FORM NO.
ACA-II/05 (XI)
COUNCIL OF HIGHER SECONDARY EDUCATION,
MANIPUR
APPLICATION FORM FOR REGISTRATION OF STUDENTS OF CLASS XI
(To be filled in by the student’s own handwriting)
1. Name of the student in full : ……………………………………………………………………
(in block letters & as per HSLC/Equivalent Examination record)
2. Mother’s name in full : …………………………………………………………………………
(in block letters & as per HSLC/Equivalent Examination record)
3. Father’s name in full : …………………………………………………………………………
(in block letters & as per HSLC/Equivalent Examination record)
4. Permanent Address : ……………………………………………………………………………
P.O. ……………………………………. P.S. ……………………………………………………
District……………………………..….. E-mail ID ………………………………………………
(a) PIN ………………………………………………
(b) Mobile No. of the Parent / Student (i)…………….………..(ii)……..…………………..
5. Date of Birth : ( as per HSLC/Equivalent Examination record)
D D M M Y Y Y Y
6. Category : General / SC / ST / OBC (Tick whichever is applicable)
7. Name of Institution : …………………………………………………………………………....
8. Stream : (Arts / Science / Commerce )
(Tick whichever is applicable)
9. Details of Class X Examination Passed :
Name of Board/Council/ Div./
Roll No. Year Name of Institution
Examination University Grade
10. Eligibility Certificate No……………………………. date……………….. (for student admitted with
eligibility permission issued by the Council - migrated from Board/Council/University other than Board
of Secondary Education, Manipur).
DECLARATION BY THE STUDENT
I, do hereby, declare that the information provided in this application and in the documents appended
herewith are true and correct to the best of my knowledge and belief. I understand that in the event of any
information given by me being found false or incorrect at any stage, my registration under the Council of
Higher Secondary Education, Manipur is liable to be cancelled.
Date. ……………………….. ……………………………………………………….
Signature of the student (in full)
P.T.O.
-2-
DECLARATION BY THE HEAD OF INSTITUTION
The particulars of the student furnished here in the application form have been verified and
found correct as per records available in this institution.
Date………………………………… ……………………………………………………
Mobile/ Phone No. ………………… Signature of the Principal/Head of Institution
(with office seal)
FOR OFFICE USE ONLY
Remarks : Accepted / Rejected. Checked by : ………………..……………………
INSTRUCTIONS
1. The duly filled in application form shall be submitted to the office of the Principal/Head of the
institution concerned. The Principal/Head of the institution shall forward the same to the Council of
Higher Secondary Education, Manipur along with necessary fee and documents within the last date fixed
by the Council from time to time.
2. Incomplete application form (i.e. without necessary document & fee) shall be rejected summarily.
3. A fee prescribed by the Council from time to time shall be charged for correction of any wrong entry in
the Application Form / Enrolment and Registration Statement beyond the stipulated time.
4. A student should register from only one institution. “In case, a student is found to have been
enrolled/registered in more than one institution, – (a) his/her enrolment and registration shall be
cancelled for that particular session; or (b) he/she shall be fined a sum of Rs.10,000/-(Rupees ten
thousand) only if he/she desires to opt only one of the institutions and continue to be a student of that
institution”.
5. Students should offer MIL/Alternative English subject as per Council Notification No. 3(1)/111/2016-
HSC dated the 13th November, 2024.
6. LIST OF DOCUMENTS TO BE ENCLOSED :
Photostat copy of –
(a) Admission Card and Mark Sheet of HSLC/Equivalent Examination.
(b) Eligibility Certificate issued by the Council (For students from Boards / Councils /
Universities other than Board of Secondary Education, Manipur)
(c) Valid SC/ST/OBC Certificate issued by the concerned authority (if applicable).
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