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old PM Palem, Madhurawada, Visakhapatnam -41Day Cum Residential

Admissiontoclass:Estream:STATE/CBSEEllLanguage:I

Day scho,ar : I Resjdentja, I semi.Resjdentja, I

1. Name of the Student :

2. Gender

3. Date of Birth :

4. Place of Birth :

5. Aadhar No :

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6.Natjona,jtyH7.Re,jgjonH8.CommunjtyHspecjfy:BC,SC,STcategoryH9. Address for

Correspondence

Mobile :

10. Name of the Father :

11. Occupation :

Pin code :

E-mail :

13. Name of the Mother :

14. Mother Tongue :

12. Annual Income

15. Identification Marks : 1.

2.

Occupation :

16. Name of the School last studied :

17. Place where School is located :

18. Board to which School is Affiliated : (CBSE/lcsE/STATE)

19. Indicate with a tick mark below, extra curricular activities :

Games

Dance

Painting / Drawing

Musical Instrument

Yoga

20. Mention if any achievements and the awards or honours received :

Music

21. Aim and objective which the cadidate may have set for himself in life :

22. Address :Permanent Address

Pin code :

23. Previous Academic Record :

Local Address

Pin code :

Class Syllabus Medium Name of the School place Grade / %ofmarks Result

24. Guardian's Name :

Address :

Occupation :

DECLARATION BY THE APPLICANT

1. I here by declare that all the particulars given above by me are true to be best of my knowledge.

2. I undertake to abide by the rules and regulations of the school in respect of academics, sports, co-curricularactivities code of conduct and discipline and moral education as given in the prospects. In the event of any actof indiscipline on my part the decision of the principal shall be final and binding on me. I endorse the above

statements.

Parents' Signature Applicant's Signature