This form consists of four pages GOVERNMENT OF KERALA VOCATIONAL HIGHER SECONDARY EXAMINATION APPLICATION FOR REGISTRATION 1. Month and year of Examination 2. Name of Examination Centre 3. Examination Centre No. 4. Name of Candidate (in block letters as in S.S.L.C). Attested copy of the concerned page of the S.S.L.C Book to be attached 5. Date of birth 6. Male of Female 7. Year of admission to the V.H.S. Course 8. Religion with Caste/Community 9. Whether the applicant belongs to Scheduled Caste/Scheduled Tribe (Score off which is not applicable) Scheduled Caste/Scheduled Tribe 10. Address to which communications are to be sent (in block letters) with Pincode 11. Name of Vocational Course 12. Whether the candidates has opted Part III (write 'Yes' or 'No') 13. State whether this is the first appearance or a subsequent appearance 14. If for subsequent appearance, furnish the name(s) of subject(s) in which the candidate intends to appear now 15. If for a subsequent appearance, give the Register No. Month and Year of previous appearance. Attested copy (s) of marklist (s) of all previous appearance (s) should be enclosed. Reg. No. Month Year 1 :2: 16. Details of remittance of Examination Fee : (a) If remitted in the Treasury, furnish the details : Chalan No . Date of remittance Name of Treasury and Place Amount remitted ---- (b) If remitted in the Institution, furnish the details : Receipt No. Date of remittance Amount remitted --- 17. Whether the Candidates has been granted Educational concession by the S.C/S.T Development Department (write Yes/No) 18. In the case of S.C/S.T and O.B.C students, state whether this is the first or second appearance. Also state whether the second appearance is within a continuous period of two years (write Yes/No) DECLARATION I affirm that the details furnished above are correct. Place: Date: Signature and Name of Candidate CERTIFICATE Certified that the entries made by the candidate in this application have been verified with the records and found correct. Also certified that the candidate is eligible for appearing for the Vocational Higher Secondary Examination as per the conditions laid down in G.O (Rt). No. 2018/93/G.Edn. dated 4-6-1993 and that the candidate have secured the minimum internal assessment marks required Passport size Photograph of the Candidate to be affixed here and to be signed with date on the Signature, Name and photograph by the Head Designation of the of Institution Head of Institution (School Seal) Place: Date : 2
