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GOVERNMENT MODEL SCHOOL, PATRASAYAR
( ENGLISH MEDIUM COEDUCATIONAL GOVERNMENT SCHOOL)
VILL-SAHAPUR P.0.- BHARA P.S.- PATRASAYAR PIN: 722157 DIST_BANKURA
ADMISSION NO:-_____ DATE:-________ Signature and Seal of the Headmaster/ Assistant Master in Charge
FORM NO:
1. Name: (Spelling as per T.C) : _________________________________________
2. Father’s Name: (As per T.C) : ________________________________________
3. Mother’s Name: : _______________________________________
4. Name of legal Guardian: : _______________________________________
(If both parents are dead)
5. Permanent Address : ________________________________________
(With phone no, if any)
6. Address for Communication: : _________________________________________
(With phone no, if any)
7. Local Guardian, if any: : __________________________________________
(With address & phone no.)
8. Annual Income of Guardian: : __________________________________________
9. Date of Birth (attach Birth Certificate, if available ): _____________________________
10. Caste : (Tick appropriate Category): General / SC / ST / OBC(A) / OBC(B)
11. Whether physically handicapped: Locomotion/ Vision/ Speech/ Hearing/ Mental/ Others (If so, tick
appropriate category of Handicap & attach certificate if available.
12. Seeking Admission: : In class _____ ( in words_____________)
13. Bank Account Details : Name of the Bank: __________________________________________________
Branch Name: _________________________________Bank Account No: _________________________
IFS Code : ________________________
Date:-_________ _________________________ ___________________________________________
(Signature of student) (Signature/LTI of Father/ Mother/ Legal Guardian)
________________________________________________________________________________________
(FOR OFFICE USE ONLY)
_________________________________Son / daughter of ______________ is admitted to
class__________ on his/ her transfer from
___________________________________________________ school Vide T.C No
_____________________ Dated ____________________.