For Office Use PASTE PHOTO
ROLL NO.
Signature of HOI
APPLICATION FORM For Admission into Class XI (2020-21) Science / Arts / Commerce Stream (Please put which is applicable)
To The Head of the Institution
Chandernagore Kanailal Vidyamandir (English Section)
Chandernagore , Hooghly
Respected Sir,
I would like to apply for admission into Class XI of your institution for the session 2020-2021. Necessary particulars are furnished below for your kind perusal. I declare
that the details given are true to the best of my knowledge. If however , anything is found contrary to truth , my admission is liable to be cancelled.
Date. Yours Obediently
Signature of the guardian Signature of the applicant
1. NAME ( in Block Letters ) : (As per Madhyamik admit card)
2. Father’s Name ( in Block Letters ) : (As per Madhyamik admit card)
3. Father’s Occupation :
4. Mother’s Name ( in Block Letters) :
5. Residential Address :
6. Mobile No. 7. E-mail ID.
8. Nationality : 9. Religion :
10. Category : GENERAL/S.C./S.T./OBC-A/OBC-B/P.H.
11. Aaddhar No. 12. Date of Birth as per M.P./ EQV. Admit Card : / /
13. Name of the school last attended :
14. Name of the Board from where passed :
15. Marks obtained in the last Examination according to the Mark-Sheet :
BENG ENG MATH P.SC. L.SC HIST GEOG TOTAL SCIENCE GR. TOTAL GRAND TOTAL
(FOR SCIENCE STREAM) (FOR SC. STREAM)
Selected Subject for Applied Stream Language 1 BENGALI Language 2 ENGLISH
OPTIONAL 1 OPTIONAL 2 OPTIONAL 3 OPTIONAL 4
Signature of the guardian Signature of the applicant