fasma By *EI/Not for sale Case No. aero wa wae & fore sree wort wer wT FOR OFFICE USE at) ont ft staat of weit a on wed 81 Received Rs. Vide Use separate form for each certificate/document ‘Scroll No. .. photocopy of the Form can also be used, ae ort Aayag. H anege 8 of sreccits fen oT warn B) .(For Office Use) ote wee fren as Central Board of Secondary Education BAU BALA /arery MATES / HPAP sow weAtoka TVLya/seae wa Be S fay ones TAL Application form for obtaining Migration Certificate/Provisional Certificate/Certificate of Date of Birth/Duplicate Passing Certificate/Duplicate Marks Statement Cashier Bank Incharge This form can also be downloaded from CBSE website : www.chse.nic.in/publicportal/Forms exe aeNe 10. 1. 12. 13, ea oe ae A yw F gad ae wT Pea BH art Fw Read directions printed overleaf carefully before filling this form BIBT wT FI/Name of the candidate vi fei 1 =TH/Father’s Name ... ARH I 7P}/Mother's Name rife THT-7a WI _ATH/Name of the Certificate required ‘iler sieenften (ae1/T)/For Marks statement indicate Main or Compartment. wat wary af ya #TB/Name of Exam with Year & Month ‘SFATI/ROI No. cont Fe/Result i frost srgarie (aft qye Prue 4 gare wien &1 & a1 "4 ah 8)/Previous Roll No. if placed or passed in Compartment/Improvement of Performance, rere an ary reel aden A ag of CAT kee BH tera ogi waa & Ferg order fren @)Subject offered (If applying for a Marks Statement or Duplicate Certificate) T z 3. 4 S: 6. TORT OTA OTT & ACTS BT AT WAS BA CTA SAT WETS WIA TAG Name of the School of the Regular Candidate .......... Private candidate write only as ‘Private Candidate’ SAR oT MAME. & Ret A eat 2). Date of Birth (As recorded in CBSE records). ‘prare a tar —reng (aR af ere we Setar erafara H omar reer 8) Peas sine /mree eeeat onde | aR APTA Feats gree aes one 4 Bt a Gee ae see ARR, Fels, fr We Te of warmer or fern & Mode of payment ie. Cashii personally depositing a tne Regional Ofice)D.D/P.O, please indicate its No., Date, Amount & details of issuing Bank/Post office here: ie = rir! WM IT/Candidate’s correspondence Addres fi @rg/Pin Code......... fRaiw/Date yee /Phone No. SIGH /BTA/ TTA % TUTER/ Signature of the Applican/Candidate eefat wre va ure ae & fee Tar wIa/orm ert wad a eee feet Te) For Duplicate Certificate, the application must be signed by the Candidate himself/herself only‘Barf. & afr Trafera/Regional Offices of CBSE - Website : www.cbse.gov.in OR aaa @raiea/Regional Office MYER F4/Jurisdiction aaa TaIeT/Regional Office afer &1/Jurisdiction aay feet we frtahh we har, Soft erafereseregen| TH ME PEN, ARTE Tee, aoa arate - feet Delhi & Foreigna Schools |] taey_5 ora, efearon iq 12, sategera Tel :011-2239177-80 i fe ed sites ze ‘&. Fax : 011-22248990 ‘waget—134109 ) |J & K, Himachal Pradesh, a EES a Telex: 68015-CNSE-N _|| CBSE Regional Offic Punjab, Haryana & U.T. of ‘yaeéera, fea - 110092 Rar Panchkula Chandigarh CBSE Regional Office cbsedli@nda.vsni.net.in Sector- Tel : 0172-2585193, 2583547, Delhi rodelhi.cbse@nic.in Panchkula-134109 2606184 PS. - 1-2, Institutional Area, (Haryana) Fax : 0172-2585163 LP. Extn, Patparganj, ropanckula.cbse@nic.in Emeil Deihi-92 \d@sancharnet in Aaing. eta oiea, [oer see, mina waaay. TORUS, YORI, RATE, Fares Uttar Pradesh, Uttaranchal || xfoned orafera-sorte area ote ry wie ve 2 @, Rafts eer, ee (072 Hetsems art, sre - 305001 a eee ; radesh, Dadara & Nagar esha, fates ares, Fax : 0532-2602077 (eros) Haveli ‘Fererare . 211001 (8.5.) Email CBSE Registered Office, Tel : 0145-2627460, 2877451, CBSE Regional Office, cbseald@sancharmet.in Aimer 2421543, 2627139 Allahabad (0532-2408971-72 ‘Toder Mal Marg, Fax : 0145-2421543 35-B Civil Station, M.G. Merg, 2407970, 2407710 Ajmer-305001 (Rajasthan) Telex : 303-237 CBSE-IN Civil Lines, Allahabad- 211001 Telefax - 2407970 Email : cbseajm@vsni.net.in (UP) roallahabad.cbse.@nic.in roajmer.cbse@nic.in Aenean Rafeera, ore, tarera, Wtiewd, dota orafratery | rere g, tha, wee, Shilpgram Road orooraa wee, args, |] care vi, 1630- siren, Perry, Bea, Necr Sankardev Kolakshetro | aftrge, Fage, rte Sears sion are (stem) | SSE, sivas ote Prater Panjabari sikkim, Assam, art . 600040 (after) | ATW aR we aera ote PR Guwahati ~ 781 037 Meghalaya, Arunachal Regional Office, Chennai Maharashtra, Goa, Karnatal Pradesh, Nagaland, Plot No. 1630-A, Block Andhra Pradesh ete Menipus Tripura ‘Anna Nagar (west) Tomi Hach, Kerala, ajgarh Road, Rajgarh - Chennai-600040 luchery, House No. 10, Seuj Sarani, _| Te! 0361-2229002-85 (Tamil Nadu) ‘Andaman & Nicobar LLakhimi Nagar, Hathigaon, _| Telex: 0286-2402 CBSE-N’ |) Emat Island and Daman & Diu Laie Nagas as Fax: 036%-2229004 chserom@giasmdolveninet.in | Tel: 044-26161100, 26162244] Email: ebseghy@auwi.net.n || Email: cserom@hotmail.com | 26162212 roguwahati.chse@nic.in Fax: 044-26162212 Rte, sears aaa, deta aratera es ee Complex Bihar, Jharkhand awe, 6a 7a Orissa, Chattisgarh, West Nee en coon orate are tetas, erfte | Bengal Sea vompestian are, YET 8751007 wet I ‘eekhpure i Bailley Road. 6th floor, Alok Bharti Complex, Bos Shaheed Nagar, Bhubneshwar| ‘tna - 800014 =7510007 ORISSA rax-vorezoszzwe —————— Tel: 0674.2547312 Email: ropatna cbse@nicin Fax: 0874-2542312 Email | robhubneshwar.cbse@nic in : 6. até & fA asta orate A wae Rael A ada Ret aaa rai REGIONAL OFFICES | wen w came Rare "AVAILABLE EXAMINATION RECORD (Year wise) eae DelhiForeign 2003 8 ott TH 2003 onwards - till date ae ‘Allahabad 2001 @ sia TH 2001 onwards - tl dete Chennai 1901 a oa we 7981 onwards - i date 2002 8 a ae 2002 onwards - tl date | 2001 @ sia ae 2001 onwards - til date Ba oan Red oon eee Ty a a wr ore ata wala wr ee Row Aimer (Registered Office) | Own Region records + Balance records of other Regional Ofices of years earlier than ce those indicated above ae 2011 & 2011 onwards Bee 2011 & 2011 onwards aSee ae a a ee ‘Sew, ard, srg hh ee fen (1) eT (2) we (9) he 8 sreeaar a8 #1 Note : For Migration, Provisional, Marksheet and Date of Birth Certificate following formaities (1) Attestation (2) ‘Affidavit and (3) Press Notification are not required. ref tte hoe ker ere GARR ar wesw Fe ahd The following requirements are necessary for obtaining Duplicate Copy of Qualifying Certificate only (1)sgemer/Attestation Sa ced of umrem hv we Ab ate wd hE a ces A agISR aid wet A omit wea G1 have verified the bonafide of the candidate snd recommend that @ duplicate copy of the Board's certficate may be issued to hime. @ eae (ie ita) Signature (with Stamp) surnand worth aftert/Prncipal of Gazetted Officer sraesry/AFFIDAVIT ‘reer 101, wet a erent tees ee we re mar A ee seer het fs eT ee ee Affidavit to be executed on Non-Judicial Stamp Paper of Rs. 10/- ‘The affidavit must be attested by {st Class Magistrate or a Notary Public. vrehet 4 gpvggh rem ee ae wen (7 CRs nhs /eme ati en Pere ga RE AER AY 120. OM be A RT A Ro TS TT re ec a He A wet pata ae men am] ae a sa Res AR a ee a OR, sea set fat 8 Ge ey oh Ae ar hee fo shee ot ee wan FORMAT NOTE: | ssonidaughter of declare on oath that my Qualifying/passing Certificate issued by the Central Board of Secondary Education of having passed the Secondary/Senior Secondary Examination in the year 19.../ 200... from school of privately, has been actually ostdestroyedimutilated and that i is my true statement. ‘My Roll No. was... ‘Sworn before me on this day of... (Date) ‘SIGNATURE OF CANDIDATEIDEPONENT Ba Permanent Address. Signature & Seal ofthe 1st Ciass Magistrate or Notary Public ‘ie siirguevPRESS NOTIFICATION fet A one the sam sch w OA wea 8 oe iene wg ge FER AR aT TONNE TB em eH wR se ql ate fet se # aL TY OMe ge GC, ere A aT ek eS aA we A ‘ga af oo ca mica Aap nae uaa fl a oR /aaI wa roe pre OR, see PRESS NOTIFICATION Note To be published in any one (English or Hind] National daily newspaper ‘origional Ful pane of the concerned Newspaper hiahting the portion of the matter should be enclosed withthe form EC 11 Js notified fer the information that my OriginalDupicate Qualifying Examination Certificate of Main/Compartment, Second- ‘any/Senior Secondary Examination Of Year cr €90 ROW NO. «nnn ISSUed by CBSE has been actually lostidestroyed! mutilated. Name of the candidate Full Address A mg RL: A) sens eH 8) om we AA. _ ye ail eh Sw ore A aA a a as, « st) oeroct & renee rach tetra to ater ‘Amount Deposited : (In figures) Rs. s-ssnsen(IM WOFKS) RS. Date of Deposit Roll No. svn Year of passing. Paid into the credit of §.8. .. snnnsns Of CBSE on account of Migration Certficete/ Provisional Certicate/Certiicate of Date of Birh/Duplicate passing Certificate/Marks - Statement. Name ‘Amount Rs. (Rs seencOMI9) of Candidate Sign of Depositor Scrot! No. Cashier Bank officerswoftel $ very fréw/Direction forthe Guidance of Applicants ee wen 8 de a0 8 at gh A wt oes er ge Satya A Triplicate OR further copies of qualifying certificates shall not be issued unless the controller of Examinationithe concemed Reglonelofcer is further satisfied by some éocumentary evidence that the duplicate/as issued copy has also been actually lost destroyed 2 eehers see wef or/orme a ot rr ohh whan hs Rog ed & eT Sh EAI A UA Th ‘Riera wee ar anczere @ whe A adr a ger ey Migration certificate is issued only to those candidates who have passed on examination of the Board orto those who have been placed in Re-Compartmentimprovement of Performance category, n order to enable them to seek admission eleewhere for 2 further course of study 3. ey a guration Fre far fo rd aor re sen ans & Py no a wt Failed candidate & improvemen/Additonal subject examination candidate should not aply ether for Migration cetiicate or provisional certificate sre oa /GRG omer a wen hd we ae amet hae ns ne Pn a, ES we hn we 4. samen nt Be ar oe) Paths apa erg wee ora ci ea A a BRAY Provisional Certficate is issued toa private candidate, who has passed Secondary/Sr. Secondary Examination, ony ti the ssuance of the main quaiying cerifate by the Board Regular schoo! candidate may obtain ther provisional certicate from their respective school only. ys retire centr er ae a ee (eA ae WB fg fs Wr wa) wel oat wed ex fete meta eRe Gee Rs,100/- Teen aeaa ee | ww emte ee ge R5.200/- fe 15 ard Rare (gReat aT otras awe ares 3.00 a | ert ete me wT RUZ wie (Rea ahem) x steer 3h Foor wats wanssemder stent | eiasoowa Seweee wan sae ue 8 0 8m Se ee sae rc es ED sa ote core 9.0 481.00 baer | SEE HE ew 950 ps oo eh wr rr 930 gE A 4.00 (reas we wt fer we me sae wie wate Pie pew °5:100/- wie wate 8 fe germ R5-200/- IR wen 5 (eT ARTA A OTK 2 (TT mee) 36): (oat & are # RR) 735i (awe 8 ate & fe) Senta gat 40-45 wed Fee rortol # gf 15-18 od Root A edd $e wep wo PROINARY BASIS URGENT BASIS epost cotton By Hane Deposit/Collection By Hand | oe foreach documenta Ra °100/- Fee foreach document —RS.200/- | ocuments will be issued on The presccworrof receipt after 15 Documents will be issued ore prowew~—--o receipt aftor 2 rking days (excluding holidays) between 3 p.m. to §.m. from | working days (excluding holidays) between 3 p.m. to 5 he concemed Regional Office of the Board Fee depositing ming : | p.m, om the _concemed Regional Office of the Board 30 am. 0 1 pam. on all working days, Migration Certificate to Local candidates shall be issued ‘on the same day of depositing a fee of Rs. 100.00 Provisionat Certificate shall be issued only to, local Private) candidates on the same day of depositing a fee of Rs. 100.00 Fee depositing timing : 9°30 am to 1:00 pm on all working days By Post Delivery By Post Delivery ee for each document _R5.100/- Fee for each document Rs, Rs.200/- otal Postal charges Rs. 25100 (Tor Coca candidates) Total Postal charges Rs. 25.0u wor cover vereniates) Rs. 35.00 (For outstation candidates) Rs. 36,00 (For outstation candidates) Belvery of documents} within 40-45 days Deilvery of document(s) within 15-18 working days at the respective ediress of the candidate through speed/Revistered| Post. EE