1

NAME OF THE STUDENT

2

ADDRESS

VILLAGE/HABITATION

POST

DISTRICT

PIN 

3

       MOBILE NO        

+91                                 

4

CITIZENSHIP

INDIAN

5

CAST

6

RELIGION

7

DATE OF BIRTH

dd   / mm  /yyyy         

8

GENDER

9

FATHER’S NAME

10

MOTHER’S NAME

11

GUARDIAN’S NAME

12

RELATION SHIP WITH GUARDIAN

13

ANNUAL INCOME

14

TRADE

15

EXAM. PASS

MADHYAMICK/

EQUIVALENT

16

PASSING YEAR

17

MARKSHIT NO

17

MARKS OBTAIN IN MADHYAMIK

NAME OF SUBJECT

MARKS

GRADE

BENGALI

ENGLISH

MATHEMATICS

PHYSICAL SCIENCE

LIFE SCIENCE

HISTORY

GEOGRAPHY

18

TOTAL

19

OVERALL AVERAGE

%