PÀ£ÁðlPÀ gÁdå ªÀÄÄPÀÛ ²PÀët
¥ÀjÃPÁë ªÀÄAqÀ½, ¨ÉAUÀ¼ÀÆgÀÄ
KARNATAKA STATE OPEN EDUCATION EXAMINATION BOARD
1st Block, 19 Main, 10 Cross, Rajaji Nagar, Bangalore
Admission Application Form for
Please Attach
the Candidate
Photo
(Passport Size)
10th STANDARD (SSLC)
No.
NAME OF THE CANDIDATE :
FATHER’S NAME :
MOTHER’S NAME :
COMMUNICATION /PERMANENT ADDRESS :
PHONE / CELL :
PIN :
DATE OF BIRTH (WITH PROOF RECORD)
(IN WORDS : ______________________________________________________________________________)
QUALIFICATION FOR ADMISSION PROOF : ________________________________________________________
Attached Photostat Copy : Yes
or Not
SELECT SUBJECTS SSLC (10TH STANDARD)
1st LANGUAGE : KANNADA (COMPULSORY)
2nd LANGUAGE : ENGLISH (COMPULSORY)
3rd LANGUAGE : HINDI (COMPULSORY ) (For 10th)
4th OPT. : MATHS
5th OPT. : SCIENCE
6th OPT. : SOCIAL SCIENCE
/ HOME SCIENCE
/ ECONOMICS
/ POL.STUDIES
Details of Fees Paid
If Fees Exempted

Yes
No
Note : If Yes Proof ofFees Exempted Should Be Attach Along With Form
Mode of Payment

Cash
Receipt
No.
D.D.
Receipt
No.

Bank Name
Declaration:
I am declaring that I knew it and well aware that the Board/Institute is an autonomous educational
body and all educational Board/Universities are autonomous bodies. Each educational organization having
discretionary powers. according these powers every Board/universities govt./central govt. of India having
the liberty and right to take own decision either to allow or refuse any admission/service. the course of the
futher educational use and job and course for self-help and employment only. hence I am taking admission
after knowing all legal facts and own choice and without and pressure and I never be entitled to claim any
way on any ground of recognition and legal and legal status of the Board/Organization.
If found incorrect or wrong an stage in documents and statement given by me the Board/Institute
will be fully authorized to cancel admission/exam/result and forfeit the free deposit by me.
I have read and understood and accept the rules and regulations, terms and conditions of the
Board/Institute and agree to abide by them
Date:
Place:
Signature of the Parents/Guardian
Signature of the Candidate
Declaration by Institution:
It is certified that:
1. The candidate is eligible for secondary examination conducted by the Board
2. All documents provided by the candidate are true & best of our knowledge.
3. The candidate has signed the registration form in our presence &the particulars filled in by him/her are
correct.
4. The candidate has remitted the required fee for the exam.
5. We clarify the candidate & Parents both about constitution of board, rule & regulation and all the
information relevant to the Board
6. The candidate is not on active rolls at present.
Signature of State Co-ordinator
If appointed (affix office seal)
Signature of head of the institution
(affix office seal)
SELE DECLARATION
I_______________s/o _____________Mother’Name________________Date of Birth_____________
Class/course____________Resident of V.P.O___________The._______________Distt____________
Declare as under:I am declare that l knew it and well aware that The Karnataka State Open Education Examination
Board, Bangalore (www.ksoeeb.com),is an autonomous educational body ,the Board Exists solely for
educational purpose ,purely Non Government , Non –Beneficial, self, self financial organization and all
educational boards/universities/Institutes are autonomous bodies. Each educational organization
having discretionary powers. according these powers every board/ University govt./central govt. of
India having the liberty and right to take own decision either to allow or refuse and admission
service.
The course of The Karnataka State Open Education Examination Board, Bangalore (www.ksoeeb.com),
are the Board own autonomous programme. the running course is for knowledge and wisdom and not
guaranteed for further educational use and job and the course is for self help employment
only.________________(Name of school/center/institute)is never give any guarantee for passing any
course /class. Hence I am taking admission in this institution for the course /class of The Karnataka
State Open Education Examination Board, Bangalore (www.ksoeeb.com). knowing all legals fats and
own choice and without any pressure and I never be intited to claim any way on any ground of
recognisation and legal staus of The Karnataka State Open Education Examination Board, Bangalore
(www.ksoeeb.com)
_________________________________ (Name of school/center/institute)
I have read and understood and accept the rules and regulations, terms and condition of The
Karnataka
State
Open
Education
Examination
Board,
Bangalore
(www.ksoeeb.com),_________________________ (Name of school/Center/institute)and agree to
abide by them.
Sign. of School/center/institute/notary etc.
Signature of student