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TRIPURA BOARD OF SECONDARY EDUCATION
P.O: Kunjaban, Agartala, Tripura West, PIN: 799 006
APPLICATION FORM FOR ELIGIBILITY CERTIFICATE FOR ADMISSION TO CLASS XI IN RESPECT OF
STUDENTS PASSING SECONDARY OR EQUIVALENT EXAMINATION FROM BOARDS / UNIVERSITIES OTHER
THAN TRIPURA BOARD OF SECONDARY EDUCATION
To
The Secretary,
Tripura Board of Secondary Education,
Nehru Complex, Gurkhabasti,
P.O. : Kunjaban, Agartala,
West Tripura.
Through the Headmaster/ Headmistress,
_____________________________________________School
Sir,
I have passed the Secondary Examination / Madhyamik Pariksha/ School Final Examination from
________________________________________________________________________________Board /
University. Now, I request the favour of your kindly granting me Eligibility Certificate for admission in Class –
XI in an institution under Tripura Board of Secondary Education.
Necessary particulars are furnished hereunder :
1. Full Name of the applicant ~ ______________________________________________
(in Block Letters)
2. Father’s Name ~ ______________________________________________
3. Mother’s Name ~ ______________________________________________
4. (a) Address ~ ______________________________________________
______________________________________________
______________________________________________
PIN: __________________________________________
(b) Phone /Mobile No. ~ ______________________________________________
5. Nationality ~ ______________________________________________
6. Name of the Examination Passed ~
(i) Name of the Examination ~ ______________________________________________
(ii) Name of the Board/ University~ ______________________________________________
from which passed
(iii) Year of Passing ~ ______________________________________________
(iv) Roll No. ~ ______________________________________________
(v) Result ~ ______________________________________________
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7. Name of the Institution where ~ _____________________________________________
Admission in Class –XI is sought
8. Name of subject with which ~
the Secondary or Equivalent
Examination passed
(a) Language Subjects
(i) (ii) (iii)
(b) Subject other than Language Subjects
(i) (ii)
(iii) (iv)
(v)
9. Subjects intended to offer at the H.S.(+2 stage):
(a) Language Subjects
(i) _________________________________________________________________________Group-A
(ii)_________________________________________________________________________ Group-B
(b) Compulsory Elective Subjects
(i) (ii)
(iii)
(c) Optional Elective Subjects, if any
(i)
10. Documents submitted
(i) Attested copy of Admit Card. (ii) Attested copy of Marksheet.
(iii) Original Migration Certificate(Outward). (iv)Transfer Certificate.
Signature of the Applicant in Full
Signature of the Guardian in Full
I declare that the statements made by the above applicant are true to the best of my knowledge and
I recommend the case for admission in Class-XI of my School with the language and Elective subjects
mentioned in the application.
Signature of the Head of the Institution with Office Seal
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