BY HAND /

POST

BOARD OF INTERMEDIATE & SECONDARY

EDUCATION ABBOTTABAD
APPLICATION FORM FOR ORIGINAL CERTIFICATE

Ordinary / Urgent

NORMAL / REVISED / IMPROVEMENT / ADDITIONAL

This form must be filled in carefully by the candidate in his/her own handwriting and as per
admission form/school/college/Registration record.
1.

Examination (HSSC / SSC) Roll No. __________ Session (Annual/Supply) year_______

2.

Name (in Capital Letters)___________________________________________________

3.

Father Name (in Capital Letters)_____________________________________________

4.

Date of Birth

5.

Name of School/College (for regular Candidates only) ___________________________

6.

Subjects __________________ Group_______________ Marks Obtained ___________

7.

Previous Roll No., Year & Session (marks Improvement only) ____________________

______________________________ District ___________________

Declaration: I do hereby solemnly declare that all particulars filled in by me are correct and as per
school/college/registration record. I shall be responsible for any discrepancy found therein.

40 (1)

(Care Of)

Mailing Address:__________________________________________________________________________
Phone/Mobile No: __________________________
..............................................................................................................................................................................................

2000 1995 iv iii ii i

100 ORIENTAL LANGUAGES

vi 200 100 2000 1995 v

viii vii 250/-

(DUP LICATE) (CANCE L) ix 5

0992-392014-Ex t.228 x (APPLY )

Signat ure of Candidat e: ___________ Signature of Dealing Clerk at Window No.5: ____________ DATED: _________

BISE ABBOTTABAD

ROLL NO. .......................... SSC / HSSC (ANNUAL/SUPPLY) ........................................ ISSUE

SIGNAUTRE OF DEALING CLERK AT WINDOW

DATE: .......................................

NO. 5: ............................................... DATED: .................................................

3 2 1

5 20 4
(APPLY ) (DUPLICATE) (CANCEL)