BOARD OF SECONDARY EDUCATION, A.P.

, HYDERABAD
APPLICATION FORM F0R SSC PUBLIC EXAMINATIONS - MARCH 2011
REGULAR CANDIDATES ONLY
FORM NO - 5003851

District Code School Code Sl No. as per MNR Name of the School
116 2078 201 St. Pius -X- Girls High
School

Gender Date of Birth Physically Challenged

F 08-Jul-1995 No

*5003851*
Community First Language Group First Language Paper 1 First Language Paper 2
Hinduism-OC A TELUGU TELUGU

Second Language Third Language Medium Non Languages

Hindi English Medium ENGLISH (E) Mathematics, General
Science, Social Studies

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District Code School Code Sl No. as per MNR
116 2078 201

*5003851*
Candidates Name
AMILINENI TEJASWINI

Father's Name
AMILINENI RAVINDRANATH

Mobile Number / Telephone No Paste

Black & White
9177389193 Photograph of
the Candidate Do
not staple or
Identification Marks pin the
photograph
1. A MOLE ON LOWER LIP
2. - Left Hand Thumb Impression of the
Candidate

Signature of the Headmaster Signature of the Candidate