SEBA ONLINE SERVICES

APPLICATION FORM FOR CORRECTION OF DOCUMENTS

1. Name of the Candidate :

2. Father's Name :

3. Mother's Name :

4. Date of Birth:

5. Roll :

6. No :

7. Registration Number :

8. Year of Examination:

9. Name of the School Last Studied:

10. Address of the School :

11. Village/Town :

12. Post Office:

13. District:

14. PIN Code:

15. Name of Examination:

16. Upload scanned copy

* Upload Registration Card for Correction of Registration Card / Admit Card / Marks Sheet / Pass Certificate for students of 1998 batch or after and Admit Card in case of students prior to 1998 (jpg,jpeg,png formats only and max size 1MB/1024KB)

17. Corrections To Be Made in :

Registration Card ( Rs. 300 ) + ( Rs. 700 as Late Fine )

Admit Card ( Rs. 300 ) + ( Rs. 700 as Late Fine )

Marksheet ( Rs. 300 ) + ( Rs. 700 as Late Fine )

Pass Certificate ( Rs. 300 ) + ( Rs. 700 as Late Fine )

( Payable Application Processing Fee: Rs. 0 )

* Please fill only the required field/s that needs to be corrected below:

Sl No	Particulars of the Candidate	Record in my Document as	To be corrected as
1	Name of the Candidate
2	Father’s Name
3	Mother’s Name
4	Name of the Institution last attended
5	Registration No
6	Date of Birth
7	Subject /(Elective)
8	Roll No & Year
9	Medium Change
10	Photo Change
11	Signature Change

* For photo/signature change please submit one sample of photo/signature along with the downloaded application form.

18. Mobile Number :