Form A (Statistics) School Index No. Mar 04.

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(To be enclosed with each lot of applications forwarded to this office) To, The Secretary, Goa Board of Secondary & Higher Sec. Education, Alto-Betim, Goa. Sir/Madam, I forward herewith the applications of 03 candidate who have fulfilled the requirements as laid down in the regulations and are appearing at the ensuing S.S.C. Examination of March 2012. The centre wise distribution of the candidates sent for the examination by the school is as follows. Candidates Candidates appearing with appearing exemption in subjects Sr. Name of the for the No. Centre Involving Not Involving whole Practicals Practicals examination 01 Vasco 03 TOTAL 03 No. of candidates appearing in technical subjects --

Date: 05/12/2011 Place: Vadem Nagar Signature of the Head of the Institution

ADVICE NOTE C ACCOUNT OF FEES PAID To, The Secretary, Goa Board of Secondary & Higher Sec. Education, Alto-Betim, Goa.

School Index No. 04.13

Sub: Account of fees enclosed. Sir, Drawn on Please find enclosed herewith a crossed D.D.No. dt. Branch in cash for Rs. 1410/- (Rupees One Thousand Four Hundred Bank Ten only) towards the fees of candidates sent up for S.S.C examination of April 2012 from this school. The particulars of fees are as below. Sr. Fees for No. 1 Examination 2 Statement of Marks 3 Science Pract. Exam

Rate of Fees 410/60/-

Number of candidates Total paying respective fees Amount 03 1230/03 180/TOTAL 1410/-

Rs. 1410/- (Rupees One Thousand Four Hundred Ten only.)

Yours faithfully,

S. A. Kamat Headmistress