Form Serial No. =~ 9051 DAV PUBLIC SCHOOLS cy DHANBAD ZONE ‘A Ke tans ew Delhi - Ly Managed by DAV College Managing Committe, New Delhi -55 sieve ee ir TES Name & Address of the School To be filled by Office Registration No. BNS DAV PUBLIC SCHOOL | g,,., T ‘Admission No. GIRIDIH, JHARKHAND oe xg | Name ofthe applicant E | ate ot aren oo NM wy 3 | adhar No 23 Bank Ac. of Ward ij agte | IFSC Code of Bank ranch A 3 | Fathers Name ur # | Mother's Name abe 1, |] Permanent Address eae, | 1a ear Present Address Ph Not E-mail WardParent) a 2, | Sibling ma wot = = 300) Tick the appropriate) be = the sae hoo] Sieg Rave | mate Class-Section 3. | School Alumni a 3545) Tek the aproate a [wre | ~C (@) Mother velar] hela] 4, | Child with Special Needs Ys [—] Be [aera 46) ides nthentned doce “5. | Educational Qualification] Post Graduation | Graduation ‘sr Secontary | Secondary School | 5120) foun ca on ‘on sd barbton |“ Eametston Protemionat Degree] lnt Tozer tanon uate trey (A) Father: i L (8) Mother ae : 6. | Gender Git 6) “7. | Parents Occupation ff : 7110+ 10) Father] Occupation Code [ cov nant oro cb rt | Cope lens Organisation Add Ah Wcthar | Onseaten cote vtconaet | perience | ese Orgran Name Organon Ad Single Parent —= Tekno apple fatter (] etter] Cc Nationality ReligionGeneral Instructions Use only black ball pen to fill the form Do not enter registration number yourself Do not fill anything in the last column of the form Use appropriate tick mark as [| in the relevant box given in the sections 2, 3, 4, 5, 6 and 7 Use the codes given below to fill in the section 1 (Locality Code) and section 7 (Occupation Code) Occupation Code Code] Occupation Code | Occupat Code Occupation ADV | Advocate DOC | Doctor ‘ws | Journalist /AIR7 AWS | Airways EDU | Education Print Media ‘aR _| Architect EMB_| Embassy Employee MER_| Merchant Navy DEF | ArmyNawyiAirForce- || FIN. | Finangal Organisation || OTH_| Others Defence Services Employee PVT _| Private Sector Employee NK | Bank Employee ATL_| Hotel PUB_| Public Sector Employee BUS | Business av_| Civil Services RWS | Railway Employee a CAC | Chartered Accountant | [INT | International Organisation | [SCT | Scientist” {To be filed up By students of Class-xt} For Science stream : Compulsory - English, Physics, Chemistry Elective : [Tick Mark any two of the subjects opted] — (1) Biology; (2) Maths; (3) Economics; (4) Computer; (5) Hindi (Combination is depend on the availability of seats only) For Commerce Stream : Compulsory - English, Accountancy, Business Studies, Economics. Elective : [Tick Mark any one of the subjects opted] — (1) Maths; (2) Hit Note : PHE will be given as sixth subject. x Seas List of Supporting Documents to be produced Code] Distance Range - Locality by the Parents atthe Time of Admission 1. Date of Birth Certificate ofthe Child, Undid 2. Medical Certificate of the Child (for Children with Special Needs), Ge UU 3. Pass out Certificates of Father /Mother (School, Graduation, [Above 5 km upto 8 km] Postaraduation etc) 4 Proof of Residence. Proof of Sibling (Wherever Applicable) Proof of Alumni (Wherever Applicable) rere ie OF : olnlel>lo CERTIFICATE FROM THE PARENTS ‘Wwe hereby certiy that the above information provided by metus is correct and Wwe understand that ifthe information is found to be incorrect or false, the ward shall be automatically debarred from selection/admission process without ‘any correspondence in this regard lve also understand that the application/registration/short listing does not guarantee ‘admission to my ward. Vwe accept the process of admission undertaken by the school and Vwe vill abide by the decision taken by the school authorifies. ‘¢ Thereby declare that the particulars given in respect of my sor/daughter/ward are true to the best of my knowledge ‘and I shall not request the authorities for any alteration in date of birth ete. given above. ‘¢ My ward will attend the class regularly and as per CBSE norms he/she will fulfill the criteria of attendance ie 75%. ‘¢ My ward will pass subjectly as well as aggregate in all the examinations held during the session. ‘¢ He or she, if found in any indisciplinary activity in the School his/her T.C. should be sent to my residence. Signature of the mother_______________ Signature of the father Nameofthemother_________________Nameof the father page ee Date afters & eer afar et ar vat Certified that father/mother of master/miss _____ class regular employee of the under area and is entitled to fee payable at the rate chargeable from the wards of company employees. isa Dy. P.MJSr. P.O. Dy. CME/SOM Manager/Area Personnel Manager/ Authorised Signatory ‘Sign with Seal Sign with Seat ‘Sign with Seal FOR OFFICE USE : ADMITTED TO Class Section on Scholar's Regn. No. ss