1. Name of the child: FIRST Name ................................SURNAME................

2. Date of Birth (In Figures).................................................................................

3. Father's Name...................................................................................................

4. Mother's Name.................................................................................................

5. Sex.....................................................................................................................

6. Do you belong to Schedule Caste / Schedule Tribe / Backward Class

...............................................................................................................................

7. Full Postal Address...........................................................................................

8. Profession of Father............................Phone(Res)..........................Office.....

9. Class for which Applying .................................................................................

10.Name of the School (s) Previously attended:

(1) .........................................................................................................................

(2) .........................................................................................................................

The particulars given above are correct to the best of my knowledge . I undertake to

abide the regulations of the School .

Date .......................... (Signature of Parent/Guardian)

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For OFFICE USE ONLY

Admitted to .........................................................................................................

                                                                                   Signature of the Principal