Admission SSC (10th) 2011 BISE Lahore Private

Form No. 108556

Bay Form Name ASMA ASGHAR

Gender FEMALE DOB 05-10-1994

Specialty Father's Name ASGHAR ALI

HUMANITIES GROUP
Father/Guardian
Group (WITH TWO ELECTIVE
CNIC 35404-1600857-9
SUBJECS)

Medium Urdu Religion Muslim Nationality Pakistani Locality Urban Hafiz No

Mohallah Rehman Pura Near Hameed Market Street Qutbuddin Khan, Master Yousaf Wali
Address
Sheikhupura - SHEIKHUPURA

Center SHEIKHUPURA CITY - SHEIKHUPURA

Subjects

1. MATHEMATICS (COMPULSORY) 2. MATHEMATICS (COMPULSORY)

Note: Please affix a recent colored photograph of 1.5 * 1.5 inch size in the box given below. Write your name and Form
Number on the back side of the photograph with ball point pen.
Affidavit: I have read this form. The data / information on this form and in online system is same as last entered / modified /
provided by me and its correctness is only my responsibility. I understand that only the information / data provided in the online
system along with the photograph and some other handwritten details on this form will be used for further processing. I accept
all the terms and conditions in this regard.

Signature (URDU) Name (URDU)

Affix Recent

Colored
Signature (ENGLISH) Address (URDU)
Photograph

1.5 * 1.5 inch

Thumb Impression (RIGHT)

Attested By

EMIS Code Date 29-12-2010

Institute Name

Signature of Head / Principal Stamp

Challan No: 140136444 Registration No: 56468-SP.04-2010 *108556*

Due Date: 08-01-2011 1. Board's Copy Due Date: 08-01-2011 2. Bank's Copy
Board of Intermediate and Secondary Education Lahore Board of Intermediate and Secondary Education Lahore

86 Mozang Road Lahore *140136444* 86 Mozang Road Lahore *140136444*

Bank Challan No. 140136444 Dated: 29-12-2010 Bank Challan No. 140136444 Dated: 29-12-2010
Habib Bank Account for Board of Intermediate and Secondary Habib Bank Account for Board of Intermediate and Secondary
Education Lahore Education Lahore
Account No: 0042-79000670-03 Account No: 0042-79000670-03

Name ASMA ASGHAR Name ASMA ASGHAR

Father's Name ASGHAR ALI Father's Name ASGHAR ALI
Registration No. 56468-SP.04-2010 Registration No. 56468-SP.04-2010
Mohallah Rehman Pura Near Mohallah Rehman Pura Near
Hameed Market Street Qutbuddin Hameed Market Street Qutbuddin
Address Address
Khan, Master Yousaf Wali Khan, Master Yousaf Wali
Sheikhupura Sheikhupura

Bank Information Bank Information

Bank Draft No.______ Dated:______ Bank Draft No.______ Dated:______

Particulars Amount (Rs.) Particulars Amount (Rs.)

Fee (Single) Fee (Single)
- Part1 Exam Fee 550/- - Part1 Exam Fee 550/-
- Part2 Exam Fee 550/- - Part2 Exam Fee 550/-
- Processing Fee 100/- - Processing Fee 100/-
Total Amount 1200/- Total Amount 1200/-
Amount in Words: one thousand two hundred rupees Only Amount in Words: one thousand two hundred rupees Only

Cashier_____________ Manager_____________ Cashier_____________ Manager_____________

Due Date: 08-01-2011 3. Student's Copy Due Date: 08-01-2011 4. Board's Copy
Board of Intermediate and Secondary Education Lahore Board of Intermediate and Secondary Education Lahore

86 Mozang Road Lahore *140136444* 86 Mozang Road Lahore *140136444*

Bank Challan No. 140136444 Dated: 29-12-2010 Bank Challan No. 140136444 Dated: 29-12-2010
Habib Bank Account for Board of Intermediate and Secondary Habib Bank Account for Board of Intermediate and Secondary
Education Lahore Education Lahore
Account No: 0042-79000670-03 Account No: 0042-79000670-03

Name ASMA ASGHAR Name ASMA ASGHAR

Father's Name ASGHAR ALI Father's Name ASGHAR ALI
Registration No. 56468-SP.04-2010 Registration No. 56468-SP.04-2010
Mohallah Rehman Pura Near Mohallah Rehman Pura Near
Hameed Market Street Qutbuddin Hameed Market Street Qutbuddin
Address Address
Khan, Master Yousaf Wali Khan, Master Yousaf Wali
Sheikhupura Sheikhupura

Bank Information Bank Information

Bank Draft No.______ Dated:______ Bank Draft No.______ Dated:______

Particulars Amount (Rs.) Particulars Amount (Rs.)

Fee (Single) Fee (Single)
- Part1 Exam Fee 550/- - Part1 Exam Fee 550/-
- Part2 Exam Fee 550/- - Part2 Exam Fee 550/-
- Processing Fee 100/- - Processing Fee 100/-
Total Amount 1200/- Total Amount 1200/-
Amount in Words: one thousand two hundred rupees Only Amount in Words: one thousand two hundred rupees Only

Cashier_____________ Manager_____________ Cashier_____________ Manager_____________