BOARD OF INTERMEDIATE & SECONDARY EDUCATION PESHAWAR

PRIVATE ADMISSION FORM FOR HIGHER SECONDARY SCHOOL CERTIFICATE EXAMINATION (ANNUAL) 2021

Receipt No 204086257 Roll No __________________________

(FOR OFFICE USE ONLY)
EXAM INFORMATION
Exam: Annual (2nd Year) Year: 2021 Status Private
Group: Pre-Engineering Appear Status Additional
Prev Year: 2019 Prev Exam Annual Prev Roll No 80661
Proposed Center GOVERNMENT HIGH SCHOOL RAHMAT ULLAH KHAN SHABQADDAR
PERSONAL INFORMATION
Name: MUHAMMAD WAQAS
Father Name: ATTA ULLAH JAN
Gender: Male

9)
Registration No: 0716-B/LCSFP-2017 Religion: Muslim

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Father NIC #: 17101-8441067-1 Form(B) #: 17101-1263017-3
Mobile No: 0346-9857463 Phone No:

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CONTACT INFORMATION
Country PAKISTAN Province: Khyber Pakhtunkhwa District: Charsadda

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Postal Address: KHAZANA SUGAR MILLS LABOR COLONY PESHAWAR

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Permanent Address: POST OFFICE HASSANZAI VILLAGE MULAKHEL TEHSIL SHABQADDAR DISTRICT CHARSADDA
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SUBJECT INFORMATION
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75 Biology - I 76 Biology - II
Saved Date & Time 2021-07-05 10:27:57 Exam Fee Rs. 4000/- Upto 05-07-2021 [Tripple Fee]
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AFFIDAVIT I solemnly declare on oath that all the entries made in the Admission Form are true to the best of my knowledge and in
accordance with the school record. I also affirm that I shall abide by the rules/regulations made and notified by BISE Peshawar
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from time to time.

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_________________________________________________ _________________________________________________
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SIGNATURE OF FATHER/GUARDIAN SIGNATURE OF CANDIDATE

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SIGNATURE __________________ STAMP ____________________

I certify that the candidate bears good moral character and he/she is eligible PRINCIPAL/HEADMASTER/HEADMISTRESS (Affiliated with BISE Peshawar)
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for examination
CNIC: - -
D

Mobile 0 3 -
D

FOR OFFICE USE ONLY

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Entries & Result Checked Checked & Found Correct Eligible Allowed REMARKS

DEALING ASSTT ASSTT / INCHARGE SUPERINTENDENT A.C.E

Print Date & Time : 2021-07-05: 10:28:54 & IPAddress : 111.119.177.46

 DEPOSIT SLIP
BOARD OF INTERMEDIATE & SECONDARY EDUCATION PESHAWAR
CASH MANAGEMENT COLLECTION.
Payable at any Branch of MCB/ABL in Pakistan.
A/C # 0977261141007172 A/C # 0010005344900220

Day Month Year

Date
2 0

BANK COPY

Receipt Number: 204086257 Print Date & Time 2021-07-05: 10:28:54

Student Name: MUHAMMAD WAQAS

Father Name: ATTA ULLAH JAN

9)
In Figures In Words
Amount (Fee)
4000 FOUR THOUSAND ONLY

01
Fee Head HSSC Admission Fee (Private) (1202)

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BANK OFFICIAL SIGNATURE DEPOSITOR SIGNATURE

Y
G
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-----✂-----------------------------------✂-------------------------------✂--------------------------------✂-----------------------------✂-----
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B
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A

DEPOSIT SLIP
N

BOARD OF INTERMEDIATE & SECONDARY EDUCATION PESHAWAR

CASH MANAGEMENT COLLECTION.
IO

Payable at any Branch of MCB/ABL in Pakistan.

A/C # 0977261141007172 A/C # 0010005344900220
IT

Day Month Year

Date
D

2 0
D

DEPOSITOR COPY
A

Receipt Number: 204086257 Print Date & Time 2021-07-05: 10:28:54

Student Name: MUHAMMAD WAQAS

Father Name: ATTA ULLAH JAN

In Figures In Words
Amount (Fee)
4000 FOUR THOUSAND ONLY

Fee Head HSSC Admission Fee (Private) (1202)

BANK OFFICIAL SIGNATURE DEPOSITOR SIGNATURE