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Form No-
CATHEDRAL MISSION HIGH SCHOOL
(Under Diocese of Calcutta, C.N.I.)
(SECONDARY & H.S. SECTIONS- Govt. Aided)
46, Lala Lajpat Rai Sarani, Kolkata – 700020
Form for Admission to Class XI for the Academic Session 20_____
Student Code:
A. Basic Information:
1. Name:_________________________________________________
2. D.O.B.:________________________________________________
3. Birth Regn. No.:_________________________________________
4. Gender: Male/Female/Transgender:________________________
5. Social Category: Gen/SC/ST/OBC:________________________
6. Religion:_______________________________________________
7. Mother Tongue:_________________________________________
8. Nationality:_____________________________________________
9. Aadhar No:_____________________________________________
10. Blood Group:_________________________
11. Identification Mark:_______________________________________
B. Educational Information:
1. Academic Year:_______________ 2. Admission No:_________________ (For office use only)
3. Admission Date:_______________ (For office use only)
4. Passed Madhyamik or Equivalent Examination in the year:__________________________________________
5. Percentage of Marks:
6. Subject opted in HS: (i)_____________________ (ii) _______________________ (iii)______________________
(iv)____________________ (v)________________________ (vi)______________________
C. Contact Information:
1. Address:_____________________________________________________________________________________
2. Habitation or Locality:__________________________________________________________________________
3. District:_____________________________________________
4. Block/Municipality:_______________________________________
5. Panchayat:_____________________________________________
6. Post Office:_____________________________________________
7. Police Station:___________________________________________
8. Pin Code:________________________
9. Contact No.:_______________________________
D. Guardian's Details:
1. Father's Name:____________________________________________
2. Mother's Name:____________________________________________
3. Guardian's Name:__________________________________________
4. Relationship (with Guardian):_________________________________
5. Annual Family Income:______________________________________
6. Guardian's Qualification:_____________________________________
7. Guardian's Contact No.:
E. Others Information:
1. BPL Status: Yes/No 2. BPL No:_______________________
3. Child with special need: Yes/No 4. Type of Disability:____________________
5. Minority Status: Yes/No
F. Bank Details:
1. Bank Name:___________________________________________________
2. Branch Code:__________________________________________________
3. IFSC:___________________________________
4. Account No:___________________________________________________
________________________________ ________________________________
Signature of Students Signature of Father/Guardian
Date:_____________________
Date:_____________________ __________________________________
Signature of H.O.I
N.B.: Applicant must submit self-attested Xeroxes of Marksheet, Admit Card, Aadhar Card, School Leaving Certificateand 2 copies of recent passport size photograph
(black and white) with the application form.