SCOLE - Kerala

(State Council for Open and Lifelong Education - Kerala)

Vidyabhavan,Poojappura,Thiruvananthapuram-695012
APPLICATION FORM FOR VOCATIONAL HIGHER SECONDARY ADDITIONAL MATHEMATICS (2021-2023)
Application Number : 197/2021 Register Number :

Personal Information

1. VHSE Admission No 3292/13006

2. Name of School & Code Govt: VHSS (Sports)

Kannur
(13006)

3. District KANNUR

4. School Address CIVIL STATION KANNUR

Phone number 9446872111

Email Id joshyparayiljps@gmail.com

SSLC Register No 595129

Passed Year 2021
5. Name of the candidate ANNA SANDRA
6. Name of the guardian JOSHY P.S
7. Relationship with the student FATHER
8. Address for communication PARAYIL HOUSE KOTTIYOOR
POST VENGALODY
District
KANNUR
Pincode 670651
9. Telephone No with STD code 9446872111
Mobile No. if any, (Student's/Parent's) 9446872111
Whatsapp No(Student) 9446872111
10. Account Number [Student/Guardian] : 67330137919
IFSC Code: SBIN0070878
Bank Name: SBI
Bank Branch: PERAVOOR
District : KANNUR
11. Gender Female
12. Date of birth 27-03-2005
13. District of Study Centre Opted KANNUR
14. Study Centre 1 & Code GVHSS, Kalliassery(24)

Details of fee paid

16. Amount of fee paid 500

17. Payment Id: 470158572
18. Date of payment: 28/12/2021
 DECLARATION
Certified that the particulars given above are true to the best of my knowledge and belief. I agree to abide by the decisions

taken by SCOLE - Kerala authorities during the course of my study.

Place :

Date : Signature of Applicant

DECLARATION
Certified that the student mentioned here is a regular student in my school and the particulars given above are true to the best
of my knowledge and belief.

Place : Name and Signature of Principal

Date : School seal

For Office use only

Check List

1. Original Bank receipt of fees

2. Copy of S.S.L.C Certificate (Attested by principal)

Defect code ................................................................... Date of memo................................

Signature of Section
Assistant

Applied Date : 28-12-2021