IDC

ENGLISH HIGHER SECONDARY SCHOOL

Issue No. / Date: 01/02.06.2014
PERSONAL DATA EHSS /QSF/TL/406 D
Revn. No. / Date: 00

1. Name of the Student : ……………………………………………………………………….

2. Standard: …………………………………….. Div ……………………………………..

3. Admission No : ………………………….

4. Date of Birth : …………………………..

5. Name of Class Teacher : …………………………

6. Father’s Name : ……………………………………………….

Occupation : ……………………………………………………………………………………….

7. Mother Name: …………………………………………………………………….

Signature : ………………………………………………………………………..

8. Address: ………………………………………………………………………………………….
…………………………………………………………………………………………………….

9. Phone Res: ………………………………… Office: …………………………………………

Phone No: ……………………………………………. (change of residence)
Phone No: ……………………………………………….. (nearest residence, if any)

10. Name of brother / sister in this school

1. Name: Class: Division:
2. Name: Class: Division:
3. Name: Class: Division:

11. Height : ……….Cms, Weight: ………………….Kgs. Blood Group :……………………..

12. Name of Local Guardian: ………………………………………………………

Relationship with the student: ………………………………………………….
Signature : ……………………………………………………………………..

13. School Bus Name / No …………………………………………………….

14. Bus Boarding No. & Point ………………………………………………..

15. Signature of Class Teacher : …………………………………………………..