BOARD OF SECONDARY EDUCATION :: ANDHRA PRADESH

SSC Public Examinations April / May - 2022

District : KRISHNA-I
Section Code : 12
Mandal : PENUGANCHIPROLU
School / UDISE Code : 11162 / 28160300702 Application No.
S K N & R Z P HIGH SCHOOL,KOLLIKULLA 22044980
Child Id
Stream : Regular
MNR Sl.No : 1 1506171203
Student's Name : MULLAGIRI BHUMIKA
Father's Name : MULLAGIRI RAMBABU
Mother's Name : MULLAGIRI MUTHYALAMMA
Gender : Girl
Date of Birth : 25-07-2007
PH Status :
Religion : Hindu
Caste Category : SC
Medium : Telugu
Contact No. : 9505787749
Fee Amount : 125
Fee Paid Status : PAID
Payment Ref No. : 50170888072021 / 11162_SSC_10034660
Payment Date : Jan 28 2022 10:32PM
Migration Fee Paid : No

Languages & Subjects :

1st Language : Telugu (01T/02T)

2nd Language : Hindi (09H)
3rd Language : English (13E/14E)
Non Languages : Maths (15/16)
General Science (19/20)
Social Studies (21/22)

Identification Marks 1) A BIG MOLE ON THE LEFT CHEEK

2) A MOLE ON THE NOSE
I, hereby, declare that, the entries made by me in the Application Form are correct and true to the best
of my knowledge and strictly in accordance with Admission register only.I hold sole responsibilty for any error in
the particulars of the candidate.
I, Sri./Smt. , father/mother of , who is appearing for the SSC Public
Examinations, April/May-2022 from S K N & R Z P HIGH SCHOOL,KOLLIKULLA School, hereby declare that I
have personally verified all the personal details of my ward submitted in this application and I hereby declare that
all the submitted details are true to the best of my knowledge and in accordance with the details in the Admission
Register of the school.

Signature of the Student Signature of the Student's Parent Signature of the Head Master

31 January 2022 21:04