STATE BOARD TECHNICAL OF EDUCATION EXAMINATION, HARYANA

PERMISSION-CUM-ADMISSION FORM FOR
WHO CAN APPLY FOR PCA FOR UPCOMING BOARD EXAMINATION

Students of 3yr Diploma Courses (prior to 2016 batch) / 4yr Part Time Diploma Courses (prior to 2014 batch) can fill PCA in their institute in Mercy Chance.
Regular students of 2021 Batch of Ist Year Annual Pattern, 2ndsem, 4thsem& 6thsem. regular students (Batch 2019, 2020 and 2021) of Diploma Courses.
Reappear of 1st, 2nd, 3rd, 4th, 5th & 6th sem. of all Diploma Courses for Batches 2016, 2017, 2018, 2019, 2020 only.
Ist year & 2nd Year Regular students of MSME under Advance Diploma in Tool & Die
Reappears of 1st year of Diploma Courses under Annual Pattern of 2018, 2019 & 2020 Batch.
Regular and reappear of 1st and 2nd year of Diploma in Pharmacy Course for any Batch.
Regular of 2ndsem , 4thsem& 6thsem of MSIL and reappears of all semesters of MSIL
Regular students of Sem. 2 of Level 3, 4 & 5 and reappear of Sem. 1 & 2 of Level 3, 4 & 5 of DVOC Courses
Regular of 2nd , 4th , 6th& 8thsemPart Time Diploma students and reappear of 1st to 8th sem. students of Part Time Diploma Courses
Regular and Reappear of Post Diploma in Industrial Safety.
Improvement cases as per HSBTE Exam Regulations
STATE BOARD TECHNICAL OF EDUCATION EXAMINATION, HARYANA

(Fill the form in block letters)
Reference No of Fees Slip*
Amount Paid*
Date of Fees Submission*

DayMonthYear
Date
Roll No
2. Name of Discipline*
Name of Candidate (as per 10th DMC)
4. Father's Name (as per 10th DMC)*
5. Mother's Name (As per 10th DMC)*
6. Institution: Govt. Polytechnic, Mandi Adampur, Hisar
7. Address*
8. E mail ID*
Mob.*
Upload Passport Size Photo ( Without Cap)*
Signature of the Candidate*

Clear
Documents to be attached- Copy of tenth DMC (Maximum Size 200 KB)*

Cancelof
Exam fee receipt (Maximum Size 200 KB)*

Cancelof

Subject in which the candidate wishes to appear (Give Subject Name & Subject Code) Only Twelve Theory Subjects allowed*

	1st Year	3rd Sem	4th sem	5th Sem	6th Sem
1
2
3
4
5
6

Should be Empty:

PERMISSION-CUM-ADMISSION FORM FOR

STATE BOARD TECHNICAL OF EDUCATION EXAMINATION, HARYANA