Form No.1 H.S. (+2 stage) Registration...........................of 20.........

Male/Female (To be filled in by the candidate)

Regular/Continuing/ Comp./ Ext. Roll.......................................................
(strike out whichever is not applicable) No.................................................
Centre....................................................
(To be filled in the Board)

TRIPURA BOARD OF SECONDARY EDUCATION

Application Form for Admission to H.S. (+2 Stage) Examination 20........

A passport size photograph of the

d APPLICATION candidate to be affixed and attested
To (New Syllabus) by the Headmaster/Headmistress/
The Secretary, Teacher-in-charge of the School.
Tripura Board of Secondary Education, Signature of the attesting authority
P.O. Kunjaban, Agartala. and seal should partially cover the
photograph and the form.

Sir,
I request permission to present myself at the H.S (+2 Stage) Examination 20............ as a
.................................. Candidate.

If any of the statements made herein below be found to be not true or if it appears that in the opinion of
the Board, I have in any way contravened the provisions of the Bye-laws relating to the Examination my admission will
be liable to be cancelled by the Board.
Yours obediently,

Full Signature of the Candidate..............................................

Enrolment Number with year .................................................

Particulars to be filled in by the candidate

1. i) Name in full ( in block letters).......................................................................................................................
ii) Name in full ( in Bengali scripts).................................................................................................................
2. Date of Birth Day Month Year
(according to the English Calendar)

3. (a) Father’s Name .........................................................................................................................................

(b) Mother’s Name .........................................................................................................................................
(c)Address......................................................................................................................................................

4. (a) Name of guardian/husband......................................................................................................................

(b)Address
(c)Contact Number if any................................................................................................................................

5. Nationality........................................................... Religion ............................................................................

6. a)Candidate’s Present address.......................................................................................................................

Village ................................................... P.O........................................... Dist ...............................................
b)Permanent Address.....................................................................................................................................

7. Whether you belong to ST/SC/PH/RM/OBC.................................Yes/No

(If you belong to SC/ST/PH/OBC, enclose an attested copy of the certificate from appropriate authority)
(Score out which is not applicable)
If yes specify the community..........................................................................................................................
8. Examination passed with particulars (Madhyamik Pariksha or equivalent)
Name of Exam Year Roll No Division/Grade Name of school Board/University

9. Whether you have migrated from any other Board or University. If so, state, name of the Board/
University ......................................................................................................................................................
10. Whether you appeared at the H.S. (+2 stage) Examination conducted by TBSE in any previous year/
years . Furnish year(s) of the Examination and other particulars.
Year Roll Number Name of School Category

11. Name of subjects of H.S.(+2 Stage) course in which you desire to be examined.

Language Elective-I Elective-II Elective-III Elective-IV Elective-V

I II ENGB PRAC/ PRAC/ PRAC/ PRAC/ TH PRAC/
TH TH TH TH
TH IA TH IA IA IA IA IA IA
12. Name of specified activity you participated.......................................................................................
13. Language in which question in elective subject will be answered..................................................................
14. Whether you have been debarred from appearing at the Board’s Examination for any year /years on a
charge of break of discipline, is so state-
(a) Name of the Examination with year in which you were reported against Examination
..................................................................................................................... year 20....................
(b) Roll ............................................................. No. ...............................................................................
(c) Registration No. ................................................................... of 20..................................................
(d) Enrolment No....................................................................... of 20..................................................
(e) Year/ years for which debarred ......................................................................................................

I have enclosed attested copy of Marksheet of Madhyamik Pariksha (SE)/Other Equivalent Examination
passed.

Place............................
Date............................ Signature of the candidate

CERTIFICATE
I certify that the above mentioned Candidate has satisfied me by the production of a certificate from the
relevant authority, that he/she passed the Madhyamik Pariksha (SE) of the Tripura Board of Secondary Education
any equivalent Examination, that he/she completed in one or more of the recognised Institutions, the course of
Instruction prescribed by the Board for the H.S. (+2 stage) Examination, that his/he conduct has been good, that
he/she has diligently and regularly prosecuted his/her studies, that he/she has satisfied me with his/her performance
in the Half-yearly and Pre-Board examinations held during the course of his/her studies in this Institution, that
judging from the work done by him/her there is, in my opinion, reasonable probability of his/her passing the H.S. (+2
stage) examination, that I know nothing against his/her moral character, and I believe the account furnished above
by the candidate to be true.
I further certify that he/she has taken a practical course of training as prescribed in the Laboratory based
subject(s) in which he/she offers to be examined.
I further certify that
i) a) No. of days for which the school met in the two academic sessions 20......... and 20....... days
b) No. of days for which the school met from the date of admission of the candidate for the two
academic.
c) No. of days for which he/she attended school for the two academic sessions 20........(in class XI)
and 20........................................... in class XII) ............................... days.
d) No. of days for which he/she attended school from the date of
i) his/her re-admission to class XII for his/her failure to maintain requisite percentage of
attendance is in Classes XI & XII within condonable limit of ............................. days
ii) his/her re-admission as Continuing candidate..................................... days .......................
a) The percentage of attendance from the date of admission/re-admission of the candidate
in the school .........................................................................................................................

ii) a) the aforesaid candidate was admitted to H.S. (+2 stage) course in this institution on..........
b) the aforesaid candidate was re-admitted on ........................................................................

iii) The candidate has attended school for the required number of working days the deficiency in percentage
attendance in school in respect of the candidate is within the condonable limit and he/she has obtained a
special order of the Board to the effect that the deficiency has been condoned vide the Board’s letter No
.......................................... dated..................................

(The letter in original should be enclosed if received. If not, following information is to be furnished)
a) Date of submission of application for condonation..............................................................
b) Date of submission of condonation fee ................................................................................
iv) The marks obtained in the Pre-Board Examination : -
Compulsory Elective Subject
Language Elective-I Elective-II Elective-III Elective- IV Elective-v
I II ENGB TH PR/IA TH PR/IA TH PR/IA TH PR/IA TH PR/IA
TH IA TH IA

N.B. : The subjects offered to be shown in symbols. The Particulars, of candidate and the statement of his/her
marks furnished by him/her are verified and found to be correct.
v) He/she is eligible to appear as Continuing/Special Candidate as per rule as he/she appeared for the first
time in the H/S(+2 stage) Examination in the year.............................. as regular candidate.

Signature of Head of the Institution

Name of Institution with Seal

School Code No :- ...............................