


NAME OF THE STUDENT..............
MOTHER AND FATHER NAMES...........
OCCUPATION.......
PERMANENT ADDRESS...........
NAME OF GUARDIAN...........
DATE OF BIRTH..........
AGE AS ON DATE OD ADDMISSION
RELIGION AND NATIONALITY
NAME OF LAST INSTUTION FROM WHICH HE/SHE PASSED
STUDENT CODE NO WITH DATE IF ANY.
CLASS TO WHICH HE/SHE SEEKS ADMISSION .
SIGNATURE OF PARENT/FATHER OR MOTHER/GUARDIAN. WITH DATE.