DELHI PUBLIC SCHOOL KALYANPUR

STUDENT NO DUES FORM

CLASS : X [Session 2022 – 23]

Students Information

 Name : ____________________________________________

 Class/Section : ____________________________________________

 Student ID : ____________________Session ________________

 Father’s Name : ____________________________________________

 Mother’s Name : ____________________________________________

 Address : ____________________________________________

 Phone No/s : ____________________________________________

 Father’s Signature : _____________________Date __________________

 Mother’s Signature : _____________________Date _________________

Dues Clearance checklist (Department Heads must sign against their

respective departments.

 School Fees : ____________________________________________

 Bus Fees : ____________________________________________

 Library : ____________________________________________

 Please attach the photocopy of all 4 quarters fee receipts.

 Please submit the form to the Class Teacher by 10th February’23