OUR ADMISSION FORM
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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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