BOARD OF INTERMEDIATE AND SECONDARY EDUCATION, GUJRANWALA

ADMISSION /REVENUE FORM (Private Candidate) for SSC SUPPLYMENTRY EXAMINATION , 2019 GRT
SCIENCE GROUP Roll No: _______________
(For office use only)
Form No: 164834 (9th: Re-Appear 10th: Re-Appear)
Name (urdu): ____________________________________________ Father's Name (urdu): _______________________________
164834

Prev Roll No: 442973 ( A, 2019 ) Bay Form No: 34202-7982622-7

Name: ALI AKASH Father CNIC: 34202-0810249-9
Father's Name: MUHAMMAD IKHLAS Mobile No: 0343-4972796
Date Of Birth: 10-11-2003 Board Name: BISE, GRW
Registration No: 2-1-1027574-17 Religion: MUSLIM
Speciality: NONE
MALE
Address: BHALOT SHERA P/O HAJI MUHAMMAD
Student Id: 56073

Proposed Exam Area: 92 - LALA MUSSA

Part I Subjects Part II Subjects Paste Recent

Photograph & Must Be

Cross Attested by the

Head/Deputy Head of
Candidate's
Thumb Institution
Impression

6. PHYSICS

7. CHEMISTRY 7. CHEMISTRY

Affidavit:- I have read this form. The data/information on this form and in online system is same as last entered/modified/provided by me and it's correctness
is only my responsibility.I understand that only the information/data provided in the online system along with the photograph and some other handwritten
details on this form will be used for further processing. I accept all the terms and conditions in this regard.

Candidate's Signature in Urdu______________________ Signature

Headmaster/Headmistress/Principal
Candidate's Signature in English____________________ Head Of Institution Name
School/College Code Head of Institution Stamp
Due Date: 22-07-2019
CNIC
Printing Date: 17-Jul-2019 02:56 PM CMD Account No. 00427900072103 Bank Challan No. 10896035
Admission Fee 1400/- Late Fee 0/- Processing Fee 395 /- Certificate Fee 0/- Registration Fee 0/-
Total Amount Rs. 1795 /- Amount in Words: One Thousand Seven Hundred And Ninety Five Only.
Manager/Cashier:___________________________

BOARD OF INTERMEDIATE AND SECONDARY EDUCATION GUJRANWALA (SSC SUPPLYMENTRY EXAMINATION ,2019 )
Bank Copy: (To be retained with HBL)
Printing Date: 17-Jul-2019 02:56 PM
Due Date: 22-07-2019
Form No: 164834 CMD Account No. 00427900072103 Bank Challan No. 10896035 GRT
Name: ALI AKASH Father's Name: MUHAMMAD IKHLAS
Total Amount Rs.1795/- Amount in Words: One Thousand Seven Hundred And Ninety Five Only.

Manager/Cashier:___________________________

BOARD OF INTERMEDIATE AND SECONDARY EDUCATION GUJRANWALA (SSC SUPPLYMENTRY EXAMINATION ,2019 )
Board Copy: (Along with Scroll)
Due Date: 22-07-2019 Printing Date: 17-Jul-2019 02:56 PM
GRT
Form No: 164834 CMD Account No. 00427900072103 Bank Challan No. 10896035
Name: ALI AKASH Father's Name: MUHAMMAD IKHLAS

Admission Fee 1400/- Late Fee 0/- Processing Fee 395/- Certificate Fee 0/- Registration Fee 0/-

Total Amount Rs. 1795/- Amount in Words: One Thousand Seven Hundred And Ninety Five Only.

Manager/Cashier:___________________________

BOARD OF INTERMEDIATE AND SECONDARY EDUCATION GUJRANWALA (SSC SUPPLYMENTRY EXAMINATION ,2019 )
Candidate Copy Printing Date: 17-Jul-2019 02:56 PM
Due Date: 22-07-2019
CMD Account No. 00427900072103
Form No: 164834 Bank Challan No. 10896035
Name: ALI AKASH
Father's Name: MUHAMMAD IKHLAS
GRT
Total Amount Rs. 1795/-
Proposed Exam Area: 92 - LALA MUSSA Manager/Cashier:___________________________