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TALLIGURI HIGH SCHOOL (HS)
Vill+Po-Barashalbari, Dist-Cooch Behar
ADMISSION FORM FOR CLASS-XI (Arts)
Index No-02-039 HS Institution Code No-10219
FOR OFFICE USE ONLY
Session.......... Name of the Students........................................... Classs..........................Roll No........................
Elective Subject 1.......2...............3......................Addl...........................
Signature of the Headmaster Signature of the office Assistant
1. Name of the Candidate ( in Block Letter)...................................
2.a) Fathers Name......................................
b) Mothers Name........................................
c) Occupation...............................d) Monthly Income Rs.........................
e) Address (Present.................................................
f) permanent......................................................
3.a) Legal Guardians Name.......................................................
b) Relationship.................................c) occupation...............................d) Income Rs..................
e) Address..........................................................
4. Date of Birth ( as per MP certificate/Admit).....................................
5. a) Male/Female............................b) Married/Single.............................
c) Nationality..........................................d) Religion............................
c) Caste -SC/ST/OBC/General..........................................
6.a) AAdhar No............................b) BPL No..................c) contact No.........................
7. a) Bank Name.......................................b) Branch Name...............................c) A/C No............
8. a) Name of the Last Exm Passed.......................................................
b) Name of the Board........................................................
9.
Year Roll No Beng Eng Math P.Sc L.Sc Hist Geo Total Remark
a) Regular
b) CC
c) Com.
10. Name and Address of the Institution where Studied last...........................................................
11.a) Elective subject to be taken (Three) 1...........................2...............................3......................................
b) Addl. Subject (one) 1...................................
Elective Subject available;- 1. Pol. Science 2. History 3.Geography 4.Philosophy 5.Sanskrit 6. Environment Studies 9ENVS)
12. We do here by declare that the particulars given in the form are true.
Signature of the Student Signature of the Father/Guardian
Enclo;- Attested copy of the Admit Card, Mark Sheet, Pass Certificate, Transfer Certificate, Caste certificate.