Form 17

Application for Direct Enrollment as a Private candidate at the HSC Examination of March 2024

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: *

(2) Residential Address*

Pincode:*

District:*

Taluka: *

State:*

(3) Contact Details:

Aadhar No:*

Mobile No:*

Email Id:*

( एक ईमेल आयडी एका विद्यार्थ्यासाठी च वैध राहील.एका ईमेल आयडीने पुन्हा नोंदणी करता येणार नाही.पुन्हा अर्ज करत असताना नवीन ईमेल आयडीचा वापर करावा.)

(4) Birth Details:

Date of birth according to Christian Era :*

Village/Town of birth:*

Taluka of birth:*

District of birth:*

(5) Year and month of passing S.S.C Exam:

Month:*

Year:*

(6) Name of the Examination Board or University:

Select Division Board:*

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

(8) Name of last attended recognised Secondary School :*

School Index No:

School Udise No:

Village/Town:*

Taluka:*

District:*

State:*

(9) Have you attended junior college ? (Yes/No): *

9(C) The month and year of passing 1st year of junior college Examination :

Month*

Year*

Status:*

(10) Select college where you want to submit application.

(1)District:*

(2)Taluka:*

(3)Stream:*

(4)Medium:*

(5)Select College:*

College Index :

(11) 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:*

(12) 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 Secondary School Certificate and Marksheet(s).

YES/NO:*

(B) Junior college Leaving Certificate.

YES/NO:*

Passport Size photo:*

Original LC/TC OR Duplicate School leaving Certificate and its attested true copy with self attested Affidavit (Original):*

Original/Duplicate Secondary School Certificate and Marksheet(s) and one Xerox copy or true copy of each of it attested by the principal:*

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 HSC Examination by Private candidates in Medium:*

खाजगी विद्यार्थी नावनोंदणी अर्ज (FORM 17) ऑनलाइन पद्धतीने शुल्क जमा केल्यानंतर विद्यार्थ्याला पोचपावती प्राप्त होईल सादर पोचपावती स्वतः जवळ जतन करून ठेवण्यात यावी.
एकदा नावनोंदणी अर्ज सादर केल्या नंतर कोणत्याही कारणास्तव नावनोंदणी शुल्क विद्यार्थ्याला परत केले जाणार नाही .तसेच नावनोंदणी अर्जात दूरस्ती करावयाचे असल्यास विद्यार्थ्यास पुनःश्च अर्ज सादर करून नाव नोंदणी शुल्क जमा करावे लागेल याची विद्यार्थ्याने नोंद घ्यावी.
Payment success झाल्यास व तांत्रिक कारणास्तव पोचपावती न भेटल्यास दुबार payment करू नये,केलेल्या payment ची पावती २४ तासात सांकेतिक स्थळावर उपलब्ध होईल.

MAHARASHTRA STATE BOARD OF SECONDARY

& HIGHER SECONDARY EDUCATION,PUNE