Shaktimandirpremwati Public School

Shaktimandirpremwati Public School

ShaktiMandirPremwati Public School

1024, SHAKTI MANDIR DARYA GANJ. NEW DELHI-110002

Ph: 23276310 Website:

E-mail-

Registration Form (2017-18)

Prep

Read the instructions before General Category To be filled byoffice

filling up the form

Fill in block letters Registration Fee – Rs.25/-(Not refundable) Registration No.

Full Name of the Child / Last column to be filled by school office only (Weightage point)
Sex [Tick the appropriate] / Male Female
Date of Birth / DayMonthYear
(In words)
Age as on 31st March 2016 / ______
Year Month Days
1. / Status of the Child / /30
Residential Address
Pin Code
Contact Phone No(s) / Mobile Res.Ph.
E-mail Address
2 / First Born Child / Yes / No / /20
3 / Girl Child
[Tick the appropriate] / Yes / No / /20
4 / Sibling Real brother/sister only [Tick the appropriate] / Yes / No / /10
If sibling in ShaktiMandirPremwati School, give details of sibling / Sibling Name / Class / Sec.
1.
2.
3.
5 / Single Parent
[Tick the appropriate] / Yes / No / /10
6 / Adopted Child/Twin Child / Yes / No / /10
Information for School Data - Base
1(a) / (a) Father’s Name
(in block letters)
Educational Qualification
Occupation
Office Name & Address
Income (Annual)
Tel No. / (R) (O) Mob.
(b) / Mother’s Name
(in block letters)
Educational Qualification
Occupation
Office Name & Address
Income (Annual)
Tel No. / (R) (O) Mob.
(c) / Guardian’s Name
(in block letters)
Educational Qualification
Occupation
Office Name & Address
Income (Annual)
Tel No. / (R) (O) Mob.
2. / Nationality & Religion / Nationality …………………………. Religion ……………………………
3. / Last school attended(if any)
4. / Aadhar Card KYC No.
5. / Bank Name & Account No

Declaration By The Parents

I/We, the parent of ______(Name of the child) hereby declare that the information given above is true and correct to the best of my knowledge and belief. I have read and understood all the provisions of the notification in this regard. In case any information is found false or incorrect on verification, the admission of my ward may be cancelled.

Signature of Mother……………………… Signature of Father/ Guardian………………………………

Name of the Mother ……………………… Name of Father/Guardian ………………………………...

Date …………………………

General Instructions / Self attested photocopy to be submitted with the Registration Form
  1. Use only ball pen to fill the form in block letters.
  2. Do not enter registration number yourself.
  3. Use Appropriate tick mark in the relevant box given in the sections 2,3,4,5,6.
  4. Minimum age 4+ as on 31.3.2017 (Born between 1.4.11 and 31.3.2013)
  5. Incorrect/Incomplete form is liable to be rejected.
  6. Retain the registration slip till admission.
/
  1. Self attested photocopy of Birth Certificate issued by Municipal Corporation.
  2. Self Attested photocopy of parent(s) U.I.D.Card/Voters Identity Card/Ration Card/Passport/Electricity Bill etc.
  3. Proof of sibling(photocopy of latest fee slip of real brother/sister studying in ShaktiMandirPremwati Public School.
  4. Proof of single parent (photocopy of affidavit or court papers)
(Tick the appropriate)

Note:1. Please bring all certificates in original for verification/submission at the time of admission.

(Issue of Registration form does not ensure admission)

2. Change in Date of Birth, spellings of any name shall not be made once recorded in school.

PRINCIPAL

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