use)

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Subject Description

Medium

Date of Exam.

Time of Exam.

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For Date of Exam. Please

See the Date Sheet

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Time of Commencement
of Exam. 10:30 A.M.

Controller of Examinations
central Board of secondary Education

Attested)

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( Full Signature of the Candidate

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Address of the Candidate

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Candidate's Name

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Sub Code

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guardian, Mother,s name be teft btank

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The candidale must keep thisAdmil card et the time ot exemination snd produce it on demand to lhe Centre Superintendent or any olhe. person authodzed |n
lhb behelf.

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given
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name
list
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end
againsl each
in the
of candidales supplied lo
Candidale will be allolved lo appar in tho Subjects filled in by them theApplication
the cnlre. A cendideto shall nol ordinerilv be allowed to apDear in lhe subiecb/ courses olher lhan lhose given in lhe lisl
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v0er n Xd 'rq c{r B-dra
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lor lhe year^ol
Candidale wiJ
will b
b.xaminFd
xaminad o_!
onky in
in.the
the syllabu!.as
svllabus as pr*cribd
or*cribed l9r
vear ol Eraminalio.n.
Eraminalion.
Qandidale
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The code No. nd nar.r6 of sutiecl sl|ould be as oer cod lisl. In caso anv disc.ooancr comes lo notice. lhe code No. ol the Sutiect will be lrealed es co.rect

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6.

gook and lh sanre shall be checked and sioned bv lhe Assll. Suodt {s).
minut$ Extra) lhe students would read the Oueslrc'n Paper and plan pio
7.

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a oned b each candidate. Canddate I

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A seat marled wilh Roll Numbe,will be

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nd oul and occuDv his allotled seal.

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ve his / her seal or lhe examinalion hallbefore lhe end ofthe examinahon. No
communicale wilh theAsstl. Supdl., he shallstand up in his/ her place and the

9.

10.

swer book or drawing sheet etc olher than the space provided for the purpose,

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11.

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Condidale is raouirad lo b.

13.

'rA
iendenl
even thoigh the candidate may not have answered any pan of he

es of lhe oeoer.
oaoer.
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14.

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nd doing so during the course of exminalion shall be liable lo be expelled

expelle! from lhe

Etemna|oon uenr6 Dv tno buDennlendenl.

Eremna|oon

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No can
can

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hall be liable lo be cancelled and resull

candid
wilhh.ld.
(E)
iR ;
(a)
in lh6 paper concmed;
(q)
El yqr E{ T6t ?
(b) gilin or^rcQivlrfe$iltancc .directv or indirpclly of 4.ry kind ot?ttemplhg-lo
do so
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quolti4or aNwr on any malerjal other 0llan lhe answer boof( given by the Cent e Superinlendenl lor witing answers :
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(d) telnng ol^arypagg ot^th.aqlwor
boot or s^uPple$entary answer.book ,elc. i.
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connecl@n with lhe examinalion

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s.upplemenlay answer sheel or part theroot ; and

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thrcatanino anv ol the olliciab connected wilh lhe conduct of the examinalions or lhrealeninE of any of lhecandidales.

16.
r dudno lhe examinalion

lan Bae

17,

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afler lhe thrcl chance comptl, Exam. or He/she c5n

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lmarks ol his lirsl

tirsl eram. would
w.UEf6-6
b6 carried
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overupto z2

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Bob
lo
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paymenl ol Rs.
Rs 50/- bV submtting the prescribed applrcalion
lhe olfice ot the Board on payment
inslilulion concerned This will be issued by lhe
e dulv forwarded by lhe Head of the insl
ent / Oualifying
OualilYinq Cedilicl
Certilicte is received
till Marks Stalement
lill

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Controllerot Examinations

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All India Senior School Certificate (Class Xll) Examination, 2015

(To be retained by the candidate)
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Please read the instructions carefully before filling up the application form
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All entries should be filled in Block Capilal Letiers only without touching edges ol lhe boxes

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whiten lhe tlox and lhen wrile lhe
eraser or while lluid
oveMrile
cheraclers ll you wish lo change,
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new character.

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Name of cuardian is to be menhoned only in case of orphans (prefixes such as Shri/Sml be also wrilten in the names ol guardians) and column of
molher's name be lell blank-

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CANDIDATE S name, IttOTHER'S name and FATHER'S name be enlered as perexample Prefix such as MASTER, [4R, MISS, KUMARI, MRS.,
SHRI, OR , COL , BRIG, LATE, FULL STOP ANO CO^i[4AS must nol be used For Example :

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The code number of Subject and Medium should be enlered very carefully. Partlcular care should be taken for indicaling the Code against languages es there
are two types ol courses For medrum code write 1 for Engtish and 2 for Hindi For Language Medium Code is nol required

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Incomplele form is liable to be rejected.
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t

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The candidate.s Dracticat marks obtained in the main examinatron will be carried over lill lhe lhird chance compa.lmenlal eraminalion The candidate
shall have lhe oplion lo appear al lh6 practical examhalion in the subjects involving ptactical or retain their previous marks in one mor annual
examinalion allea lh lhird chanco compa menl

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A fa ure candic,ate has to re-appear in all lhe theory subjecl3 in lhe exam The practical marks of his / her first examination would be car.ied over uPto
lwo conseculive years aller his / her lirsl exam.

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6q

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td 3d Td

lo sppear es privale candidale

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Frcsh candidatei ere not eligible

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Candidale will be examined only in lhe Syllabus as prescibed lor the yoar of Examnation

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The cenlre once alloned will be linal and no request for change of centre will be attended to 6ven on account of change in residence

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Payment of Fees

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Oflice Ajmer
Candidales wilt deposil tee in form ot crossed Demand Oraft of Nationalised Bank in favour ol Secretary CBSE Payable at Regional

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candidate musl mention his/her name and roll no & year of previous exam on lhe reverse side of the Bank orall

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Informing lhe
reiecled
without
liable
to
be
will
differenl
add.ess
Note:. One candidate wt submrt onty one form. Filling of the lorm by candidate on
candidale,

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RULES FOR IMPROVEMENT OF PERFORMANCE

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{ FAvI r|IF t} mt t, e frard Frqtud qa * f{Enff * sq d ift qfrer t woi tr * qfr qfrar 3-*v{ ?i{i
* qrqrt f6S A RqFd t fear4 siql d {qR tE qq s{ * srfird * qrq rfi *a rrrrm t
n

cftsflrd

Th C.ndidsleg who havo pegged an examinetion of the Board may .eappar et lhe x;mination in the succeeding year only
tor improving their performanct in a subjecl (s) or in lhe whole examination p.ovided they hav6 not pursued higher gtudies in
ths meantim. Candid6ia who has passed under vocgtional sl.eam can feappeer in the succeeding yea. or in the following yea..
They should appear es privat candidate. Those reappearing in tho whote exahihation snd if permitted by the school may appear
as rgule, achool candidates in full subjects elso. Howevir, th6 candidates shall not be allowed lor improvement of Drfomance
afle, 9 lapse of one yar ater pagsing lhe oxaminalion under any ckcumstances.

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The last date lo. submlssion of tonn and fea fot ths improvehent ex.mination shall b the same as prescribed fo. reoular
pdvalo candidats

as ths case may

s. sial t

grrn + eaq w+sr

Ersrrqdr rfi tr

qd ql vqr q.nfr qm qfrqffitqT Em Itr

Th odginal mslk shet and crtilicte need not to

tonn for irDprovment of

or

b.

te

oic ntfuqi

*r

ccm q{ q}g E} Sn qrt

surondered by ttro canoiaate to the Board whil submining his/her apptiction

perlormance.

ql M ili*i { qqr t( cftEr i rt t T+ * Em firG eie gun M d i}i6 nr?trqr r<n +1 qqftr yt
Tq ct$ eik sim gun qtqn +1 qfi niq irFffir qrfr Tfi d vrEfr 1 66 Tqr lqrqr qr qrt rd fuqr qrqrn
r

Candid.ts who appe.r

tot

imp.ovment

ot

pertormanco

will be bsusd only statement of marks

impro\romont axminaton. No combined marks stiatement indicting pervious

msfis & merks of

aoftecting

th ma.ks of

impaovemenl gxaminalion will

No trssh cortifcatr vrlll be i$ugd.

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frqq {

b6

the

igsued.

frftq sregr 1r{ qfrfl (ql f6 qr{ z srtf, { *fr t) { qfrqr t ra t qr ffi ffs6 gm qftqr +
qtm i v;rar tr qa ffi Xro qSru * rrq <R frqc { ei6 gun rfr *r vear tr

Candidale! gppqaring at Socond Chsnc Compartment Eraminalion bs hld in M.rch ,/ April will not bg etigibl to. improvement of
hi! / hrr porfo.menco In .ny other subject .longlntth the cornpadment subject.

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fu

scar

tr

CandHato cnnot aPpa.

fot

improvmenl

of

a1

qtfl { Esi i{ra rfi frqr qr, :rio tun frqq +

pdo.manco

&

Additional subject togethe.

nrq qtqr n cfr

in which he / she hai not

.ppeE

th p.evioug yat

sctqmc ( Itk6F ) qtm nfua frqc { si6 grrr $ ei{S cfrfl t+ sre
rq}tnso t Srti si6 d qW Ei e-6< el fri qifi r
Candldate .ppcarlng for lmp.ovomnt

P.gctical will b

ffi

t ken into

In the Subject (s),

ffi d *{d

invotuing practicals will havo

fdkd

qfrqr

t it

ed

i.n

trft

to appea. onty in theory The otd marks of

account.

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d qs iin qrqw6 f,trr
ftcc'f

Bc{ fdfud qd rftniq-a vfrEr t erarr-sre'r cr EhT *{ qn

tram fi

In

hr

sublect(3) wheas Practlcal Ereminalion

of tho lwo will be

is

invofued, seperate pass in theory

compulsory.

&

Practical examination as also in the eggrgate

srfu-d

ELIGIBILTry CRITERIA,

1.

l
2

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u*

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qa

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q} Gdq sw{T{qr6

ftq

d, cr{+e 3{qaff

frFr

FEE SCHEDULE FORALL INDIASCHEME

srdtr d rrqT t

candidate who has faired at lhe Afi rndia senior school

cerrificate Exam,nal ion

of the Board.

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Those canditates who are erigibre for 2nd chance

comptt. shat appear as prvab candidates onry.

g' iqrqcfiiBfrqeF{R{rs*+rqt,
3

q.r qrr-<o-s,

', OF RECEIPTOF FORMSAND

DATE

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earT

frq qri erd

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vri c{

Thos. candidates who are eljgible for 2nd chance comptt. and wish
lo appear for the whole exam may appear as a p.vate
candidate or regular candidate, jf admjtted by the school as
regular student.

+' tvitftnftqcl*

ergvnrfrErddrFoq{ zorqql s{rfrkasa-mcrqfu+'tdarirqqfrqn{qqcqr1qfrrfudttmtaqr"..-u,r

srrA qd * Trdrgf,rt.i m.qw; cEc, Ffrq nsnTfrq srag{td

fl

or*s1 q1 q=t

i rrer*r s q.r{ rr$ t

st time in the Senior School Certificate Examinalion,2Ol4 and

ff iifi
qd qrd ffr{I

f{f,E

uld Frqfuka

ga
Pe-+tq

J,1"':

[iJi,'; # ],.'15 :3ffi J,:;:

ts fuaer zor4 (tc-qn) i6i slc[6 r qi a-o qr sst qt-d +c + E qf-dq

+ eqvn F+oe qte rfra vwr unat w w+ar }

"T:l#?ii:1."x1

qfa qrrr qrfrq rgsg qrq

This form should reach the Board's oflice on or belore 1 p.m.

on 15 sept 2014 (Monday) Form and lee may atso be deposited after the
above date in addition to other prescabed fee with following late
fees.

r. qfiqrrEw's

EqqT* frq

unat

Exam. Fee for 5 Subjects in India

Rs.6001

2. s{frfi.iru}frqq*ftqrp
Fee for Additionat 6th Subject

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7 r. gi6

Fee lor Comptt.

+.

Rs.250f

{rrn z t. srfrfi-t' frqc d

1. lmprovemenl

1.

fd{q

{6

Additional Subtect

Rs.250i

dsi*.t:rnM* Hvgm
Fee lot 2 ot more subjects for improvement

Rs.550/-

s. frrqrqrEr 3r+ {ERffi + frqyJai

Fee for 3 or more subjects for improvement

0. r&o r*.n"q-* fevc + 6U .,t*t' EftTrtrfi

Rs
qfrqTr

t*

{e'

600/-

( 4ol_ 6c} cfr fuqq ) rfr

qFrerd r
candidales who wanl to give theory exam (in which practical subject involved)
have to pay fee fof practical sub.iect also to carry
forward practical marks.

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ffi

a{

u-*mq+ giq ir ad

Addl Fee tor each practicarsubject. (to retain previous years pfacticar marksjor
fuf,q
Late Fee
16 September 20'14 30 September 2014 (Tuesday)
'15 October 2014 (Wednesday)
01 October 2014
16 October 2014 - 30 October 2014 (Thursday)
31 October 2014 to t5 December 2014 (N.4onday)
(For all the categoaes i.e. Regular, private
Full Subjects, Comptt. / tmprovement /
& Addilional Subject)

ges'

qFq

a-+ gfqrd

rs+

Fdq

consecitive years)

Rs.40/-

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t

iir q-ffi 3rre ard t<+s

Rs

150/-

Rs.250/.

Rs.350^
Rs.5,000f

In case, the last date is a holiday, the fee wilt be accepted on the next working day

fu

dm

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qt

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rrc+qn,..<r*rmnrffi ffi"ii#'9"99"""
';"d.
&
;=r*,"i
;ri*o'i"!il"

cujret. Madhye pradesh, Rajasrhan, Dadar

NagarHaveli

2.

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!-qvr

3.

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qrgFra

i"17'31"

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l"i'ff l;t""ffililf#

a.

Th Regionetoflicer,

Vnfud

Jammu & Kashmir' Puniab, union

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q$$fr

sfr{

oraDelhi' candidatos rrom Foreish counrdes

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rrga,

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Manipur' Mizoram, Nasarand,

Efirfu
Utlar Pradosh

cFEc tqrd, ESr,

B*f,rB

Wst Bengal, O.issa Chhatisgarh

I:ir[:'d::?l?l's::"ndaryEduca,ion
6rh Floor, Alok Bharti Cornpilgr,b_iirriei

Bhubaneshwar. orissa -

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rarr\sv!
Eihar and

f.

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Jhe*hend

itiRnt!.lt
Unarakhand

ro.

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Krgla & L.k3hsdweop

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rh'qil xil-2015 fqv{ER

ZF+[[{ITr+nq*

SUBJEGT.WISE LIST/GODE.WISE LIST OF CLASS XII.2O{5

CODE

MMEOFSUBJECT

CODE

NAMEOFSUBJECT

037 Psychology
1g7 Kashmiri
o3gSocio|ogy198|vlizo(specialinvestigationimaging
199 Bhasa Melayu
o4o Philosophy
301 Ensrishcore
041 Marhematics

coDE NAMEOFSUBJECT

643
644
654
655
656
657
658
659
660

661
662
663
664
665
666
667
668

ent & Housekeeping

065

Informatic

Praclices

105 Bengali
106 Tamil
107 Telugu
108 Sindhi
109 Maralhi
110 Gujarati
111 Manipuri
112 Malayalam
113 Oriya
t +ig qs taqq
. +t
Any one out of these subjects

Itions
of Bank Office
ience
es

621

Management

633
634
635
636
637
639
640

Air Conditionin

641
acz

Microbiology
Fundamentals of Nursing ll
Community Health Nursing ll
Maternity and Child Health Nursing ll
Radiation Physrcs
Radiography-l(General)

Radiographyll

3t3 i'g??::I"":i[33il*""
677

686
687
688
690
691
692

Establishment & Mgml. of Food

Service Unit

I"Jil"",i!'"J?"",,",nr"*"n
Clothing Conshuction
Basic Design
D'eing and Printing
Food Preparation ll
Accommodation Services
Food & Beverages Service ll

693
694

695

wer Planning

696

697

698
699
protection
299
avrour &

ClinicalBiochemistry

and Radiotherapy)

practces. 33:
& Accountancy

ion
omPuler
glish)
ish)
mputer
i)
'
lrng
Accountinq- &

Floricullure
Post Harvesting Tech Preservation
Beauty Theraphy & Hair Designing ll
Cosmetic Chemistry
Yoga Anatomy & Physiology
Biology(Opthalmlc)
Optics
OpthalmicTechnology
Laboratory Medicine
(Clinical Pathology, Haeomotology
& Histopathology)

Confectionery
lT Systems
Busine^ss^Data. Processing
D.T.P CAD & Multimedia

ill
Hiis#,1;'il1tHi:13E[lil'
704
705
706
712
716

Reference Services
Principal & Practice of Life lnsurance
Computer and Life Insurance Admn'
Transportation System & Management
Poultry ltutrition & Physiology

Refrioeralion I
Etectionic Dev
Radio Engg. &

Television & Video Syslem

736
Electrical Engineering
737
Milk and Milk Products
738
Milk Products - Transport and
739
Milk Cooperatives
Dairy Plant Instrumentation
74o
Vegetable Culture

Food Service - ll
Food & Beverage Cost & Control
underslanding The Evolution and
Forms of Mass Media - ll
The Cteative & Commercial Process
in Mass Media ' ll
Geospatial Technology - ll

qrfrq qrqfrmqE qfrelvqfso qrrdq qR qe etrfin*z q0m zots fr'

s{+qq q? +g 6mtcq El ifr( +,{i t Td 5.v<t w gFtr+t o'.t ai :
eqfu-d

Before sending application form to the Board's OfIice forAll India Secondary School
Exanr/All India Senior School Certificate Exam 2015 please ensure that :-

l.

qr+fi rr{ g{i qfrqnd

e{e

ERt ( block letters)

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Application form has been filled-in properly and adequately in hiVher hand writing in
block letters written neatly and legibly.

frqfRa rqn q{ E{rtrn .fir rdr fqsq

qqm q rKrlrm sl|6ql

ffi

qt lrq, <lq

*t

fc{ etc qFqfrd d, rq

A cornplete correspondence address including district name, state and pin code have
been'written at the proper place in block letters.
J.

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fiqitrc *qH q{ fi{q-srq

vrqrd am cFrcgtelRd

fia

en+qq

rd c{ fqq rK

Two photographs duly countersigned by the Principal ofthe school alliliated with this
Board have been affxed in the space provided in the form.

4.

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Fsrfrd yfrqr'rfr erq{q {d.{ E1 qT(,
An attested copy ofMarks Sheets / statement ofsubject wise performance ofclass
must be attached with the exam form.

qf( fu s{

t d nc q{ *

onq qq qrs S sc d vtcQt-qt

e1

vFc arq{q

XII

ridr{ qt

Ifthere is a gap year, original Affidavit mentioning reason ofgap year must be attached
herwift.

vtm go' t'

d RF'q, fr.d.\rs{., ervft

t' w

iq tcqis Erw "fr o'l of

A demand draft drawn in favour ofSecretary CBSE payable at Ajmer, has been attached
for remittance ofthe requisite exam fee.

7.

cqd

q1qff rd

+ srs Tiar{

i'1n

vor

tsni

twd qil rrrr {lcr

qi

frq

Ehis qFqFd

d,

qtr
Acknowledgement card supplied along with the foim has been attached with the form
filled in block letters with complete conesponding address including district name, state &
pin code.
Filled in complete corresponding address (IN BLOCK LETTERS) including district name,
state name and Pin Code in Acknowledgement card attachedwith the form.

8.

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Acknowledeement card has been enclosed.

lo

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