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Our Admission Form


                                                                 OUR ADMISSION FORM



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Mob. 9474142286, e mail :-mirzapurjbs.011@rediffmail.com,      www.facebook.com/MirzapurJuniorBasicSchool

MIRZAPUR JUNIOR BASIC SCHOOL
P.O.- J.J. MIRZAPUR  DIST.- BANKURA
ADMISSION FORM

1.Student’s Name:- 1.(In English) ………………………………………………….. 
                                2.(In Bengali)…………………………………………………..
2. Father’s Name:-…………………………………Occupation:-…………………..
3.Mother’s Name:-…………………………………Occupation:-………………….
4.Guardian’s Name:-………………………………..occupation:-…………………..
5. Nationality:-……………….., Religion:- …………….., Caste:-………………….
6.ADDRESS: Village:…………………. P.O. …………………..Dist……………..
                      PIN Code:………………….. Contact No:…………………………..

 7.Date of Birth:-……/…../ 20…….. (……………………………………………)
8. Age (At the time of Admission):-…………..Yrs. …………Months………….Days.
9. Has the Student the Birth Certificate or any Equivalent record? ……………………
10. The Name of the School, if he/she has read before:-………………………………. 11.Address of the School:- ……………………………………………………………
………………………………………………………………………………………….
12. Up to which Class he/she has read there ? …………………………………………
13. To which Class the Student is admitted:- ………………………………………….

I do hereby declare  that the information stated above are true & correct to the best of my knowledge and belief.

Date:…………………       Signature of the Guardian:………………………………
      
I also declare that all the information’s given by Guardian are true & correct.

Date:……………… Signature of any responsible person:-………………………….

 Sri/ Km./ Smt. ………………………………. Is admitted to Class  ..................



 Date:-……………                                      Signature of the Head Teacher                        

                                                                                          




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