THE PUNJAB STATE BOARD OF TECHNICAL EDUCATION & INDUSTRIAL TRAINING

PLOT NO. 1-A, SECTOR 36-A, CHANDIGARH - 160 036

Note : Use Block Capitals only.

EXAMINATION FORM
- Examination Fee : Rs 400/- per semester (per year for annual courses)
- For Subject Codes visit Subject Code List under Diploma link on Board’s websites : www.punjabteched.net OR www.punjabteched.com
- Failure to fill in any of the columns may result in non-issue of roll number or delay in declaration of result. Candidate shall be permitted to
appear only in those subjects which are listed in this form. (Maximum of 12 Theory papers are allowed in an examination.)
- No addition/alteration shall be allowed after the form has been received in the office of the Board.
May
1. Registration No. 2. Month Year : ________
December

3. Name

4. Father's Name

5. Institute

6. Course

7. Total No. of Theory Subjects (all Semesters) : (Maximum of 12 Theory papers are allowed in an examination)

8. Regular Class 9. Reappear Class 10. Reappear Class

Subject : 1 Subject : 2 Subject : 3 Subject : 1 Subject : 2 Subject : 3 Subject : 1 Subject : 2 Subject : 3

Subject : 4 Subject : 5 Subject : 6 Subject : 4 Subject : 5 Subject : 6 Subject : 4 Subject : 5 Subject : 6

Subject : 7 Subject : 8 Subject : 9 Subject : 7 Subject : 8 Subject : 9 Subject : 7 Subject : 8 Subject : 9

Subject : 10 Subject : 11 Subject : 12 Subject : 10 Subject : 11 Subject : 12 Subject : 10 Subject : 11 Subject : 12

11. Reappear Class 12. Reappear Class 13. Reappear Class

Subject : 1 Subject : 2 Subject : 3 Subject : 1 Subject : 2 Subject : 3 Subject : 1 Subject : 2 Subject : 3

Subject : 4 Subject : 5 Subject : 6 Subject : 4 Subject : 5 Subject : 6 Subject : 4 Subject : 5 Subject : 6

Subject : 7 Subject : 8 Subject : 9 Subject : 7 Subject : 8 Subject : 9 Subject : 7 Subject : 8 Subject : 9

Subject : 10 Subject : 11 Subject : 12 Subject : 10 Subject : 11 Subject : 12 Subject : 10 Subject : 11 Subject : 12

14. Fee Deposited : Rs. _______________________ Date : ______________

Fees in words :Rs.________________________________________________________________________ (Signature of the Candidate)

CERTIFICATE BY THE PRINCIPAL

1. Certified that ______________________ is /was a bonafide student of this Institution and the particulars given above by the candidate are correct to
the best of my knowledge and office record.
2. Certified that the conduct of the candidate is/was _______________ and he/she has not been barred from sitting in the examination(s).
3. The Roll No. Slip shall be delivered to the candidate only if he/she is eligible to appear in the Examination under the relevant Examination Rules.
4. Certified that the student is not appearing in more than 12 theory subject papers.

Date : __________________ (with seal of the Institution) Signature of the Principal