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O/o Commissioner for Public Instruction, Right to Education Cell,

Nrupathunga Road, Bangalore - 560 001 O/o State Project Director,


Sarva Shiksha Abhiyan(SSA),
Nrupathunga Road, Bangalore - 560 001
KARNATAKA RIGHT TO EDUCATION - 2017
( APPLICANT COPY )

Application No: 144285 Mobile No : 9945643710 Submission Date : 16/03/2017

Name of the Child : Jeevan A M Date of Birth : 11/01/2013


Parent / Guardian Name : R Manjunath Child Aadhaar ID / Enrollment ID : 981391903076

Address Type : Aadhaar ID Parent / Guardian Aadhaar ID / Enrollment ID : 341938415955

Parents / Guardian Residential Address

Address Entered by the Applicant Address as per Aadhaar ID / Enrollment ID


Educational District : MANDYA House No/ Bldg /Apt. : akkihebbalu hobali
Educational Block : KRISHNARAJA PET Street/ Road/Lane :

Revenue Village / Ward Name : AKKIHEBBAL Area/Locality/Sector :

Habitation / Locality : AKKIHEBBAL Village/Town/City : Akkihebbal

Pin Code : 571605 Pin Code : 571605

Nationality : Indian Religion : Hindu Mother Tongue : Kannada

Reservation Claimed under : Category-2A Caste : MADIVALA Annual Income : 13000

Certificate Number : RD0038723051466 Date Valid From : 15/03/2017 Date Valid Till : 14/03/2022

Class to be Admitted : LKG Preferred Medium : English Application Uploaded by : Parents

Preferred Schools in Residing Ward / Village

School Code School Name and Address Preference

29220100707 S.K.I. EDUCATION TRUST AKKIHEBBALU 1

Preferred Schools in Adjoining Ward

Softwaredevelopment Centre, G-Governance cell, CPI Office, Bangalore. 3/22/2017 12:00:00 AM 1


O/o Commissioner for Public Instruction, Right to Education Cell,
Nrupathunga Road, Bangalore - 560 001 O/o State Project Director,
Sarva Shiksha Abhiyan(SSA),
Nrupathunga Road, Bangalore - 560 001
KARNATAKA RIGHT TO EDUCATION - 2017
( APPLICANT COPY )
School Code School Name and Address Preference

Declaration : I hereby declare that the information given by me OR my Parents/Guardian along with documents reference no/id are true and correct to the best of my knowledge.

Jeevan A M

Softwaredevelopment Centre, G-Governance cell, CPI Office, Bangalore. 3/22/2017 12:00:00 AM 2