BIHAR SCHOOL EXAMINATION BOARD

ONLINE APPLICATION FORM FOR ANNUAL SECONDARY EXAMINATION, 2023

ijh{kk vkosnu dsoy vaxzsth ds cMs+ v{kjksa ¼Block Letter½ esa Hkjsa vkSj izR;sd 'kCn ds chp ,d ckWDl [kkyh j[ksaA
ijh{kk vkosnu i= ds lHkh fooj.k dsoy iath;u dkMZ ¼Registration Card½ ds vuqlkj gh HkjsaA

BSEB Unique ID-

1. School code
2. Registration No.

3. School Name
(In English)

4. Student’s Name
(In English)

5. Father’s Name
(In English)

Full Signature of Student

6. Gender (Please tick-√ )

7. Caste Category
(Please tick-√ )
8. Differently Abled
No Yes Specify (if yes) 9. Visually Impaired Yes No
(Please tick-√ )
(Please tick-√
√)
10. Mobile No.
(Compulsory)
11. Email Id (Compulsory)
(If required, it may be
changed later on)

12. PLEASE MENTION "AADHAR NUMBER"

(If candidate has not enrolled in Aadhar and doesn't have
"Aadhar number" then he/she is required to submit
declaration in column 13 that he/she has not been
enrolled in Aadhar and has not got "Aadhar number".)
d`Ik;k **vk/kkj uacj** vafdr djsaA Aadhar Number
¼;fn vH;FkhZ dks **vk/kkj uEcj** vkoafVr ugha gqvk gS] rks vH;FkhZ
ds }kjk bl vk'k; dh ?kks"k.kk LraHk&13 esa dh tkuh vko';d vk/kkj uacj
gksxh fd mUgsa **vk/kkj uacj** vkoafVr ugha gqvk gS½
13. If candidate has not given "Aadhar number" in column 12 above, then following declaration
on should be given by candidate:-
candidate
(Please note that any WRONG DECLARATION made here, may invite action against the candidate and his/her
candidature may be cancelled due to making falseful declaration about non
non-allotment
allotment of "Aadhar number")
DECLARATION :- I, hereby declare that I have not enrolled in Aadhar and have not got any "Aadhar
number". I also understand that any false declaration made by me in this regard may have consequence
of cancellation of my candidature.
;fn vH;FkhZ ds }kjk mi;qZDr LraHk&12 esa **vk/kkj uacj** vafdr ugha fd;k x;k gS] rks muds }kjk fuEukafdr ?kks"k.kk dh tk,xh %&
¼d`Ik;k uksV djsa fd ;gk¡ fdlh Hkh rjg dh xyr ?kks"k.kk ds fy, vH;FkhZ ds fo:) dkjZokbZ dh tk ldsxh rFkk **vk/kkj uEcj** ugha gksus ds
laca/k esa bl feF;k@xyr ?kks"k.kk ds dkj.k mudk vH;fFkZRo jÌ fd;k tk ldrk gS½
?kks"k.kk %& eSa] ,rn~ }kjk ?kksf"kr djrk gw¡ fd eSa us **vk/kkj uEcj** vkoafVRk djus ds fy, vkosnu ugha fd;k gS rFkk eq>s
**vk/kkj uEcj** vkoafVr ugha gqvk gSA eSa ;g Hkh le>rk gw¡ fd esjs }kjk dh xbZ bl feF;k feF;k@xyr ?kks"k.kk ds vk/kkj ij
esjk vH;fFkZRo jÌ fd;k tk ldrk gSA

Signature of Candidate
vH;FkhZ dk gLrk{kj
 14. Student Category
(Please tick-√ )

15- iwoZorhZ] dEikVZesUVy] ,dy fo"k; ¼vaxzsth½ ,oa csVjesUV¼leqUur½ dksfV ds Nk=@Nk=k fuEufyf[kr fooj.k Hkjsa %

15.1. Roll Code 15.2. Roll No. 15.3.

.3. Prev. Exam Year

16- Nk=@Nk=k ijh{kk gsrq fuEufyf[kr fo"k; dk p;u djsa rFkk ,dy fo"k; ¼vaxzsth½ ds Nk=@Nk=k ek= vaxzsth
th fo"k; dk p;u djsa %
i. M.I.L.:
(Please Tick -√)
ii. S.I.L. :
(Please Tick -√)

iii. Compulsory:
(Please Tick -√)
For Visually
Impaired:
iv. OPT. SUB.
(Please Write)

uksV %
1-fu;fer@Lora
fu;fer@Lora= dksfV ds iathd`r@vuqefr izkIr Nk=@Nk=k vius iath;u ds vuqlkj mi;qZDr dkWye ye dk fo"k; p;fur djsaxsA
2-okf"kZd ek/;fed ijh{kk] 2022 ds mÙkh.kZ Nk=@Nk=k csVjesUV¼leqUur½ ijh{kk ds fy, vius fdlh ,d ;k ,d ls vf/kd ;k lHkh mÙkh.kZ
fo"k;@fo"k;ksa dk p;u djsaxs rFkk dEikVZesUVy dksfV ds Nk=@Nk=k vius ek= vuqÙkh.kZ ,d ;k nks eq[; fo"k; ,oa vax zsth fo"k; dk
p;u djsaxAs
3-iwooZ rhZ dksfV ds Nk=@Nk=k
@Nk=k ds ijh{kk ds fo"k; muds iath;u dkMZ@iwoZ ijh{kk ds fo"k; ds vuqlkj gh gksxaAs

17. Address (Compulsory) :

(In English)

Pin Code:
Code

ijh{kk vkosnu esa mi;qZDr vafdr fooj.k dk feyku

esjs }kjk ijh{kk vkosnu esa Hkjk x;k lHkh fooj.k lgh gSA fo|ky; vfHkys[k@iath;u i=d ls dj fy;k x;k gS] tks
lgh gS] ijh{kk vkosnu Lohdkj fd;k tk ldrk gSA

Signature of Student in Hindi Signature of Student in English Signature of Parent/Guardian Signature of Principal & Seal

uksV % dkWye uaŒ& 09 n`f"Vckf/kr fo|kfFkZ;ksa ds fy, gS] ftldk ijh{kk dk fo"k; xf.kr ds cnys x`g&foKku ,oa foKku ds cnys
laxhr gksxkA