KATLAMARI * MURSHIDABAD

Application for Tab of class XII

Name (in capital letter) : ……………………………………………………….

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

Mother’s Name: ……………………………………………………………………..

Address:

Vill: ………………………………………….. P.O. ……………………………………

Dist: ……………………………. Mobile No: ……………………………………

Date of Birth: ………………………………………………………………………….

Sec: ………………………… Class Roll No ……………………

Registration NO: ……………………………………………… of ………………

Account Details:

Acoount No: ……………………………………………………………………….

IFSC Code: …………………………………………………………………………..

Branch : ……………………………………………………………………………...

I do hereby declare that the information given above is true to

the best of my knowledge and belief.

................................................
Place: Signature of the Candidate .

Date: