CENTRAL BOARD OF SECONDARY EDUCATION

Regional Office, Bhopal

Rohit Nagar, Phase II, ward no. 53, Bawadia Kalan, Bhopal 462039 (MP)

P R O F O R M A

For Fixation of Examination Centre, Willingness for Head Examiners and Appointment of Centre
Superintendent for Class X & XII Examination – 2025.

Name of State: - Madhya Pradesh

Name of Tehsil: Affiliation No:
Name of District: School Code No:

Affiliation granted for Secondary/Senior Secondary level upto (Year).

Category: Govt./KV/JNV/Govt. Aided. /Individual

1. Principal/School Name with full Postal Address and PIN Code (Strictly in Block Letters only) as per
affiliation Letter
(a) Principal Name:
(b) School Name:
(c) School Address:
Pin Code:

Distance in KMs. form nearby:

CBSE Affiliated Govt./KV/JNV School :

Other Board Affiliated Govt. School :
Bus Stand :
Railway Station :

Name of the Nearest:

Govt. /KV/JNV School (Under CBSE Affiliation):

Government School (Under other Board Affiliation):
Internet facility available : Yes/ NO
Contact Details (Please furnish with STD Codes) (Strictly in Block/Capital Letters only)
i. School Tele No.: STD Code Telephone No.
ii. Principal’s E-mail ID :
iii. School E-mail id :
iv. School Website Address :
v. Principal’s Mobile No. : 1. 2. (Whatsapp)
vi. Principal’s Android/IOS Mobile No. for CMTM App

Whether Principal’s Near relation(s)/Ward(s) appearing in the Board Exams.2025-Yes/No, If yes,

Class Candidate Name/Mother Name/Father Name School Code & Name Relation

Details of Examination In-charge (Strictly in BLOCK/CAPITAL Letters)

i. Name of Employee:
ii. Designation:
iii. E-mail ID:
iv. Mobile Number: 1. 2.

2. Name/Address/Telephone Nos. of the President/Manager/Controlling Authority of School with

STD Codes
i. Name:
ii. Designation: President/Manager/Controlling Authority :
iii. Address:

Pin Code:
iv. Tele No. (Office): STD Code Telephone No.
v. Mobile No. : 1 . 2.
vi. E-mail id :
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3. School Bank Detail (Strictly in BLOCK/CAPITAL Letters only)
i) A/c Holder’s Name :
ii) A/c Number :
iii) IFSC Code :
iv) Bank Name & Full Address :
Pin Code
Nearby Post Office Detail (Strictly in BLOCK/CAPITAL Letters only)
i) Name of Post Office :
& Full Address
Tehsil District State Pin Code
Contact No. of Postmaster

4. Name of the Exam Centre where the students of your School were appeared in

S.No. Year Centre No. School No. Name of the School/Centre

1 2024
2 2023

**Whether your school was fixed as Board Examination Centre in 2024 Exam. Yes/No
**If yes, please mention the No. of Candidates accommodated at your Centre Class:
X XII Total

5. For allotment of Exam. Centre for your School, please mention 5 nearby CBSE affiliated Schools
where the candidates of your school may appear in Board Exam.

S.No School School Name Category Distanc Conveyance

KV/JNV/ e (in is available
code
Govt./Govt.Aided KMs) (Yes/No)

1
2
3
4
5

6. Whether your school is suitable to be fixed as Board Examination Centre? Yes/No

a) If no*, why?
b) If yes, no. of candidates that can be accommodated (24 Candidates per room)
c) No. of Rooms / desks available in the school for examination purpose Rooms Desks
d) Whether proper electricity arrangements are available in School Yes / No
e) Internet facility available in School Yes / No
f) No. of Photocopier(s) available
g) No. of Printer(s) /Multifunction Printer(s) available
h) Power Backup Yes / No Source of Power Backup

7. Whether the school has hostel facilities? : Yes / No

a) If yes, from which class :
b) Whether Boys or Girls only or both boys & girls :
c) Accommodation capacity of the Hostel

* AS PER AFFILIATION BYE-LAWS 2018

14.3 The Board shall select a school as a center for any Public Examination or Board's Examination with or
without the formal acceptance of such assignment by the school. If a school has been selected as a center
for any Public Examination or Board's Examination by the Board, the school shall compulsorily arrange for
all facilities like strong room, basic minimum IT infrastructure etc. or any other requirement communicated
by the Board.
14.4 The building and furniture of Affiliated Institutions shall be placed at the disposal of the Board for
conducting any examination and spot evaluation free of charge. The Management and the Principal shall
cooperate with the Board in the conduct of examinations, evaluation of scripts and other ancillary activities.
If directed by the Board, the school shall provide teachers and principal to act as examiners in all subjects
offered by the school. In case they fail to do so, the Board shall have the right to take appropriate action
including initiating action for disaffiliation of the school.
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8. It is mandatory to mention the Name of 5 (Five) experienced and responsible Vice Principal/Senior
Most- PGTs, in order of Seniority who will act as Centre Superintendent at Board’s Examination
Centre in the city or Outside the city. It may be kept in view at the time of recommendations of
their names that no near relation (s)/ward(s) will be appearing in at the Board Examinations 2025.
They are to be relieved without fail, if appointed.

SI. Name of Vice Principal / Designation Sub/ Exp Mobile No. Email I.D.
No. PGT(s)/ (Seniority Wise)
(in years)

9. Details of Schools run by same management in the vicinity:

S.No School Code School Name and Address

10. For appointment of Centre Superintendent specially for self centres, please mention nearby
district with distance in Kms.

S.No Name of District nearby Distance in Kms. From Your School/District

A. Person once appointed as Centre Superintendent at a centre shall have to accept the
assignment and in no case, he/she will delegate the assignment to any other person.

B. “Near relative" means and includes wife/husband, sons and daughters and members of their
family, nephew, niece or similar relations of wife/husband.

Note: - In no case, the refusal at any stage shall be accepted for duty assigned by the Board.

Date:

Place: Signature of Principal

(with Rubber Stamp of School)
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11. Details about availability of infrastructure for the conduct of Practical Examination 2025, in your
school/centre :

Students Accommodation capacity per day per batch of the school:

Details of Play Ground for Physical Education practical :

Practical/Project work Whether Labs and Total Name of Regular PGT Teaching
involving Subjects for Facilities for conduct No. (only Experience
which affiliation has of Practical/Project of those who are teaching (in Years)
been granted by the work involving Labs classes XI & XII)
Board. (Subject Code & subjects available?
Name) (YES/NO)

Please use separate sheet if required

BANK CUSTODIAN FOR STORAGE OF QUESTION PAPERS

NOTE:-

1. Certain additional precautions for proper and safe custody of question paper packets in the
Nationalized Banks were taken by the Board in previous years. The question paper packets
are to be kept in the nearby Nationalized Bank. An undertaking to the effect that the Bank is
ready to undertake the responsibility and ensure safe custody of question paper packets may
be obtained and the same may be sent to this office.
2. The Custodian Bank should not have an extension counter / Branch Working in the premises
of the school for conduct of any Examinations of the Board.

The following information may also be given:-

i. Please indicate if a nationalized bank is available near the school. If so, provide the full
address, including the PIN code, for the custody of confidential material for the 2025
examination.
Name of Bank :
& Address PIN
Tel. No/Mobile of Branch E-Mail

ii. Provide the approximate time required to take delivery of the question paper packets from
the bank, the availability of conveyance, and the distance between the school and the bank
in kilometers.
Time : Conveyance : Distance (in Kms) :

iii. Is the custodian who kept the question paper packets for the 2024 examination in safe
custody ready to handle the packets for the 2025 examination as well? Yes / No

Date:

Place: Signature of Principal

(with Rubber Stamp of School)

Note:-
Please return these proformas i.e. from page No. 01 to 06 duly filled in by Speed Post on or before
20.09.2024 (Friday) immediately to the Regional Officer, Central Board of Secondary Education,
Regional Office, Rohit Nagar, Phase II, Ward No. 53, Bawadiya Kalan, Bhopal- 462039 (Madhya Pradesh)
as well as submit the format in the online link https://forms.gle/rNLMU4rEStX8vMD26
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PROFORMA FOR STORAGE OF QUESTION PAPER PACKETS FOR 2025 EXAMINATION

An undertaking to be obtained from the Nationalized Bank and the same may be sent to the Regional
Office, Central Board of Secondary Education, Bhopal (Madhya Pradesh) (Duly filled in and signed). The
scanned copy of this format to be uploaded in the link https://forms.gle/rNLMU4rEStX8vMD26
1. I undertake the responsibility to store and
provide safe custody of the question paper packets for Secondary & Senior School Certificate
Examination 2025 pertaining to (Name of the school)
School No. The Bank will deliver the question papers only to the persons authorized
by the Board and as per the instruction communicated by the Board.

2. In the event of Bank holiday, strike, or lock out in the Bank, I,

Bank Manager, will ensure that the question paper packets
for the day of Examination will be delivered to the authorized person.

3. The Bank is not an extension counter / Branch is not Working in the premises of the school or working
in a building owned by the management of the school.

Note: -Please don’t delete any of the column given above.

Complete address of the Bank in all respect (in Block/ Residential Address of the Bank
Capital letters only) for sending the question paper Manager
packets to the Bank
Bank Name
Branch Address

District State District State

PIN Code
PIN Code

For Payment of Custodian Charges (Please fill custodian bank’s account details only)
Please make sure that the Bank is not providing details of Parking account for Custodian Charges.
Account Holder Name :
Bank Account No :
IFSC Code : MICR Code :
Telephone No. of the Bank with STD Code Name of the Bank Manager (in Block
Letters)

Bank E-mail id: Manager (Res.) Tele. No

Distance between bank & School……………………… Manager Mobile No. 1
Mode of Conveyance for collection of QP…………. Manager Mobile No. 2
(Android Enable Number for using
CMTM App)
Manager E-mail
id:

Signature of the Bank Manager :

Name of the Bank Manager :

(Rubber stamp of the Bank)

Date :
Place :
 PROFORMA FOR WILLINGNESS TO WORK AS HEAD EXAMINER FOR AISSE/AISSCE 2025

The following PGTs/TGTs are willing to work as Head Examiner for AISSE/AISSCE 2025 from out school, if appointed by the Central Board of Secondary Education, Regional
Office, Bhopal. The details of such teachers are as under :

For AISSE (Class 10th) : School Code :

Sl. Name of Teaching Teaching in Subject Subject Name Mobile No. Email id Signature
No. TGT/PGT Experience this school Code
(in years) since
dd/mm/yyyy
1
2
3
4
5

For AISSE (Class 12th) :

Sl. Name of Teaching Teaching in Subject Subject Name Mobile No. Email id Signature
No. TGT/PGT Experience this school Code
(in years) since
dd/mm/yyyy
1
2
3
4
5

*Minimum Teaching Experience for appointment of Head Examiner in the subject are 10 Years and above.

I, hereby declare that the information furnished above is true, complete and correct as per the available school record and best of my knowledge and belief. I further, undertake
that any TGT/PGT appointed by the Board as Head Examiner will be relieved immediately from school as and when his/her services are required by the Board.

Principal Signature :
Principal Name :
Principal Mobile No. :
Rubber Stamp of the School Complete Name of the School

Date :
Note : 1. Use separate/additional sheet if no of TGTs/PGTs are more than five in any class.
2. Ensure that the names of PGTs/TGSs given in the list are enrolled in OASIS data for 2025 Examination.