21/01/2016

FinalOutputNursery

DELHIPUBLICSCHOOL,BHILAI(C.G.)
(UndertheaegisoftheDelhiPublicSchoolSociety,Delhi)

Risali/MarodaSector
OnlineRegistrationFormforAdmissiontoClassNursery
Academicyear201617
Regn.No.:N/16/074
Date:21/01/2016
Admn.No........................
Date:........./.........../2016
BSPNSPCL/100044
SAILNSPCL/100044

Affix
Mother's
lateststamp
sizephoto

Affix
Father's
lateststamp
sizephoto

Affix
Candidate's
lateststamp
sizephoto

Mother'sPhoto

Father'sPhoto

Candidate'sPhoto

NameofCandidate

AKSHAYABONDA

DateofBirth

30/09/2012[THIRTYSEPTEMBERTWOTHOUSANDTWELVE]

Father'sName

SATYAGOPIBONDA

Mother'sName

NAGALAKSHMIDURGA

1.

2.

3.

4.

ResidentialAddress:

C6/7,NSPCLTOWNSHIP
RUABANDHA
BHILAI

PinCode

490006

SchoolTransportRequired

Yes

ContactPhoneNo(s)

(R)9425293535

(O)NA

MobileNo.

9425293535

EmailID

satyagopi@gmail.com

Sibling:
Sibling'sName
Class,Section
Admn.No.

No
NA
NA
NA

SchoolAlumni:

No

YearofPassingClassXII

CBSERollNo.

(A)Mother

NA

NA

(B)Father

NA

NA

Gender

GIRL

http://portal.dpsbhilai.in/admissionsnursery/previewform.php

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21/01/2016

FinalOutputNursery

5.

Mother
AcademicQualifictions
Occupation
Designation
MobileNo.
OrganisationName
OrganisationPhone
OrganisationAddress

Father
AcademicQualifictions
Occupation
Designation
MobileNo.
OrganisationName
OrganisationPhone
OrganisationAddress

Guardian
AcademicQualifictions
Occupation
Designation
MobileNo.
OrganisationName
OrganisationPhone
OrganisationAddress

Parent'sOccupation:
NAGALAKSHMIDURGA
B.Tech(ComputerScience)
HomeMaker
NA
9993880502
NA

SATYAGOPIBONDA
B.Tech,MBA
PublicSectorEmployee
Dy.Manager
9425293535
NTPCSAILPOWERCOMPANYLTD
0788223308
PowerPlant2,
NTPCSAILPowerCompany(p)Ltd.
Bhilai
CG
NA
NA
NA
NA
NA
NA
NA
NA

CERTIFICATEFROMTHEPARENT
I/weherebycertifythattheaboveinformationprovidedbyme/usiscorrectandI/weunderstandthatifthe
information is found to be incorrect or false, the ward shall be automatically debarred from
selection/admission process without any correspondence in this regard. I/we also understand that the
application/registration/shortlistingdoesnotguaranteeadmissiontomyward.I/weaccepttheprocessof
admissionundertakenbytheschoolandI/wewillabidebythedecisiontakenbytheschoolauthorities.

Mother'sSignature

:_________________

Father'sSignature

:_________________

Mother'sName

:_________________

Father'sName

:_________________

Date

:_________________

http://portal.dpsbhilai.in/admissionsnursery/previewform.php

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