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ISLAMPUR ADARSHAMADHYAMIK VIDYALAYA (H.S)
Recognised and Govt. Sponsored Co-educational institution
Index No- F1-248 VTC: 2128 H.S Code- 106335
VILL+P.O- ISLAMPUR, P.S- J.B. PUR, SUB, DIV.- HOWRAH SADAR, DIST- HOWRAH, PIN- 711401
Admission Serial No. (Office Use):-
ADMISSION FORM FOR CLASS XI
1. Name of student (CAPITAL LETTER): ________________________________________
2. Father's name: ____________________________________________________________
3. Mother's name: ___________________________________________________________
4. Father's occupation: ______________________, 5. Mother's occupation: ______________
6. Permanent address (Village or City/ Police Station/ District/Post Office/State/Pin Code):
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
7. Guardian's name:
8. Guardians address:
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
9. Nationality: _________________________. 10. Religion: _________________________
11. Sex (MALE/FEMALE): _________________, 12. Phone Number: _________________
13. Cast (General/OBC-A/OBC-B/SC/ST): _______________, 14. Sub Caste: ___________
(Certificate to be provided at the time of submission)
15. Date of birth (According to the Madhyamik Admit Card)
17. Whether belong to BPL category (Yes/No): ____________________________________
18. BPL No. (If Yes) (Certificate of Panchayat to be enclosed): ________________________
19. Aadhaar number: _________________________________________________________
20. Class of admission: _____________, Email (Optional): ___________________________
21. Madhyamik Pass Year: _____________________________________________________
22. Madhyamik Pass Board Name: _____________________________________________________
23. Madhyamik Pass School Name (Previous School Name): ________________________________
_________________________________________________________________________________
24. Madhyamik Admit Roll____________________________ No____________________________
25. Madhyamik Registration Number: ___________________________________________________
26. Madhyamik Exam Number (Bengali/English/History/Geography/Math/Life Science/ Physical Science)
27. Previous school and class in which he/she was studying: __________________________
28. Age as on admission date: __________________________________________________
29. Number and date of school leaving certificate: __________________________________
30. Bank account number: _____________________________________________________
31. Bank name: ______________________________________________________________
32. Branch name: ____________________________________________________________
33. IFSE Code: ______________________________________________________________
34. If handicapped, right details: ________________________________________________
35. Apply for (Arts or Science): _________________________________________________
36. Subject Name:
SL. No.
SUBJECT NAME
1
BENGALI
2
ENGLISH
3
4
5
6
Declaration
I declare that the entires in this form are true to the best of my knowledge and belief. I shall abide by the rules of the Institution
Signature of student Signature of parent / guardian
Signature of Head Teacher/Head of Institute
Enclosure
1. Xerox copy of Birth Certificate
2. Xerox copy of caste certificate ( OBC-A/OBC-B/S.C/S.T)
3. Xerox copy of BPL certificate from panchayat
4. Original copy of school leaving certificate with ID number
5. Two copies of stamp size photo graph
6. Xerox copy of Madhyamik admit card
7. Xerox copy of Madhyamik Pass Marksheet / Result
8. Xerox copy of Aadhar card
9. Xerox copy of bank passbook
ISLAMPUR ADARSHAMADHYAMIK VIDYALAYA (H.S)
Recognised and Govt. Sponsored Co-educational institution
Index No- F1-248 VTC: 2128 H.S Code- 106335
VILL+P.O- ISLAMPUR, P.S- J.B. PUR, SUB, DIV.- HOWRAH SADAR, DIST- HOWRAH, PIN- 711401
Admission Serial No. (Office use): -
ADMISSION FORM FOR V to IX
1. Name of student (CAPITAL LETTER): ________________________________________
2. Father's name: _____________________________________________________________
3. Mother's name: ____________________________________________________________
4. Father's occupation: ____________________, 5. Mother's occupation: ________________
6. Permanent address (Village or City/ Police Station/ District/Post Office/State/Pin Code):
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
7. Guardian's name: __________________________________________________________
8. Guardians address: ___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
9. Nationality: __________________________, 10. Religion: _________________________
11. Sex (MALE/FEMALE): ____________________________________________________
12. Cast (General/OBC-A/OBC-B/SC/ST): ________________________________________
13. Sub Caste (Certificate to be provided at the time of submission): ____________________
15. Date of birth (According to Birth certificate): ___________________________________
16. Phone Number: ___________________________________________________________
17. Whether belong to BPL category (Yes/No): ____________________________________
18. BPL No. (If Yes) (Certificate of Panchayat to be enclosed): ________________________
19. Aadhaar number: _________________________________________________________
20. Class of admission: _______________________________________________________
21. Previous school and class in which he/she was studying: _________________________
22. Age as on admission date: _________________________________________________
23. Number and date of school leaving certificate with school ID number: ______________
24. Bank account number: ____________________________________________________
25. Bank name: _____________________________________________________________
26. Branch name: ___________________________________________________________
27. IFSE Code: _____________________________________________________________
28. If handicapped, right details: _______________________________________________
Declaration
I declare that the entires in this form are true to the best of my knowledge and belief. I shall abide by the rules of the Institution
Signature of student Signature of parent / guardian
Signature of Head Teacher/Head of Institute
Enclosure
1. Xerox copy of Birth Certificate
2. Xerox copy of caste certificate ( OBC-A/OBC-B/S.C/S.T)
3. Xerox copy of BPL certificate from panchayat
4. Original copy of school leaving certificate
5. Two copies of stamp size photo graph
6. Xerox copy of Aadhar card
7. Xerox copy of bank passbook