Form Number:S415013

To,
The Divisional Secretary,
Maharashtra State Board of Secondary
And Higher Secondary Education,
MUMBAI Divisional Board

Sir,
I request you to issue enrollment Certificate as a Private Candidate at the S.S.C Examination
(Std.X) to be held in March 2021 and submit the following particulars for your information.

ABHINAV VIDYAMANDIR, AT GHODDEV POST KHARIGAO,

BHAYANDAR EAST
Index No:-1616012 (Medium:-ENGLISH)

REMARKS DOCUMENTS RECEIVED

Eligible LC (Std V/VI/VII/VIII)
Incomplete L.C./T.C.(Std.X/XI)
Ineligible Aadhar Card

Affidavit attested
xerox/true

Clerk Head of Br

Bonafied Certificate

Sr.Supdt. Jt.Secy

Migration Certificate

Full Name Aaditya Surendra Jain

Mother's Name Sonal
Residential Address 1006 10th Floor, 2A, Estella, JP North Garden
City, Vinay Nagar, Miraroad ( E), Thane-401107.
Residential PinCode 401107
District THANE
State Maharashtra
Student Email ID suren_cs1@yahoo.com
Mobile Number 9220842712
Aadhar Number 614923352070
Gender Male
Birth Date 23/12/2005
Birth Date In Words December Twenty Third Two Thousand Five
Birth Village/town Ahmedabad
Birth Taluka Ahmedabad
Birth District Ahmedabad
Name of Last Attended School Rbk school
village/town of Last Attended School Mira road
Taluka of Last Attended School Mira road
District of Last Attended School Thane
State of Last Attended School Maharashtra
Pincode Of Last Attended School 401107
Udise Code 27210700469
Is handicap no
Date of leaving the last attended School 08/07/2020
Standard in which studying at the time of 9
leaving school
Pass/Fail/Studying Passed
Debarred from appearing at any of the No
examination

Note: Kindly submit application form to college

ABHINAV VIDYAMANDIR, AT GHODDEV POST KHARIGAO,
BHAYANDAR EAST
Index No:-(1616012) (Medium:-ENGLISH)
Along with original documents on or before 30/11/2020

You have to submit following Documents:

* Original School Leaving Certificate.

Signature of the Applicant

(Aaditya Surendra Jain)
MAHARASHTRA STATE BOARD OF SECONDARY AND HIGHER
SECONDARY EDUCATION, PUNE
Private Candidate Application (Form No:17)
Payment Receipt
Division:MUMBAI
Application No S415013 Exam: SSC
Name Aaditya Surendra Jain
Address 1006 10th Floor, 2A, Estella, JP North Garden City, Vinay Nagar,
Miraroad ( E), Thane-401107.
Mobile No 9220842712 Email ID suren_cs1@yahoo.co
m
Amount Rs. 1120.06 Tranaction Status Success
Transaction ID 900026965501 Transaction Time Nov 26 2020
1:07PM