Student’s Profile Data for Government Record (2022-23)

Guidelines To Be Followed Before Filling the Profile-

● Please be informed that the details must be filled with utmost accuracy.
● All the information must be correct and valid as once submitted in the Department, it can't be changed or altered.
● In case of any documents (like EWS, BPL Categories) be assured that it should be certified by the Government
authorities. Kindly attach the photocopy of the same.
● Kindly attach the photocopy of birth certificate.
● Form has to be filled in computer itself. (Typed) (Hand written form will not be accepted).
● The form must be submitted to the class on Monday positively. For timely submission in the department, do not
delay.
● Undertaking To be filled with Blue/Black Ball Point Pen.

S.NO. STUDENT DETAILS

1 Name of the student (Full Name in Block Letters) SAANVI GOEL

2 Gender (Boy /Girl /Transgender) GIRL

3 Date of Birth as mentioned in the birth certificate 18 August,2005

(DD/MM/YYYY)

4 Admission Number in school 11524

5 Mother’s Name (Full Name in Block Letters) ANITA GOEL

6 Father’s Name (Full Name in Block Letters) ASHEESH GOEL

7 Guardian’s Name (Full Name in Block Letters) NA

8 Student's AADHAAR Number (12 Digits) 4474 3026 6856

9 Name of the student as per Aadhar SAANVI GOEL

10 Address 19-C Sanchar Lok apartment, Patparganj,

IP Extension, Plot No. 108, Delhi-110092

11 Pin code 110092

12 Mobile Number (of Student/ Parent/ Guardian) 9313124949

13 Alternate Mobile Number (of Student/ Parent/ Guardian) 9810424949

14 Contact email-id (of Student/Parent/Guardian) asheeshgoel@gmail.com

15 Mother Tongue of the Child Hindi

16 Social Category ( Gen /SC /ST /OBC) General

17 Minority Group (Muslim / Christian/ Sikh/ Buddhist/ NA

Parsi/ Jain/ NA)
S.NO. STUDENT DETAILS

18 Whether BPL beneficiary? ( Yes/ No) NO

19 If Yes, then Whether Antyodaya Anna Yojana (AAY) NO

beneficiary? (Yes/ No)

20 Whether belongs to EWS / Disadvantaged Group? (Yes/ NO

No)

21 Whether CWSN? (Yes/ No) NO

22 If Yes, Type of impairment (code)** NO

** (Type of Impairment) : 1-Blindness, 2-Low-Vision, 3-Hearing impairment, 4-Speech and Language, 5-

Locomotor Disability, 6-Mentalillness, 7-Specific Learning Disabilities, 8-Cerebral palsy, 9-Autism
Spectrum Disorder, 10-Multiple Disability incl. deaf, blindness, 11-Leprosy Cured students, 12-Dwarfism,
13-Intellectual Disability, 14-Muscular Dystrophy, 15-Chronic Neurological conditions, 16-Multiple
Sclerosis, 17-Thalassem-ia, 18Haemophi-lia, 19-Sickle Cell Disease, 20-Acid Attack victim, 21-Parkinso-
n’s disease

23 Whether the Child is Indian National? (Yes/ No) YES

24 Status of student in Previous Academic Year of Schooling SAME SCHOOL

(2021-22)
(Studied at Current/Same School/ Studied at Other
School/ Anganwadi/ ECCE Centre/ None/Not Studying)

25 Grade/Class Studied in the Previous/Last Academic Year 11th

(2021-22)

Undertaking
We Parents of _______________________________ (Name of ward) student of Class
/ Section ________________hereby declare that all the details are correct and valid.
Date: __________________
Day: ___________________
Name & Signature of Parents: ___________________________________