;:::~~=tftn:am~ifmr 1 ~~l)t~ ~ / anfWfq;rq;~ ]if ~ "Q\ fa';m' q;t I

I request that my Son/Daughter/ward be considered for Admission to Class in your School for the session........................................................................ ~~WU~-~"Q\~~mm/~Ptqq'fq)f'l1R'R~/~1 Shall

follow the rules/regulations of the school framed I issued from time to time. I

(racHUI/ PARTICULI).RS)

.••••..••••••(..,...~i/) 1................. 1..Name of Student (IN BLOCK LEITERS) .

DateofB~rth/~-ftlfu(lnfigUres/3icnT~. DtJ CCl ~Date of Birth 1iif.+T-ftfftT(ln words I~it) .

~"'iT11(~ 3l~it) ft!or 11TifT..................•............•.•............... ~.......•••••

Full Name (IN BLOCK LEITER) Father Mother .

~CfiT~ ~/~ct~~ .

SI. No.S:JDO .

SCHOOL STAMP

~if, ITa,~ / The Principal,

1.

2.

3.

4.

(I IOn Printed receipt only

«!II ~ '< ~ -~ -qf'a(1Cfi fClicri $'IH@ o:s a)-5r - 01D. A. V. PUBLIC SCHOPlS JHARKHNAD ZONE - 01

~lIH~ ~-~ ctiTJl\i1 ~ flfl1Rt, ~~ PHOTOGRAPH

(Managed by DAV. College Managing Committee, New Oeltii-55)

Ir-----~~~~~~~~~~----JI cnl4i{"t4 ~ ~ / For Office use II ~'{j. ~jq;

Regn. No..................... Date .

~Admitted in 1

~/Date .Adm. No .

I nmni.tReceipt No .

lI;f I Session 20 " I to 20 .

Guardian's Name Relation with the Student .

fQm Ill'lOT I ~CfiT~ 3W-qc: 1••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••

Father's I Mother's I Guardian's Occupation with Designation .

~~ / Monthly Income : v •••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••

. I(a) ~I Correspondence Address , .

5.

6.

7.

(b) ~:I ~~:~~~~~t~~d~'~..............1..... =:': ·..··.· :..18. ~~. (3lTQT(f~it) ~(Cfif.) (an.) .

Contact No. (in case of emergency) Ph. (0) (R) : (.[

~·'a:;tr~· ..······58·0·0· ..··..······..~~·· · ····..·· ·..· ~ q;~ .

Acknowledgment Receipt SI. No Regn. No Date Class ; .

q;ffia;~ol/~ctf~tlp;mRrq;1"11n:ofcnm I Received an application for Registration IAdmission.

~Wt<fmr / Documents received

2. 3m:.R1:rnrmUT-mr(~/\OIRlrMfQ) Character Certificate (O/C.)

4.~-mW1M-~(~/SlRll{;tfCr) Birth Certificate (O/C.)

Of Municipal Corpn I Birth I Death Regn. Office

1. ~111'f1{OI1;lll1UT-W(1@"/ QRlR1fQ)Transfer Certificate (O/C.)

3. 3lq;;f<lIet~IUIa;1(~/!OIRlR1fQ) Marks Sheet (O/C.)

5. ~"\rI:rTOT-'Q;;r(~1 !OIRiI{;ti'Q)Medical Certificate (O/C.)

6. Copy of I. Card and Payslip of Father I Mother

working in BCCL or Subsidiary of C\ L\x1C<\&l:a\~q;'{~a,R

Sign. of Receiving Authority

9. ~fWl\U""fa<Rur I Particulars of previous studies :-: 1 1 .

(1) ~~I Name of the School .

(2) f~:;~:P:n~riftr~..~mm1"t&I't' I ClassLast attended/is studying .: .

(3) q;~~~~ I Promoted to Class .

~~ I Documents furnished:

(1) WHI4HOI m:tTUT-'Q3f(lJ?r/YRrfHfCI) . (a) Transfer Certificate (OriginaIlAttestedCopy) T..(2) ~w:nvr-q-;r(~/ SlRlR1f4) (b) Character Certificate (Original/Attested COpy) ] .

(3) 3lq; l'aa((lJjt.ti1 (~/YRrfHfq) (c) Marks Sheet (Original/Attested Copy) .

(4) ~'RIfWw:nvr-q-;r(~/SlRlR1fi:1) (d) Birth Certificate (Original/Attested COpy') 1 .

tcmrmqm~~~q;r~ I Whether Pl1IPii beiongs to SC/ST/BPL .

(1"'i11ldl Nationality ~Religion ~ .

10.

11.

12.

1.

cOttOIlV DECLARATION

if~~~tfcf;~~~ ~'3?1'~/~ ~ ~t, itU ~1'1Cf1i~lif ~t 3fttif ~ ~~±~-fflfu~~ct~~~~1I here by declare that the particulars given in respect of my Son/Daughter/ward are true to the best of my knowledge and shallnot requestthe authorities for any alteration in date of birth etc. given above. Iif 'lI& ~ ~~ tftn mr '3?1'~/amwr m.m.~.l.~ WUfurlfto <iil1~ <iil175 ~ ctft ~ <t~r-qrwr~~1 .My ward will attend the class regularly and as per C'BSE norms he/she will fuifill the criteria of attendance i.e, 75% minimum.

2.

if 'lI& ~ ~~ tfcf; mr ~~/:mfWrmr<t~~ "\i'IRqn;fil['Qt trttamU if ~fat.Tm if nm~~Tfcn ~vrt<fCfi'{lrr~ I

My ward will pass subjectly as well as in aggregate in all the examinations held during the session.

4. ~ <:16R1t1IHlIiffcnm m'W-fiITCfital"i~lItltt"'ldl CfiT~CimlTt' Iqmft~~ttmift :ancmt'ctrffl~~m~ IHe or she, if found in any indisciplinary activity in th~ School his/her T.C. should be sent to my residence.

3. . if

5. if~~~CfiT~qITfqffit~~if~<iiT~~ I

I shall not request for any change in the child's particulars at any stage.

~/Date:mor!fi«:rr/~ (~T~)

Full Signature of Mother/Father/Guardi n

Certified that Shri/Smt. Father! Mother of .

Class is a regular employee of the Company I Organisation I Project I Colliery under area .

Personnel No and is entitled to fee payable atthe rate chargeable from t~e wards of company employees.

Area Personnel Manager I GMSigh. with Seal

( FOR OFFICE USIE : ADMITTED TO )Class Section on r .•.......•........•.............•........ Scholar's Regn. No 1•••

Clerk Principal

NOTE ;-

1.2.3.

Must give an undertaking for payment of fee.The student must maintain good conduct in the school.

That I have read all the terms & conditions prescribed

by the school and agree to abide by it.

Sign. of Parent I Guardian