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GOVERNMENT OF WEST BENGAL
DIRECTORATE OF SCHOOL EDUCATION
BIKASH BHAWAN (7™ FLOOR), SALT LAKE
KOLKATA- 700091
To
Headmaster / Headmistress
JAGADALLA GORABARI MGS VIDYALAYA
Application for admission to class - XI in W est Bengal Government Schools for the session - 2020 -2021
1. Name of the Candidate (in Block Letters) :
2. Date of Birth :
3. Category (Gen / SC / ST / OBC-A / OBC-B / PH)
4. Nationality :
5. Address with PIN for communication (in Block Letters) :
6. Telephone No. i) Land Line :
ii) Mobile :
7. Father’s Name & Occupation :
8. M other’s Name & Occupation :
9. Guardian’s Name :
10. Relationship with candidate :
11. Guardian’s address with PIN & Ph. No. :
12. Name & Address o f the School last attended :
13. a) Name of the Examination passed :
b) Name of the Board :
c) Year of Passing, Roll, No
14. Marks obtained in the Board Examination :