GOVERNMENT OF KERALA

DIRECTORATE OF HIGHER SECONDARY EDUCATION

APPLICATION FOR ADMISSION TO THE HIGHER SECONDARY COURSE (2015-2016)
APPLICATION NO:

29101993

Mode of Payment:

Cash Paid to School

Name:

BINILDAS K S

Guardian Name:

SIVADASAN M K

Mother's Name:

BEENA M

Father's Name:

SIVADASAN M K

Date of Birth:

27-11-1999

Sex:

Male

Aadhaar No:

359992301181

Enrolement No:

Board Passed:

Yes

SSLC (2014-2015)

Register Number:

Month of Pass:

Year of Pass:

2015

Category Name:

Hin.OBC

OEC:

No

Caste:

EZHAVA

Religion:

Hindu

Resident State:

Kerala

Resident Local Body:

Mankara

Resident District:

Palakkad

Resident Taluk:

Palakkad

Permanent Address:

KUNDUPARAMBIL HOUSE,MANKARA

Communication Address :

KUNDUPARAMBIL HOUSE,MANKARA

Scheme:

MANKARA,678613 678613

MANKARA,678613 678613

Blind:

No

Deaf

No

IEDC Number:

No

Mental/Brain Diseases:

No

Linguistic Minority:

No

Minority Language:

Jawan Priority:

No

NCC or Scout / Guide(Puraskars)

NTSE Qualified:

No

Science Club:

Forestry Club:

No

Nature Club:

Maths Club:

No

Debating Club:

Oratory Club:

No

Lit Con(School Magazines):

Red Cross:

No

Student Police Cadet:

SPORTS AND YOUTH FEST

Sports Fest
Youth Fest

358925

SL-I

D-I / A

D-II / B

No

Jawan Killed In Action:

No

Scout / Guide Participation :

No

Social Science Club:

Yes

IT Club:

No

No

Philatery Club:

No

Yes

Lit Con (Periodicals):

Yes

No

Swim:

No

No

O
2
No

P
A
D-III / C

DLP

State Science Fair

State Social Science Fair

State Maths Fair

State IT Fair

State Work Experience Fair

E-Mail ID:

Phone Number:

9495769007

Chance Number:

SSLC School:

9013 GOVT HSS MANKARA, PALAKKAD

C
s

No

Health Club:

Yes

5
1
OH:

STATE FAIRS

A-Grade B-Grade C-Grade D-Grade E-Grade

State Level First(SL-I), District First or A-Grade(D-I / A), District Second or B-Grade(D-II / B), District Third or C-Grade (D-III / C), District Level Participation(DLP)

PAPER NAME
First Language- I

CANDIDATE GRADE DETAILS

MARK

GRADE

GRADE POINT

NA

First Language- II

NA

A+

English

NA

Hindi

NA

Social Science

NA

C+

Physics

NA

C+

Chemistry

NA

Biology

NA

Mathematics

NA

Information Technology

NA

A+

.........................................................................................................................................................................................................
ACKNOWLEDGEMENT

Dist : Palakkad
Application No

29101993

Received application from . . . . . . . . . . . . . . BINILDAS K S. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . with Application no . . . . . 29101993. . . . . . . .
Place :
Date : 30-05-2015

IT Services : NIC Kerala

(SCHOOL SEAL)

Page 1 / 2

Name and Signature of the Principal

Date & Time : 30/05/2015 03:43:23 PM

Pref

School Code

No.

Course

Pref

Code

No.

School Code

Course

Pref

Code

No.

School Code

Course

Pref

Code

No.

School Code

Course
Code

9013

11

9125

15

9015

36

22

9008

9013

9139

39

16

9015

11

23

9135

39

9034

39

10

9082

17

9015

24

9135

36

9034

10

11

9082

39

18

9015

25

9135

9034

12

9138

39

19

9008

39

9006

39

13

9138

10

20

9008

9125

39

14

9015

39

21

9008

10

ATTENTION
Print out of Application along with self attested copies of supporting documents should be submitted to any one of the Govt / Aided
Higher Secondary School & pay Application Fee (Rs. 25)

.......................................................................................................................................................................................................
DECLARATION

5
1

I do state that all the information furnished above is true. I know that any false information in the application form will result in
the cancellation of my candidature.
Name and Signature of Parent/Guardian
Place :
Date : 30-05-2015

P
A

O
2

Signature of the applicant

C
s

IT Services : NIC Kerala

Page 2 / 2

Date & Time : 30/05/2015 03:43:23 PM