FORM OF APPLICATION FOR THE S.S.L.C. EXAMINATION - MARCH 200......... (For use of Private Overaged candidates) 1. Name and of Centre Centre Code 2. Name of Candidate Sex (In block letters) 3. Name of Parent/ Guardian 4. Full address of the candidate with name of Post Office 5. If employed, full official address 6. Religion : 7. Date of birth : In figures : In words : 8. Age that would be completed on 1.3.200.......... (a) Have you completed the required minimum age as per G.O (Ms) 91/88/G.Edn. dt. 30.4.1988 and G.O. (Ms) 126/88/G.Edn dt. 2.8.1988. (b) If not have you obtained orders of age relaxation from the Commissioner for Government Examinations (c) If so state the order no. and date 9. Higher Examination, if any, passed 10. Authentic evidence of date of birth produced 11. First Language : Part I : Part II : 12. Medium in which the candidate desires to take the examination (Malayalam, Tamil, Kannada and English only in non-language subject) 13. Amount of fees remitted : 14. Name of Treasury and No. & Date of Chalan 15. Whether a certificate regarding nativity as prescribed in the notification produced 16. Whether the applicant has been tested for the attainment and the certificate obtained to the effect from the Head of a Government/ Aided School has been enclosed. Signature of Applicant. Declaration I hereby declare that I have no prescribed course of study for the SSLC Examination in any recognized school in the State. Station : Date : Signature of Applicant
