Annexure – 1

Pro-forma Bill: Assessments of Students under VS & HSE Jharkhand: 2023-24

Session : 2023-24
Awarding Body : Indore Skill Assessment Services Pvt. Ltd
Class / Std. : 10th Level :2
Exam Centre Name (In capital) : HIGH SCHOOL KATKAMSANDI
Exam Centre UDISE Code : 21030
Sector (In capital) : HEALTHCARE
Date of Assessment :
Name of Assessor (In capital) :
Contact number of Assessor :
Professional Qualification :
Designation :
Office address : 32, Parasram Marg, Gandhi Nagar, Indore, Madhya Pradesh 453112

Name of Internal Examiner :

Contact number of Internal Examiner:
Total number of students allowed to appear : (In words: )
Total number of students assessed : (In words: )
Total number students absent : (In words: )

DECLARATION BY ASSESSOR
THE ABOVE DETAIL IS CORRECT AS PER MY KNOWLEDGE AND BELIEF. THE NUMBER OF STUDENTS INDICATED ABOVE ARE ASSESSED
BY ME AT THE RELEVANT SCHOOL / EXAMINATION CENTRE.

Signature of Assessor :

Date : Place : Hazaribag

DECLARATION BY PRINCIPAL / IN-CHARGE / INTERNAL EXAMINER

THE ABOVE DETAIL IS CORRECT AS PER MY KNOWLEDGE AND BELIEF. THE NUMBER OF STUDENTS INDICATED ABOVE ARE ASSESSED
IN PRESENCE OF UNDERSIGNED / MY REPRESENTATIVE AT THE RELEVANT SCHOOL / EXAMINATION CENTRE. I HAVE RECEIVED A
COPY OF ATTENDANCE SHEET OF STUDENTS, COUNTERSIGNED BY ALL STUDENTS WHO WERE PRESENT AND APPEARED FOR THE
ASSESSMENT.

Signature of Principal :

Date : Place : Hazaribag