Form Download
CHHAPNA HIGH MADRASAH (H.S.)
(Recognised by West Bengal Board of Madrasah Education and West Bengal council of Higher Secondary Education)
(Co-educational and Govt. Aided Educational Institution)
H.M. index No. 14-04-01-006, H.S. Code No. 103454
P.O.- Patharghata, P.S.- Technocity, Block- Rajarhat , Dist.- North 24 Parganas, Kolkata-700135.
Contact No. 9830530431 (H.M.), 9836162426 (A.H.M.)
email: chm.hs.1968@gmail.com
DISE Code: 19110708402
CLASS:................. SECTION...................... ROLL NO...................... ACADEMIC YEAR: 20.....
USE CAPITAL LETTERS ONLY
1. NAME OF STUDENT: ..........................................................................................
2. NAME OF FATHER: .................................................................................................
3. NAME OF MOTHER: ................................................................................................
4. DATE OF BIRTH : ......................................................................................................
5. RELIGION: .................................................................................................................
6. VILLAGE: ......................................................................................................................
7. POST OFFICE: .............................................................................................................
8. GRAM PANCHAYET: ......................................................................................................
9. BLOCK: .........................................................................................................................
10. DISTRICT: .....................................................................................................................
11. PIN CODE: ...................................................................................................................
12. MOBILE NO....................................................................................................................
13. BANK A/C NO................................................................................................................
14. IFSC NO.......................................................................................................................
15. NAME OF BANK ........................................................................................................
16. NAME OF BANK BRACH...........................................................................................
17. AADHAR NO...............................................................................................................
18. CASTE: GEN.............. SC............ ST............. OBC.................................................
19. YEARLY INCOME OF GUARDIAN............................................................................
20. OCCUPATION OF GUARDIAN..................................................................................
21. KANYASHREE ID NO.(IF ANY).................................................................................
22. TYPE OF DISABILITY (IF ANY).................................................................................
23. WETHER BELONGING TO BPL YES...................... NO...........................................
24. TYPE OF ENROLLMENT :- NEW............ OLD............. TRANSFER.......................
25. DETAILS OF MARKS OBTAINED IN THE LAST EXAMINATION:
SUBJECT: BNGA ENGB MATH PSC LSC HIST GEGR ISPY ARAB TOTAL % OF MARKS
FULL MARKS: .......... ............ ......... ......... ....... ........ ......... ........ ........... .......... ......................
MARKS OBTND: .......... ........... .......... .......... ...... ......... ......... ......... ........... .......... .....................
26. NAME OF SCHOOL WHERE STUDIED LAST..................................................................................
DECLEARATION
We, the undersign declare that all data mentioned above are true to the best of our knowledge. If any of
the data found incorrect or fabricated, the application is liable to be cancelled.
Signature of Student Signature of Guardians
...............................................................................................................................................................
Form No...............
NAME OF THE STUDENT:..................................................................................................................
ADDRESS............................................................................................................................................
STUDENT ID NO.................................................................................................................................
Signature of receiving Cleark/teacher
Subjects Offerred
CLASS-XI & XII ARTS/HUMANITIES
GROUP-A GROUP-B
1. COMP. BENGALI (FL) 1. COMP. BENGALI (FL)
2. COMP ENGLISH (SL) 2. COMP ENGLISH (SL)
(ANY FOUR) (ANY FOUR)
3. HISTORY 3. HISTORY
4. PHILOSOPHY 4. PHILOSOPHY
5. NUTRITION 5. NUTRITION
6. GEOGRAPHY 6. ENVIRONMENTAL STUDIES
7. ARABIC 7. ARABIC