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PATKATA GHOSHPARA JR. HIGH SCHOOL P.O. – Rangdhamali, Dist. – Jalpaiguri Estd. – 2010 DISE Code – 19020501404 1 . Student’s Name ( In CAPITAL letters ) : ……………………………………………………………………………… 2 . Student Code (BS Id) : ……………………………………………………………………………………………………….. 3 . (a) Father’s Name : …………………………………………………………………………………………………………… (b) Mother’s Name : ………………………………………………………………………………………………………..... (c) Address :- Vill : …………………………………………… P.O. : …………………………………………. P.S. : ………………………………………………... Dist. : ………………………………………… PIN : ……………………………………………….. Phone No. : ………………………………… 4 . (a) Guardian’s Name : ……………………………………………………………………………………………………….. (b) Relationship with Guardian : ………………………………………………………………………………………… (c) Address :- Vill : ……………………………………………. P.O. : …………………………………………… P.S. : ………………………………………………… Dist. : …………………………………………. PIN : ………………………………………………… Phone No. : …………………………………. 5 . Gender : Male / Female 6 . Date of Birth : ……………………………………………………………………… 7 . Age as on 01/01/2025 : ………………… Years ………………. Months ………………. Days 8 . Aadhaar Number : ……………………………………………………………………………………………………………. 9 . Mother Tongue : ……………………………… 10 . Religion : Hindu / Muslim / Christian / Others 11 . (a) Caste : General / SC / ST / OBC (b) Sub-caste : …………………………………………… 12 . Whether belongs to minority group : Yes / No 13 . Previous school name : …………………………………………………………………………………………………… 14 . Last class passed : ……………………………… Year : ………………………………………………………… 15 . Seeking admission in Class : …………………………………………………………………………………………… 16 . (a) Bank name : ……………………………………………………. (b) Branch name : ……………………………. (c) A/C no. :……………………………………………………………(d) IFSC no. : ……………………………………. ___________________________________________ _____________________________________________ Signature of the Student Signature of the Guardian