PRABHU DAYAL PUBLIC SCHOOLSHALIMAR BAGH, DELHI-110088

APPLICATION FOR REGISTRATION / ADMISSION

Affix photograph

of the candidate

with parents

Affix

photograph

of the

candidate here

Date Registration No. Class Date of Admission Receipt No. Admission No.

1. Name of Candidate (in Block letters)

2. Mother's Name

3. Father's Name

4. Residential Address

5. Phone No. (Residence)

6. Date of Birth

7.Gender

D D M M Y Y Y Y

PIN CODE

Mobile No.

Nationality

(1)

G

0001 to 1000

(a)

(b) Distance from Residence to School (in kms)

(M/F)

(a)8. Whether belongs to SC/ST/OBC

(If yes, attach copy of the certificate)

(b) Whether belongs to Minority Community

(Sikh, Jain, Muslim, Christian, Buddhist)

If yes, mention the community ______________

c) Whether belongs to Economically Weaker Section

(If yes, attach Affidavit of Total Income of both the parents from all sources).

Whether belongs to Disadvantaged Group

(If yes, attach certificate)

(d)

(Yes/No)

(Yes/No)

(Yes/No)

(Yes/No)

Class to which registration / admission is sought ______________________________________________________9.

Name of the school last attended (if applicable)10

Is that school recognised11. YES / NO

YES / NO

YES / NO

(a)12. Whether the candidate is single child

(b) Whether child has single parent

Name (s) of real brothers / sisters already studying in this school (if any)13.

Name of Brother / Sister(I)

Name of Brother / Sister(I)

Class _________________

Class _________________

Mother's Qualificaiton : 14. _________________________________ Occupation (if working)

Office Address

Telephone Number (Office)

Annual Income ________________________________________________________________________________

(2)

______________________

Whether Parent is an alumini of this school

(If yes, attach relevent copy of the certificate)

(e) (Yes/No)

(If yes, attach affidavit)

(If yes, attach affidavit)

Father's Qualificaiton : 15. __________________________________________________________________________

__________________________________________________________________________Occupation

Office Address

Telephone Number (Office)

Guardian's Name & Qualification : ________________________________________________________________

Annual Income _________________________________________________________________________________

16.(if guardian is applying for registration/admission)

Occupation __________________________________________________________________________

Office Address

Telephone Number (Office)

Annual Income _________________________________________________________________________________

I Certify that the above particulars are correct.

Date : Signature of Father/Mother/Guardian

UNDERTAKING

I undertake the responsibility for the payment of fee bills of my ward as per schedule1.

I accept that the decision of the Principal with regard to School discipline will be final and binding on me and my

ward.

2.

The date of birth mentioned in this form is correct to the best of my knowledge / Municipal Corporation records

and I will have no claim for a change in the above said date of birth.

3.

I declare that all the above entries made by me are correct and if found incorrect registration/admission of my

ward may be cancelled.

4.

Date : Signature of Father/Mother/Guardian

(3)

Attested copies of the following certificates to be attached at the time of registration :

1. Date of Birth of the Child.

2. Residence proof (Ration Card / Voter I.Card / Passport / Telephone (MTNL) Bill ).

3. Income certificate from appropriate authority (in case of E.W.S.).

4. Certificate of class X/XII in case of Alumini.

5. Copy of the latest fee receipt (in case of brother / sister studying in the school).

6. Copy of the Court's order (in case of divorcee).

7. In case of single parent, relevent document is to be attached.

Note :-

FOR OFFICE USE ONLY

All entries have been made in the Admission Register after verification.

Date : ______________________

ADMISSION CONFIRMED

Admission Clerk

Principal

____________________

____________________

(4)