ANNEXUREA 4 ‘weet (We anti) Adsuigsion Form Session 2016-17) ‘Waren Ree PATRACHAR-VIDYALAYA) ‘flan Pokaan, Ua sh ‘DIRECTORATE OF EDUCATION, GOVT. OF NCT OF DELHT Sue alta, “edn ar Reese (BL-BTOCK, SHALIMAR BAGH, DELHI-B), ‘Dostra vrais feat StL era Geer (aifiated with CBSE) RT / Chass XK — [AMIE OF THE SCHOOL eve SCHOO, 1D see eae etn ean QA. Gon (vara Perera rr oe Gre. ~. Student EB-~-- PNNesCobegiven byte Puincher dials} |” BERT ITI TTI ames fey (IMPORTANT INSTRUCTIONS an it Rover faery Paka wh net B weaig Ah oot Ee Please fill he Admission Form after resling the instructions given inthe Prospectus, » RRR A C4 FHA Sere or Tel freer ae ee ig See ee SFL pe Wy wT wea AL Paste x em Size Photograph onthe entity Cand and Meskchisher signature ia tho specs provided, Student should fill up the cohimns in the t-cand. ‘fern sa as sarangi wth. ve aca Ph oe Re ‘Choose subject carefully. Change af mbjet i no slowed an tate stag, 4 Real Peg 1g Ror Gara Prove Serrt wr RRrat (GIV1/ Choose and virine the Disuron were the: student ssslies (North, East, South, West, Centre) t 2, Rell 1 get WA / Name of the Candidate (in CAPITAL LETTERS) ss Sa TA Mother's Nene EAT AL STS * iit Pot Seo a I a ‘5. (7 Date of Hirth Cie ieta ooo ( Minisanm Age 14 years s9-00 31.03.2016), 8 BIZ Gender OO 207 cup, =a SURPRY Natignality — [_] 9 fsa Disabied ey TO TGIM/ Marder Togas (J TNH Religion [7] ‘eG hia Four Previous Qualification 7] spear SEN. z[eafes [rl 4 TRF ar aA? Paahors NaeDECLARATION BY-THE APPLICANT.(fO BE FILLED BY TIE APPLICANZ) aie Braden batew S ae a aay Seawater ia wate 814 wen / a Se eee dee vo sata Freer He Sse Ben rw tr if} 1 . (my et hc a nro esi te gyn bore llsiaperdadl eaten pope bt ngeny eee ings ; Card Agcument nt ied the oni St Zing ie oy ‘ould iret be sles iy. she Pugin’ Vaya f tay tan deco dou Wb miei eee DR een ey he ear prospectus. Pris /Data 7 ; Redt Feet re Rety sers 8 sige : Sighatute ofthe Student Counter Signature of the Pareats/ Guardian Shale: physica choles al thse: Gotamnie: tind Round ian -cofmect to the. best. of mj incwtidige and 1 ain responsible fot Bt hie ents. : ‘Sign.-Of PiineipalHH0S.. (Seal)Annexere-3 (TOBE SUBMITTED AT THE IME OF SUBMISSION OP CBSE EXAM FEES) ‘nbar dee Wt (eet aore-1) Exain. Fos Form Session 2016-17) ‘WataR ftaera (PATILACHAR VIDYALAYA) ”_ Rest Rewer ethereal Oa DIRECTORATE OF EIXICATION, GOVT. OF NCT OF DELHI “RL was, tha a7, PRcel-ob (BL-BLOCK, SHALIMAR BAGH DELEEE “Srdta mentee Rares 8 ere ees (Alisted with CBSE) - WAT / Class X ‘Nhe ofthe Setiqghi sa nn SOOO TO ame tt idk stan fat sravay Ferere-wor get art} Student Dp. ee eee ESEECCOCELT ‘fides IMPORTANTINSTRUCTIONS: agrertc Bete gag ah ee Please fill the Adailssion Form after reading the instructions given in the Prospect. EU We 4c 3 AL rere wr hel Plea cor PREG ATR ROR | TT Tw at ald i a Sim Petoernt de det Cand and Mar List spp othe space provided. Siodent should fill up the-coluenns in the Heard. Raced or gpae ering Us, Rel A wey Boe Re A all Pear iD Choose subject carefully. Change of subjects. not allowed ata later stage. 4, Rend Rex a frat Barat Poa WF oF fhreT RBI Choose snd write the Dissict where the student resides (North, East South, Wost, Centra} S 2. Reel 4/ Name of he Conlin CAPITAL LETTERS) faa ir 8 wy aN WEATRAL LETTERS : . fa Tes [ees eal E q CT 4 Rare ay aed Nanaia CARTACLETTERS po feeleeten pclae Leahey, C 5. 94 E/ Desc of Binh a Cate) les] ESL c 8. 7 Gender CO 2847 coy =] 8. TRT/ Nationality — [—] 9. RRI/ Disbled [] 10. HGAUY Mother Tongue [] 1@4/ Religion = [7] 12. aad wee / Your Previous Qualification oO 18, ROA/ Subjects: BR HON/ Catia ER / Mediom UT eae A EP Ean Store, . SSS See ‘Fete foes : ‘Reel 3 ee mr Ra rs ENE : ; ‘Signature-ofthe Student Ihave physically:checked all the: Lcolurins-afid found correct. I ara fully responsible for all the enteries made in the form. Class Incharge/Examination Incharge: ‘Sign: Of PrincipaltHOs (SeahANNEXURE -C PUNJAB NATIONAL BANK USE-FCMBR MENU. JOURNALNO, cece Hane Date. een 1D DDOPY Collection Code DOOFY Please credit in SB Ve No, 41840001002096290r D.D.0. Patrachar Vidyalaya, Delbi Name of dhe Candidate Adhdess ‘All PAN.B, Branches shall mention journal number all copies of the challan, (To be attached with form by the Depositor. PUNJAB NATIONAL BANK : USE-PEMBR MENU JOURNAL No oo Br eae Dates Institutional ID: DDOPY Collection Code POON’ Please eredit in SB Ale No, 4184000100209629 of + 12D, Patoachar Vidyalaya, Delhi Nate of the Candiate 1 CWSE Fam f Reread Addie. 2 Pestial Fes Rs : % Addons Suh, Fees Rs not Total Rs. - CBSE Exam Fees a 4 Bank Chonses Rysconesnen 80 ratial Fees” Riven Grand Tota Rs. Adsiionst Sub, Foes Rs Rs tesa ws 4) Bonk Changs Rs ws | Grand Tot Ree | Patrachar Vidyalaya Copy through BT Block, Shalimar BANK COPY Hogh. Delhi ; PUNJAB NATIONAL BANK PUNJAB NATIONAL BANK ; : USE-FCMBR MENU MBRMENU 3 JOURNAL NO. cee JOURNAL Nv, Brant ate Beach Date... Sustitational 1): DDOPY Collection Code DDOPV. Pease ened in SB Are No, 4184000100209629 of 1D.D.0, Parachar Vidyalaya, Delhi z me Additional Sub. Fees tot 3. Bank Chanzes * Grund Tol DDOPY Collection Code DDOPY 1B Ale No. 4184000100209629 or idyalaya, Defi id tl Pleage ered D.DO, Patrachar Name of the Car Ades, i tution On account of Lr CBSE Exam Fees 2 Peaetical Fees 3. Additional Sub, Fees Toral Rovseseseene 4.f Bonk Charges Raccrrene 30> Grand Total Rs. Rs,