ઋिक्रय हॐतुनह ॓ केन्द्री ाध्मक Central Board of Secondary

आवेदक के ार्डदिडि ¡ेतुनिदेि/ Direction for the Guidance of Applicants 1. ुआिॐिक कृपया...
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विक्रय हे तु नह ीं/ Not for Sale

केन्द्रीय माध्यममक मिक्षा बोर्ड

Case No. …………………... (For Office Use)

Central Board of Secondary Education

माईग्रेशन प्रमाण-पत्र, अींक सच ू ी, अनलु िवप प्रमाण-पत्र, प्रोविजनि प्रमाण-पत्र आदि िस्तािेजों के लिए फामम (छात्र/छात्रा स्ियीं अपनी लिखाई में भरें ) Application Form for obtaining Migration Certificate, Manual Certificate of Date of Birth, Provisional Certificate (for private candidates only) and Duplicate Marks Statement/ Qualifying Certificate/ Grade Sheet cum Certificate of Performance/ Statement of subject-wise Performance (To be filled by the candidate himself/herself in his/her own handwriting). प्रत्येक प्रमाण-पत्र/ िस्तािेज के लिए अिग फामम का प्रयोग करें । फामम की फोटोकापी भी प्रयोग की जा सकती है । Use separate form for each document Photocopy of the Form can also be used This Offline form can also be downloaded from CBSE website http://www.cbse.nic.in/publicportal/Forms

For Office Use Received Rs. ………….Vide ………... Scroll No. ……………………………… Cashier

Bank Incharge

इस फामम को भरने से पूिम पष्ृ ठ के िस ू र ओर छपे ननिे शों को ध्यान से पढें : Read directions printed overleaf carefully before filling this form: 1. 2. 3.

छात्र/ छात्रा का नाम/ Name of the candidate……………………………………………………………………………………..........

वपता/अलभभािक का नाम/ Father’s/Guardian’s Name…………………………………………………………………………………. माता का नाम/ Mother’s Name…………………………………………………………………………………………………….

4. 5.

जो िस्तािेज प्राप्त करना है उसका नाम/ Name of the document required……………………………………………………. पर क्षा अींक सूची –(मुख्य/पूरक/अींक सुधार/ अनतररक्त विषय)/ For Marks statement must indicate whether Main/compartment/improvement/Additional Subject Exam…………………………………………………………………..

6. 7.

पर क्षा का नाम िषम एिीं माह/ Name of Exam. with year & Month…………………………………………………………….. अनक्र ु माींक/ Roll No………………………………………….. पर क्षा फि/ Result……………………………………………….

8. 9.

वपछ्िा अनक्र ु माींक (यदि परू क पर क्षा ि है या इसके द्िारा पास की है )/ Previous Roll No. if placed or passed in Compartment/Eligible for Improvement of Performance…………………………………………………………………….. विषयों का नाम जजसमें पर क्षा ि गई थी (यदि अींक सूची अथिा प्रमाण-पत्र चादहए : Subjects offered (if applying for Marks Statement OR Duplicate Certificate): 1. 2. 3. 4. 5. 6.

10. छात्र/छात्रा के विद्यािय का नाम । प्राईिेट छात्र/छात्रा केिि ‘प्राईिेट’ लिखें Name of the School in case of Regular Candidates. Private candidates write only ‘Private Candidate’ …………………………………………………………………………………………………………………………………………… 11. जन्म-नतथथ (जो सी.बी.एस.ई. के ररकार्म में िजम है ) / Date of Birth (As recorded in CBSE records) ………………………………………………………………………………………………………………………………. 12. जमा शुल्क: (अंकों में ) रु................................. रुपए ..................................................................................(िब्दों में ) Fee Deposited: (In figures) Rs……………… Rupees………………………….……………………………… (In Words) 13. भुगतान का तर का/ Mode of payment नकि/ Cash (If personally depositing at Regional Office) र्ी.र्ी./ पे आर्मर/ DD/IPO

बैंक चािान/ Bank Challan

Details of Demand Draft/Pay Order (including Postage fee, if applicable) DD/IPO Amount DD/IPO No.

DD/IPO Date

Name of Issuing Bank/Post Office 14. छात्र/छात्रा का पता/ Candidate’s Postal Address (In Block Letters) …………………………………………………… ............................................................................................................................................................................... ............................................................................................................................................................................... वपन कोर्, िरू भाष सीं एिीं ई-मेि अननिायम है / Pin Code, Phone No. and E-mail ID is compulsory वपन कोर्/ Pin Code……………………………..…

िरू भाष सीं/ Phone No……………………………….. दिनाींक/ Date…………………………

E-mail……………………………………………………… छात्र/ छात्रा/ आवेदक के हस्ताक्षर/ Signature of the Candidate

*************************************************************************************************************** BANK CHALLAN (BANK’S COPY) Date of Deposit………………………….Roll No…………………………Passing Year……………………………………… Paid into the account of CBSE on account of Migration Certificate/Marks Statement/Duplicate Qualifying Certificate/ Duplicate CCE Grade Sheet cum certificate of Performance/ Manual Certificate of DOB/Provisional Certificate (for private candidate)/ (Strike out which hever is not applicable) Name of Candidate………………………………………….Amount Rs……………(Rs………………………………………..only) Sign. of Depositor Scroll Number[For office use] Cashier[For office use] Bank Officer[For office use] (T im e for c ol l ect ion wi t h o r i g in a l Rece ip t . B et ween 3 PM to 5 PM on th e d u e w or k in g d a y s on l y) BANK CHALLAN (CANDIDATE’S COPY) Date of Deposit………………………….Roll No…………………………Passing Year……………………………………… Paid into the account of CBSE on account of Migration Certificate/Marks Statement/Duplicate Qualifying Certificate/ Duplicate CCE Grade Sheet cum certificate of Performance/ Manual Certificate of DPB/Provisional Certificate (for private candidate)/ (Strike out whichever is not applicable) Name of Candidate………………………………………….Amount Rs……………(Rs………………………………………..only) Sign. of Depositor Scroll Number[For office use] Cashier[For office use] Bank Officer[For office use] (T im e for c ol l ect ion wi t h o r i g in a l Rece ip t . B et ween 3 PM to 5 PM on th e d u e w or k in g d a y s on l y) P.T.O

 निम्िमिखित दो कायड केवि उत्तीर्ड परीक्षा प्रमार्-पत्र की प्रनतमिपप प्राप्त करिे के सम्बन्द्ध में अनिवायड हैं:The following two requirements are necessary for obtaining Duplicate Copy of Qualifying Certificate or Grade Sheet cum Certificate of Performance only:1. पहचाि प्रमाखर्कता/ IDENTIFICATION CERTIFICATE मैनें अभ्यथी की प्रमाणणकता की जाींच कर ि है और लसफाररश करता हूीं के उसे बोर्म के प्रमाण-पत्र/ ग्रेर् शीट सह ननष्पािन प्रमाण-पत्र की अनलु िवप जार कर ि जये । I have verified the bonafide of the candidate and recommend that a duplicate copy of the CBSE Qualifying Certificate/ Grade sheet cum Certificate of Performance may be issued. हस्ताक्षर (मोहर सदहत)/ Signature (With Stamp)

प्रधानाचायम या राजपत्रत्रत अथधकार / Principal of Gazetted Officer 2. प्रेस अधधसच ू िा/ PRESS NOTIFICATION

प्रेस अथधसच ू ना ककसी एक (अींग्रेजी या दहींि ) राष्र य िै ननक अखबार में प्रकालशत की जाए ।

प्रेस अथधसच ू ना की मि ू कापी का सींबथीं धत पष्ृ ठ अथधसच ू ना को िशामते हुए फामम के साथ सींिग्न करें । मसौदा

यह सूचनाथम अथधसूथचत ककया जाता है कक सीबीएसई द्िारा जार मुख्य/पूरक, माध्यलमक/उच्चतर माध्यलमक पर क्षा िषम.............. एिीं अनुक्रमाींक......................., उत्तीणम करने से सींबींथधत मेरा मूि/र्ुप्ि केट प्रमाण पत्र िास्ति में खो/नष्ट/खराब/विकृत हो गया है । छात्र/छात्रा का नाम...........................एिीं स्थायी पता.............................................................................

------------------------------------------------------------------ OR -----------------------------------------------------------------To be published in any one (English or Hindi) National daily newspaper [Joint notification in case of both X & XII] Original Full page of the concerned Newspaper highlighting the portion of the matter should be enclosed with the Form

FORMAT It is notified for the information that my Original/Duplicate Qualifying Examination Certificate of Main/Compartment, Secondary, Senior Secondary Examination of Year________and Roll No._____________ issued by CBSE has been actually lost/destroyed/mutilated. Name of the candidate______________________ Full Address/Tel._____________________

आवेदक के मार्डदिडि हे तु निदे ि/ Direction for the Guidance of Applicants 1.

2.

3.

4.

5.

6.

आिेिक कृपया आिेिन करने से पूिम ये सुननजचचत कर िें कक उनके िस्तािेजों का ररकार्म सीबीएसई के ककस कायामिय में उपिब्ध है । सीबीएसई कायामियों एिीं िहााँ उपिब्ध ररकार्म की जस्तथथ अींनतम पष्ृ ठ पर ि गई है । आिेिक द्िारा गित कायामिय में अपना आिेिन भेजने की जस्तथथ में बोर्म ककसी प्रकार की िे र के लिए जजम्मेिार नह ीं होगा। Applicants must check the status of availability of their respective records at concerned office of the Board & must apply at the concerned office only. Else, Board shall not be responsible for any untoward delay in issuing the document. प्रमाण-पत्रों की तीसर प्रनत अथिा अगि प्रनतयाीं तब तक जार नह ीं की जाएींगी जब तक क्षेत्रीय अथधकार ककसी िस्तािेजी प्रमाण से सींतुष्ट नह ीं हो जाते कक अनुलिवप/पूिम जार प्रमाण-पत्र िास्ति में खो/नष्ट हो गया हो। Triplicate or further copies of qualifying certificates shall not be issued on Urgent basis. The same is issued only after the concerned Regional Officer is further satisfied by some documentary evidence that the duplicate/last issued copy has also been actually lost/ destroyed. A formal request must be enclosed with the Application Form, supporting documents & applicable fee. माईग्रेशन प्रमाण-पत्र उन्ह ीं छात्र/छात्राओीं को जार ककया जाता है , जो बोर्म की पर क्षा में बैठे हों, आगामी अध्ययन तथा प्रिेश की सुविधा के लिए भी माईग्रेशन प्रमाण-पत्र जार ककया जाता है । Migration certificate is issued only to those candidates who have appeared for examination of the Board, in order to enable them to seek admission elsewhere for further study. अनुत्तीणम एिीं अींक सुधार/अनतररक्त विषय पर क्षा में बैठे छात्र/छात्राएीं माईग्रेशन/प्रोविजनि प्रमाण-पत्र के लिए आिेिन न करें । Failed candidates and candidates appeared for improvement/Additional Subject should not apply for Migration or Provisional certificate. प्रोविजनि प्रमाण-पत्र केिि ननजी श्रेणी के उत्तीणम पररक्षाथथमयों को ह तब तक प्रिान ककया जाता है जब तक उन्हें स्थाई प्रमाण-पत्र जार नह ीं कर दिया जाता। ननयलमत स्कूि के अभ्यथी प्रोविजनि प्रमाण-पत्र के लिए अपने स्कूि से सम्पकम करें । Provisional Certificate is issued to a private candidate who has passed Secondary/Sr. Secondary Examination, only till the issuance of the main Qualifying Certificate by the Board. Regular school candidate to obtain Provisional Certificate from their school only. आिेिक अपने आिेिन के पचचात ् केिि तीन माह के भीतर ह अपना िस्तािेज सीबीएसई के सींबींथधत कायामिय द्िारा प्राप्त कर सकते हैं। आिेिन के तीन माह के पचचात ् ऐसे िस्तािेजों को सम्भािने/जार करने की जजम्मेिार बोर्म की नह ीं होगी तथा आिेिक को अपने िस्तािेज प्राप्त करने के लिए पन ु : आिेिन करना होगा। Applicants desirous of collecting documents by-hand must collect their respective document(s) within three months from the date of deposit of duly completed Application Form & fee. The Board shall not be responsible for retaining such documents after the expiry of 03 months duration. Such document(s) shall be cancelled & the applicant shall have to re-apply in case of need. Details of Fee and Delivery time of documents(Incomplete Application Forms will take its usual course of time)

DEPOSIT & COLLECTION BY HAND NON-URGENT BASIS

URGENT BASIS

Fee for each document: `100/- + Postal Charges Document shall be issued on production of original Fee receipt after 15 working days(Excl. holidays) between 3pm5pm from M&M Section. Fee in cash & Application Form to be deposited with the CBSE Office/Designated Bank only between 10 am to 2 pm on any working weekday.

Fee for each document: `200/- + Postal Charges Document shall be issued on production of original Fee Receipt after 2 working days (Excl. holidays) between 3pm5pm from M&M Section. Fee in cash & Application Form to be deposited with the CBSE Office/Designated Bank only between 10 am to 2 pm on any working weekday.

DEPOSIT & DELIVERY BY POST Fee for each document: `200/- + applicable Postal/Courier charges as per applicable category below: ` 25/- For delivery within Delhi/ New Delhi ` 35/- For delivery within Delhi/ within India

Foreign applicants desirous of obtaining documents through courier shall include appropriate courier charges.

Fee to be paid through Demand Draft/Pay Order or Indian Postal Order favoring “Secretary CBSE” payable at concerned Regional Office only. डर्माींर् ड्राफ्ट/पोस्टि आर्मर द्िारा शुल्क भेजते समय सुननजचचत करीं कक पोस्टि आर्मर/ डर्माींर् ड्राफ्ट “सथचि, केंन्र य माध्यलमक लशक्षा बोर्म” के सींमींथधत क्षेत्रीय कायामिय के नाम में ह प्रेवषत हो।

Delivery of document(s): Within 7-20 working days from the date of receipt of Application Form. Documents shall be dispatched at the respective address of the candidate through Speed Post/Regd. Post/Courier as the case may be. Applicants must mention complete Postal Address with Pin Code, Mobile Tel. No. and E-mail ID on the Application Form. Migration Certificate can be obtained by qualified candidates on same day of depositing App. Form & fee in cash by hand Provisional Certificate can be obtained by qualified pvt candidates on same day of depositing App. Form & fee in cash by hand  बोर्ड के पवमिन्द्ि क्षेत्रीय कायाडियों में उपिब्ध ररकार्ों की वतडमाि स्स्तधि: st  Present status of availability of records at various Regional Offices of the Board (as of 1 Jan. 2015) Regional Offices Available Examination Record (Exam. year wise) Allahabad 2001 onwards Bhubaneswar 2011 onwards Chennai 1991 onwards Delhi/Foreign 2003 onwards Guwahati 2001 onwards Panchkula 2001 onwards Patna 2011 onwards Ajmer (Registered Office) Own Region records + Balance records of other Regional Offices of year earlier than those indicated above, until 1975 Dehradun 2014 onwards Thiruvananthapuram 2014 onwards As per its weeding out rules 1998, CBSE, has weeded out old records of viz Marksheet, Gazettee & Counter Foil upto 1974. Therefore, duplicate documents upto 1974 cannot be issued and applicants need not apply for the same.

के. मा. मि. बो. के क्षेत्रीय कायाडिय/ Regional Offices of CBSE

Website: www.cbse.nic.in or www.cbse.gov.in



क्षेत्रीय कायाडिय एवं उिके अधधकार क्षेत्र/ Regional Offices and their Jurisdiction

सी.बी.एस.ई. क्षेत्रीय कायाडिय, ददल्िी पी एस-1-2, इन्सट ट्यूशनि एररया, पटपड़गींज, आई. पी. एक्स्टें शन, दिल्ि -110092 CBSE Regional Office, Delhi PS-1-2, Institutional Area, I. P. Extension, Delhi-110092

दिल्ि एिीं वििे शी स्कूि Delhi & Foreign Schools Tel : 011-22239177-80 Fax: 011-22248990 Telex: 66015-CBSE-IN Email: [email protected] [email protected]

सी.बी.एस.ई. क्षेत्रीय कायाडिय, चेन्द्िई प्िाट सीं-1630-ए, नया प्िाट सीं-03, 16 मेन रोर्, जे-ब्िाक अन्ना नगर (पजचचम), चेन्नई-600040 (तलमिनार्ु) CBSE Regional Office, Chennai Plot No.1630-A, New th No.03, 16 Main Road, J-Block Anna Nagar (West), Chennai-600040 (Tamil Nadu)

तलमिनार्ु, आींध्र-प्रिे श, कनामटक, महाराष्र, गोिा, पुड्र्ुचेर , अींर्मान और ननकोबार द्िीप समूह एिीं िमन और ि ि Tamil Nadu, Andhra Pradesh, Karnataka, Goa, Maharashtra, Puducherry, Andaman and Nicobar Islands, Daman & Diu Tel:044-26161100, 26162213-15, 26164708, Fax: 044-26162212 Email: [email protected]

सी.बी.एस.ई. क्षेत्रीय कायाडिय, अजमेर टोर्रमि मागम, अजमेर305001(राजस्थान) CBSE Regional Office, Ajmer Todarmal Marg, Ajmer305001 (Rajasthan)

राजस्थान, गुजरात, मध्य-प्रिे श, िािर और नागर हिेि Rajasthan, Gujarat, Madhya Pradesh, Dadra and Nagar Haveli Tel: 0145-2627460, 2629928, 2627451 Fax: 0145-2421543 Email: [email protected]

उत्तर प्रिे श, उत्तराींचि Uttar Pradesh, Uttaranchal Tel: 0532-2407970, 2407710 2400434 Fax: 0532-2408977 Email: [email protected]

सी.बी.एस.ई. क्षेत्रीय कायाडिय, पंचकुिा, सैक्टर-5, पींचकुिा134109 (हररयाणा) CBSE Regional Office, Panchkula Sector-5, Panchkula134109 (Haryana)

जम्मू और कचमीर, दहमाचिप्रिे श, पींजाब, हररयाणा एिीं चन्र्ीगढ J&K, Himachal Pradesh, Punjab, Hayana & U. T. of Chandigarh Tel:0172-2585193, 2583547 & 2585577 Fax: 0172-2585163 Email: [email protected]

सी.बी.एस.ई. क्षेत्रीय कायाडिय, नतरूविंिपुरम बी-ब्िॉक, 2िीीं मींजजि, एि.आई.सी डर्विजजनि ऑकफस कैम्पस, पट्टम, नतरुिनन्थपुरम-695004 (केरि) CBSE Regional Office, Thiruvananthapuram Block-B, 2nd Floor, LIC Divisional Office Campus, Pattom, Thiruvananthapuram695004 (Kerala) पजचचम बींगाि, ओडर्शा, सी.बी.एस.ई. सी.बी.एस.ई. छत्तीसगढ़ क्षेत्रीय कायाडिय, दे हरादि ू क्षेत्रीय कायाडिय, िव ु िेश्वर West Bengal, Orissa, 99, राजे न् र नगर, 6िीीं मींजजि, आिोक भारती कौिागढ रोर्, िे हरािन ू कॉम्प्िेक्स, शह ि नगर, Chhattisgarh Tel: 0674-2542312, 248001, उत्तराखीं र् भुिनेचिर-751007(ओडर्शा) Fax: 0674-2547312 CBSE CBSE Email: Regional Office, Regional Office, [email protected] Dehradun Bhubaneswar [email protected] 99, Rajender Nagar 6th Floor, Alok Bharti Kaulagarh Road, Building, Shaheed Dehradun-248001, Nagar, BhubaneswarUttarakhand 751007 (Odisha) सी.बी.एस.ई. क्षेत्रीय कायाडिय, पटिा अजम्बका कॉम्प्िेक्स, स्टे ट बैंक कॉिोनी के पीछे , ब्रहमस्थान शेखपुरा के पास, राजा बजार, बैि रोर्, पटना-800014 (त्रबहार) CBSE Regional Office, Patna Ambika Complex, Behind State Bank Colony, Near Brahamsthan Sheikhpura, Raza Bazar, Bailey Road, Patna800014 (Bihar)

त्रबहार, झारखींर् Bihar, Jharkhand Tel: 0612-2295088, 2295048 & 2295080 Fax: 0612-2295008 Email: [email protected]

सी.बी.एस.ई. क्षेत्रीय कायाडिय, इिाहाबाद 35-बी, लसविि स्टे शन, एम. जी. मागम, लसविि िाईन्स, इिाहाबाि211001 (उ.प्र.) CBSE Regional Office, Allahabad 35-B, Civil Station, M G Marg, Civil Lines, Allahabad-211001 सी.बी.एस.ई. क्षेत्रीय कायाडिय, र्ुवाहाटी लशल्पो ग्राम रोर् (शींकर िे ि किाक्षेत्र के समीप), पींजाबार , गुिाहाट 781037 (असाम) CBSE Regional Office, Guwahati Shilpogram Road (Near Shankardev Kalakshetra), Panjabari, Guwahati781037 (Assam)

असम, नागािैंर्, मनीपरु , मेघािय, त्रत्रपुरा, लसजक्कम, अरुनाचि प्रिे श, लमजोरम Assam, Nagaland, Manipur, Meghalaya, Tripura, Sikkim Arunachal Pradesh, Mizoram Tel:0361-2333333, 2229994-95 Fax – 0361-2229992 Email: [email protected]

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उत्तराखींर्, पजचचमी उ.प्र. Uttarakhand, Western UP Tel: 0135-2757744, 2753248, 2753250-51, 2757766 Fax: 0135-2757766 Email: [email protected]

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