BOARD OF INTERMEDIATE AND SECONDARY EDUCATION, GUJRANWALA

ADMISSION /REVENUE FORM (PRIVATE CANDIDATE) FOR INTERMEDIATE (PART-II & COMPOSITE) ANNUAL EXAMINATION , 2019 MBD
Form No:951195 Roll No: _______________
Student Id :7387 (For office use only)
HUMANITIES GROUP (11TH: FULL APPEAR 12TH:FULL APPEAR)
951195

Name: USAMA ALTAF Bay Form No: 34402-3907160-7

Father's Name: ALTAF HUSSAIN Father CNIC: 34402-1465356-7
HSSC Info: 437449 ( A, 2018, BISE, GRW ) Student's Cell No: 0302-9298927
SSC Info: 478230 ( A,2017, BISE, GRW ) Nationality: PAKISTANI
Registration No: 2-2-1022098-17 Religion: MUSLIM

Speciality: NONE Scheme: NEW

MALE
Address: VILLAGE AND POST OFFICE SIVIA SHRIF, THEISL AND DISTRICT MANDI BAHAUDDIN.
District Name: MANDI BAHA-UD-DIN Tehsil Name: MANDI BAHA-UD-DIN

Zone Name: 546-MANDI BAHA UD DIN CITY

Part I Subjects Part II Subjects Paste Recent

1. URDU 1. URDU Photograph & Must Be

2. ENGLISH 2. ENGLISH Cross Attested by the

3. ISLAMIC EDUCATION 3. PAKISTAN STUDIES Head/Deputy Head of

4. HISTORY OF ISLAM 4. HISTORY OF ISLAM Institution

5. PUNJABI 5. PUNJABI

6. EDUCATION 6. EDUCATION

Affidavit:- I have read this form. The data/information on this form and in online system is same as last entered/modified/provided by me and it's correctness
is only my responsibility.I understand that only the information/data provided in the online system along with the photograph and some other handwritten
details on this form will be used for further processing. I accept all the terms and conditions in this regard.

Candidate's Signature in Urdu______________________ Stamp/Signature

Headmaster/Headmistress/Principal
Candidate's Signature in English____________________ Head Of Institution Name
Due Date: 04-03-2019 School/College Code
Thumb Impression
CNIC
Printing Date: 27-Feb-2019 03:54 PM CMD Account No. 00427900072103 Bank Challan No. 10857835
Admission Fee 3200/- Late Fee 0 Processing Fee 395 /- Certificate Fee 550 /- Registration Fee 0/-
Total Amount Rs. 4145 /- Amount in Words: Four Thousand One Hundred And Forty Five Only.
Form No:951195 Manager/Cashier:___________________________

BOARD OF INTERMEDIATE AND SECONDARY EDUCATION GUJRANWALA , INTERMEDIATE (PART-II & COMPOSITE) ANNUAL EXAMINATION ,2019
Bank Copy: (To be retained with HBL)
Due Date: 04-03-2019 Printing Date: 27-Feb-2019 03:54 PM

CMD Account No. 00427900072103 Bank Challan No. 10857835 MBD

Name: USAMA ALTAF Father's Name: ALTAF HUSSAIN
Total Amount Rs. 4145/- Amount in Words: Four Thousand One Hundred And Forty Five Only.
Form No:951195 Manager/Cashier:___________________________

BOARD OF INTERMEDIATE AND SECONDARY EDUCATION GUJRANWALA , INTERMEDIATE (PART-II & COMPOSITE) ANNUAL EXAMINATION ,2019
Board Copy: (Along with Scroll)

Due Date: 04-03-2019 Printing Date: 27-Feb-2019 03:54 PM

MBD
CMD Account No. 00427900072103 Bank Challan No. 10857835
Name: USAMA ALTAF Father's Name: ALTAF HUSSAIN
Admission Fee 3200/- Late Fee 0 Processing Fee 395/- Certificate Fee 550/- Registration Fee 0/-
Total Amount Rs. 4145/- Amount in Words: Four Thousand One Hundred And Forty Five Only.
Form No:951195 Manager/Cashier:___________________________

BOARD OF INTERMEDIATE AND SECONDARY EDUCATION GUJRANWALA , INTERMEDIATE (PART-II & COMPOSITE) ANNUAL EXAMINATION ,2019
Candidate Copy
Due Date: 04-03-2019 Printing Date: 27-Feb-2019 03:54 PM
CMD Account No. 00427900072103
Form No: 951195 Bank Challan No. 10857835 MBD
Name: USAMA ALTAF Father's Name: ALTAF HUSSAIN
Total Amount Rs. 4145/- Amount in Words: Four Thousand One Hundred And Forty Five Only.
Zone Name: 546-MANDI BAHA UD DIN CITY Manager/Cashier:___________________________