Basubaral School

Class in which admission is sought for

Examination Centre

: Bareilly

Session

: 2018-2019

Registration Fee

: Rs. 200

1	(a) Full Name of the child (In Capital letters ) (b) Gender (c) E-mail Id	Male Female
3	Blood Group of the Child
4	Do you belong to Gen / SC / ST / OBC / EWS / Disabled / S. G. Child ? Attach Certificate	GEN OBC SC EWS ST S.G. Child
5	Details of Parents:

	Details of Mother / Father	Father	Mother
	(a) Name (In Capital Letter)
	(b) Occupation
	(c) Name of Office & full address
	(d) Mobile No.
	(e) Full Residential Address
	(f) Permanent Address
	(d) Annual Income in Rs.

6	Name & Address of local Guardian (If any)
7	Name & Address of school last attended with Class
8	Whether last School was CBSE affiliated
9	If the last school was not affiliated with CBSE, Specify name of the Board
10	(a) Result of last Examination (b ) Marks (in %)
11	Subject proposed to offer	(1)(2) (3)(4) (5)(6)
12	(a) Whether the transfer certificate is attached (b) Date of TC	Yes No
13	Mother tongue
Note: Cheque/DD should be made in favor of Basu Baral Saraswati Vihar,Senior Secondary School.
14	(a) Payment Mode (b) Bank Name (b) DD/Cheque Date (b) DD/Cheque No. (b) DD/Account No. (b) DD/IFS Code (b) DD/Cheque Amount (b) Paid To	DD/Cheque Cash Rs. 2000 Basu Baral Saraswati Vihar

DECLARATION BY THE STUDENTS

I hereby declare that the above information furnished by me is correct to the best of my knowledge & belief.
I shall abide by the rules of the vidyalaya.

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