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AMITY BUSINESS SCHOOL

STUDENT DATA FORM (Please fill in with capital letters) Name of the Student Enrollment No. Class Roll No. E-mail ID Fathers Name Mothers Name Permanent Address of the parents Correspondence Address Contact No. Land line Mobile No. E-mail ID of Parents: Father Mother : : : : : : ASHIL JOHN PANICKER A0101911032 D-37 ashil.panicker@sify.com K. JOHN PANICKER M. LAYA KUMARI

:TC 25/3451, UR-50, SRI-NIVAS, UPPALOM ROAD, STATUE, TRIVANDRUM, KERALA, INDIA : : : : : TC 25/3451, UR-50, SRI-NIVAS, UPPALOM ROAD, STATUE, TRIVANDRUM, KERALA, INDIA 9446-32-48-32 9446-535-129, 9446-32-48-32 johnpanicker01@gmail.com layakumari01@gmail.com

This data form must be accompanied with the original (Voter ID Card, Passport, Ration Card Aadhaar card or latest utility bills i.e. electricity bill, telephone bill etc.)of parents which will be returned after verification and submit one set of Xerox copy for office record. All the ID proofs should be self attested by the parents.

Mothers Signature

Fathers Signature

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