Form Download

Sl. No.…………..

INDEX NO.F1-166                                                                                                                                                                                                                         H.S.INSTITUTION CODE: 06339

CHAMRAIL BALIKA VIDYALAYA (H.S)

P.O.-Chamrail, Dist.-Howrah, Pin-711114

 

 

1. Name of the Applicant:_________________________________________________________________

(In Block Letters)

2. a) Date of Birth (As per M.P./Equivalent Certificate/Admit Card):______/_____/_______(DD/MM/YYYY)

b) Nationality_________________c) Religion_________________________d) Caste___________________

3. Address______________________________________________________________________________

4. a) Father’s Name_______________________________________________________________________

(In Block Letters)

b) Occupation__________________________ c) Phone No._______________________________________

5. a) Mother’ Name _______________________________________________________________________

b) Occupation__________________________ c) Phone No._______________________________________

6. a) Guardian’s Name  ____________________________________________________________________

b) Phone No. _____________________________

7. Details of Migration (If Necessary):-  (Migration Certificate must be produced)

a) State______________________ b) School___________________________________________________

8. Result of M.P./Equivalent Examination:- (Attested copy of Mark Sheet should be enclosed)

a) Percentage of Marks____________________________  b) Year  ____________________________

c) Roll __________________________ No. ________________________________________________

9. Marks Obtained in M.P./Equivalent Examination:-

Marks Obtained	Beng.	Eng.	Math.	Life Science	Phy. Science	History	Geography	Additional	Grand Total

10. Subject applied for studying in class (XI)( for 20_____-20_____ Session :

a) Language (Compulsory) : (i) Bengali (1st) (ii) English (2nd)

b) Elective Subjects: (i)____________________________________ (ii)______________________________________  (iii)_______________________________________

c) Additional Subject: (i) ________________________________________

11. Student Code in Banglar Siksha Portal: __________________________

12. Declaration: I shall abide by the rules & regulation of WBCHSE & the school if I get admission.

 

 

 

 

Signature of the Guardian                                                                                             Signature of the Applicant

Date :…………………………….                                                                                               Date :……………………………..