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MAHARASHTRA STATE BOARD

OF SECONDARY
& HIGHER SECONDARY
EDUCATION,PUNE

Official Website for SSC Form 17

Application for Direct Enrollment as a Private

candidate at the SSC Examination of March 2022

To,
Maharashtra State Board of Secondary
& Higher Secondary Education,
Divisional Board

Fields marked with '*' are comulsory to be

filled.

(1) Personal Details

Last Name:*

First Name:*

Father/Husband Name:*

Mother Name:*

Gender:*

--SELECT--

(2) Residential Address*

Pincode:*

District:*

MUMBAI(SUB1)

Taluka:*

"K, P (EAST) WARD"

State:*

Maharashtra

(3) Contact Details:

Aadhar No:*

Mobile No:*

Email Id:*

example@example.com

( एक ईमेल आयडी एका िवद्याथ्यार्साठीच वैध राहील.एका

ईमेल आयडीने पुन्हा नोंदणी करता येणार नाही.पुन्हा अजर् करत
असताना नवीन ईमेल आयडी चा वापर करावा.)

(4) Birth Details:

Date of birth according to Christian Era :*

dd/mm/yyyy

Village/Town of birth:*

Taluka of birth:*

District of birth:*

(5) Name of last attended recognised Secondary

School :
*

School Udise No:

Pincode: *

Village/Town:*

Taluka: *

District:*

State:*

(6) HandiCap:*

No

(7) Date of leaving the last attended secondary school:

*

dd/mm/yyyy

(8) Standard in which school Left:*

Status:*

Pass

(9) Select school where you want to submit application.

(1)District:*

MUMBAI(SUB1)

(2)Taluka:*

P WARD

(3)Medium:*

ENGLISH

(4)Select School:*

AADARSH VIDYA MANDIR

School Index :*

3204066

(10) I here by declare that I have not been debarred

from appearing at any of the examinations held by any
examination board or university in india or by any
other examination authority.
YES/NO:*

--SELECT--

(11) I enclose documents below: [Instruction - Individual

file size should not be more than 200 KB while uploading.
Supported file type - jpeg/jpg/png]

(A) Original School Leaving Certificate:

YES/NO:*

Yes

Passport Size photo:*

Choose File no file selected

Original LC/TC OR Duplicate School leaving

Certificate and its attested true copy with self
attested Affidavit (Original):*

Choose File no file selected

I have carefully read the accompanying

'Instructions to Private Candidate'. I am prepared to
select only such subjects as are allowed to be offered
for the SSC Examination by Private candidates in
Medium:*

English

खाजगी िवद्याथीर् नावनोंदणी अजर् (FORM 17)

ऑनलाइन पद्धतीने शुल्क जमा केल्यानंतर िवद्याथ्यार्ला
पोचपावती प्राप्त होईल सादर पोचपावती स्वतः जवळ
जतन करून ठे वण्यात यावी.
एकदा नावनोंदणी अजर् सादर केल्या नंतर कोणत्याही
कारणास्तव नावनोंदणी शुल्क िवद्याथ्यार्ला परत केले
जाणार नाही .तसेच नावनोंदणी अजार्त दू रस्ती
करावयाचे असल्यास िवद्याथ्यार्स पुनःश्च अजर् सादर
करून नाव नोंदणी शुल्क जमा करावे लागेल याची
िवद्याथ्यार्ने नोंद घ्यावी.
Payment success झाल्यास व तांित्रक कारणास्तव
पोचपावती न भेटल्यास दुबार payment करू
नये,केलेल्या payment ची पावती २४ तासात
सांकेितक स्थळावर उपलब्ध होईल.

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