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            LACHIPUR HINDI JUNIOR HIGH SCHOOL

                                                                GOVT. AIDED AND RECOGNISED

                                                                                  Index No-

  LACHIPUR, P.O – KAJORA GRAM, PIN -713338, P.S- ANDAL, SUB DIV – DURGAPUR, DIST – PASCHIM BARDHAMAN

 

                                                                                  Application for Admission

 

1. Name of the student ( in Block letters) __________________________________________________________________________

2. a) Father’s name : __________________________________________________________________________________________

   b) Occupation: ______________________________________ monthly Income: ________________________________________

  c)  Present Address: _________________________________________________________________________________________

  d) Nationality: _______________________ Religion : _________________ Caste : __________ Sub Caste : __________________

  e) Permanent Home address : Vill : ______________________________________ P.O : __________________________________

   P,S: _________________________________ Nearest Rly. Stn. : _____________________________________________________

  District : ______________________________________________ State : ______________________________________________

3. a) Guardian’s name and address : _____________________________________________________________________________

 

N.B… only father of the student or in case of father being dead, the mother of the student will be the legal guardian and he/ she should                                                    put his/ her signature on the admission register at the time of admission. In case of father and mother both being dead any other nearest                                          relative of the student as per rules of the Board will be the guardian.

            b) Student relation with the guardian: ______________________________________________________________________

 

4.  Student’s date of birth : _____________________________________________________________________________________

 Panchayat Certificate, of birth issued by department of Health & Family welfare (W.B), T.C by Recognized Institution are acceptable.

5.  a) Name & address of the Institution last attended : _______________________________________________________________

     b) T.C No and date: _______________________________________________________________________________________

6. Class in which admission is sought: ___________________________________________________________________________

7. Whether first admission or not: _______________________________________________________________________________

8. State whether belongs to SC / ST or any backward Class: __________________________________________________________

     (If so certificate in respect of above must be produced at the time of admission)

 

  I _____________________________________ solemnly declare that the particulars given by me are true and correct. I further declare                                               that I shall abide by the rules and regulations as well as discipline of the school strictly without being prejudiced.

Countersigned:

 

 

     Signature of the father / guardian                                                                                              Signature of the applicant

     Date:                                                                                                                                          Date:

 

 

                                                                                                                                                  Signature of the Headmaster / T.I.C