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ADMISSION CUM DATABASE FORM FOR CLASS V-X PERSONAL DETAILS

(To be filled by Student/Guardian in BLOCK letters)

1 Student’s Name

2 Date Of Birth (DD/MM/YYYY) DD MM YYYY

3 Gender Boy Girl Other/Transgender

4 Caste GEN SC ST OBC-A OBC-B

5 Sub-Caste                                                        6 Caste Certificate No (If applicable)

7 Issue Date DD MM YYYY                                                                             

 8 Issuing Authority District (If applicable)

9 Issuing Authority Sub-Division (If applicable)

10 Religion Hindu Islam Other____________________

11 Blood Group                                         12 Identification Mark                                  13 Marital Status Married Un-Married                                                                       14 Aadhaar Status Available Not-Available Applied

15 Aadhaar Card Number (If available)

16 Aadhaar Enrollment Number (If applied) Date & Time

17 BPL Category Yes No If yes, BPL Card No (If applicable)

18 Type of Disability (If applicable)

19 Disability Certificate No (If applicable)

20 Issue Date DD MM YYYY CONTACT DETAILS (To be filled by Student/Guardian in BLOCK letters)

21 House No                            Village / Para / Road                                                          22 Post Office                                                     23 Police Station

24 Block / Municipality                                                                       25 District                                                      26 PIN Code                                                                 27 Mobile No                                                   28 Alt Mobile No                                                 

29 Email Address PARENT DETAILS (To be filled by Student/Guardian in BLOCK letters)

30 Father’s Name 

31 Education

32 Occupation

33 Aadhaar No                                              34 Mother’s Name                                                         35 Education                                        36 Occupation                       37 Aadhaar No                                             38 Guardian’s Name                                                     39 Occupation 40 Relation

41 Aadhaar No                                              42 Annual Family Income                                 

SCHOOL DETAILS (To be filled by Student/Guardian in BLOCK letters)

43 Previous School Name                                                                                                      44 Last Class Attendant IV V VI VII VIII IX

45 School Leaving Certificate No                                                                                           Issue Date (DD/MM/YYYY)                                                                                DD MM YYYY PREVIOUS CLASS MARKS & ATTENDANCE DETAILS

46 Total Marks Marks Obtained Percentage

47 Total Class Held Total Attended Percentage PRESENT CLASS DETAILS

48 Class V VI VII VIII IX X Section Roll No.

BANK ACCOUNT DETAILS (To be filled by Student/Guardian in BLOCK letters)

49 Bank Name                                                                          50 Account No                                                                      51 Branch                                                            52 IFS Code                                                   

EXTRA CURRICULAR ACTIVITIES (To be filled by Student/Guardian in BLOCK letters)

53 ADMISSION DETAILS (For Office Use Only)

54 Admission Number                                      55 Admission Date (DD/MM/YYYY) DD MM YYYY                                                                                     

56 Class of Admission V VI VII VIII IX X Comments:

                                                                                                                                                                                Signature & Seal of the Verifying Authority Comments:                                                                                                                                                                                        Signature & Seal of the Head of Institution

 

Documents To be

Form No.- Form No.-                  Session : 2020 Received from _________________________________________________________________________________ One Application form for Admission in Class : _____________ for Session : 2020 Signature of office staff with seal HOSSAINABAD HIGH SCHOOL (H.S.) CO-EDUCATIONAL , RECOGNISED & GOVT. SPONSORED, VIDE MEMO NO 1037/RMSA/SL/SS-264 12, DT. 30.09.13 ESTD.- 1984, Index No.- E2-081, H. S. Code - 116330 PO - BANSGARA, PS - LALGOLA, Dist.-Murshidabad, PIN-742148 Contact - 9732467904, E-mail - hossainabadhighschool1984@gmail.com PREVIOUS Submitted with the Form Declaration Place Full Signature of the Student Father’s Signature Mother’s Signature Date Form No.- Form No.- 1) Xerox copy of Birth Certificate. 2) Xerox copy of Aadhaar Card. 3) Xerox copy of Caste Certificate (In case of SC/ST/OBC students).4) School Leaving Certificate/ Transfer Certificate . 5) Xerox copy of Bank Account Pass Book .6) Xerox copy of Ration Card (In case of BPL) I do hereby declare that the above information provided by me is complete and correct to the best of my knowledge and belief. I understand that rendering incorrect information shall disqualify the applicant for admission to the school. I have carefully read the rules and regulations laid by the school and being desirous of having my ward educated in this school. I hereby agree to abide by them in all respects. I understand that the decision of the management of the school shall be final. I hereby certify that my ward and I shall follow all the rules and regulations enforced from time to time by the school management. I undertake that I shall not indulge into unwanted activities in order to maintain the sanctity of the Institution. HOSSAINABAD HIGH SCHOOL (H.S.) CO-EDUCATIONAL , RECOGNISED & GOVT. SPONSORED, VIDE MEMO NO 1037/RMSA/SL/SS-264 12, DT. 30.09.13 ESTD.- 1984, Index No.- E2-081, H. S. Code - 116330 PO - BANSGARA, PS - LALGOLA, Dist.-Murshidabad, PIN-742148 Contact - 9732467904, E-mail - hossainabadhighschool1984@gmail.com