BOARD OF INTERMEDIATE AND SECONDARY EDUCATION, GUJRANWALA

ADMISSION /REVENUE FORM (Private Candidate) for SSC Annual Examination , 2017
Roll No: _______________
(For office use only)
GENERAL GROUP
Form No: 169603 (10th: Full Appear)
169603

Prev Roll No: 288354 ( A, 2016 ) Bay Form No: 00000-0000000-0

Name: MAZHAR TARIQ Father CNIC: 34101-2282551-9
Father's Name: MUHAMMAD TARIQ Mobile No: 0313-6487075
Date Of Birth: 07-09-2000 Board Name: BISE, GUJRANWALA
Registration No: 2-1-118453-15 Religion: MUSLIM
Speciality: NONE
MALE
Address: HEAVEN BAKERS MAIN DELTA ROAD GUJRANWALA

Proposed Exam Area: 44 - SATELLITE TOWN (GUJRANWALA)

Part I Subjects Part II Subjects Paste Recent

1. URDU Photograph & Must Be

2. ENGLISH Cross Attested by the

3. ISLAMIYAT (COMPULSORY) Head/Deputy Head of

Candidate's
4. PAKISTAN STUDIES Thumb Institution
Impression
5. General Math

6. GENERAL SCIENCE

7. EDUCATION

8. ISLAMIC STUDIES

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: 23-12-2016
CNIC
Printing Date: 17-Dec-2016 09:58 PM CMD Account No. 00427900072103 Bank Challan No. 169603
Admission Fee 650/- Late Fee 0/- Processing + Form Fee 295 /- Certificate Fee 550/- Registration Fee 0/-
Total Amount Rs. 1495 /- Amount in Words: One Thousand Four 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: 17-Dec-2016 09:58 PM
Due Date: 23-12-2016
Form No: 169603 CMD Account No. 00427900072103 Bank Challan No. 169603
Name: MAZHAR TARIQ Father's Name: MUHAMMAD TARIQ
Total Amount Rs.1495/- Amount in Words: One Thousand Four 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: 23-12-2016 Printing Date: 17-Dec-2016 09:58 PM

Form No: 169603 CMD Account No. 00427900072103 Bank Challan No. 169603
Name: MAZHAR TARIQ Father's Name: MUHAMMAD TARIQ

Admission Fee 650/- Late Fee 0/- Processing + Form Fee 295/- Certificate Fee 550/- Registration Fee 0/-

Total Amount Rs. 1495/- Amount in Words: One Thousand Four Hundred And Ninety Five Only.

Manager/Cashier:___________________________

BOARD OF INTERMEDIATE AND SECONDARY EDUCATION GUJRANWALA (SSC Annual Examination ,2017 )
Candidate Copy Printing Date: 17-Dec-2016 09:58 PM
Due Date: 23-12-2016
CMD Account No. 00427900072103
Form No: 169603 Bank Challan No. 169603
Name: MAZHAR TARIQ
Father's Name: MUHAMMAD TARIQ
Total Amount Rs. 1495/-
Proposed Exam Area: 44 - SATELLITE TOWN (GUJRANWALA)
Manager/Cashier:___________________________