BOARD OF INTERMEDIATE AND SECONDARY EDUCATION, GUJRANWALA

ADMISSION /REVENUE FORM (Private Candidate) for SSC Annual Examination , 2017
Roll No: _______________
(For office use only)
SCIENCE GROUP
Form No: 160242 (9th: Full Appear 10th: Full Appear)
160242

Prev Roll No: 431713 ( A, 2016 ) Bay Form No: 34101-1754152-7

Name: USAMA KHALID Father CNIC: 34101-5996241-7
Father's Name: MUHAMMAD KHALID Mobile No: 0300-6482827
Date Of Birth: 22-10-1997 Board Name: BISE, GUJRANWALA
Registration No: 2-1-147931-14 Religion: MUSLIM
Speciality: NONE
MALE
Address: STREET NO 3 ABID COLONY TARIQ ABAD GUJRANWALA

Proposed Exam Area: 44 - SATELLITE TOWN (GUJRANWALA)

Part I Subjects Part II Subjects Paste Recent

1. URDU 1. URDU Photograph & Must Be

2. ENGLISH 2. ENGLISH Cross Attested by the

3. ISLAMIYAT (COMPULSORY) 3. ISLAMIYAT (COMPULSORY) Head/Deputy Head of

Candidate's
4. PAKISTAN STUDIES 4. PAKISTAN STUDIES Thumb Institution
Impression
5. MATHEMATICS 5. MATHEMATICS

6. PHYSICS 6. PHYSICS

7. CHEMISTRY 7. CHEMISTRY

8. BIOLOGY 8. BIOLOGY

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: 14-12-2016
CNIC
Printing Date: 12-Dec-2016 04:54 PM CMD Account No. 00427900072103 Bank Challan No. 160242
Admission Fee 1300/- Late Fee 0/- Processing + Form Fee 295 /- Certificate Fee 0/- Registration Fee 0/-
Total Amount Rs. 1595 /- Amount in Words: One Thousand Five Hundred And Ninety Five Only.
Manager/Cashier:___________________________

BOARD OF INTERMEDIATE AND SECONDARY EDUCATION GUJRANWALA (SSC Annual Examination ,2017 )
Bank Copy: (To be retained with HBL)
Printing Date: 12-Dec-2016 04:54 PM
Due Date: 14-12-2016
Form No: 160242 CMD Account No. 00427900072103 Bank Challan No. 160242
Name: USAMA KHALID Father's Name: MUHAMMAD KHALID
Total Amount Rs.1595/- Amount in Words: One Thousand Five Hundred And Ninety Five Only.

Manager/Cashier:___________________________

BOARD OF INTERMEDIATE AND SECONDARY EDUCATION GUJRANWALA (SSC Annual Examination ,2017 )
Board Copy: (Along with Scroll)
Due Date: 14-12-2016 Printing Date: 12-Dec-2016 04:54 PM

Form No: 160242 CMD Account No. 00427900072103 Bank Challan No. 160242
Name: USAMA KHALID Father's Name: MUHAMMAD KHALID

Admission Fee 1300/- Late Fee 0/- Processing + Form Fee 295/- Certificate Fee 0/- Registration Fee 0/-

Total Amount Rs. 1595/- Amount in Words: One Thousand Five Hundred And Ninety Five Only.

Manager/Cashier:___________________________

BOARD OF INTERMEDIATE AND SECONDARY EDUCATION GUJRANWALA (SSC Annual Examination ,2017 )
Candidate Copy Printing Date: 12-Dec-2016 04:54 PM
Due Date: 14-12-2016
CMD Account No. 00427900072103
Form No: 160242 Bank Challan No. 160242
Name: USAMA KHALID
Father's Name: MUHAMMAD KHALID
Total Amount Rs. 1595/-
Proposed Exam Area: 44 - SATELLITE TOWN (GUJRANWALA)
Manager/Cashier:___________________________