GUJARAT PUBLIC SCHOOL

Details required to be filled for ‘List of Candidates’ (for Board Registration)

form for Class IX (2022-23)
(To be filled by the parents with utmost care, on the basis of some documents)

1) Name of the Student : RUSHEE PEKETI

2) Mother’s Name : SUNEETA PEKETI

3) Father’s Name : JAYANANDA SATEESH BABU PEKETI

4) Date of birth of the Student : (in figure) 20-04-2008

(in words) TWENTY APRIL TWO THOUSAND EIGHT

5) Sex : MALE 6) Caste : SC / ST / OBC / General : GENERAL

(Attested copy of caste certificate to be produced in case of SC, ST & OBC)

7) Minority : NO 8) G.R. Number : 6168 9) Date of Admission : 06-04-2022

10) Aadhar Card No. : 256930663722

11) Subject Taken :

1) ENGLISH LNG & LIT 2) HINDI COURSE - B

3) MATHEMATICS 4) SCIENCE

5) SOCIAL SCIENCE 6) COMPUTER APPLICATION

12) Only Child : Yes / No [ NO ] 13) Disabled : NO

14) Residential Address : ________________________________________________________________

_________________________________________________________________________________

Phone No. : _____________________________ E-mail Id : ______________________________

15) Annual Income : 1500000

16) Secondary / Equivalent Exam detail (not required to be filled by the students of Class-IX & X) :
Roll No. : ___________________ Board : ___________________
Year : ___________________ Exam : ___________________

All the information provided is true to the best of my knowledge & the school will not be held responsible
for any discrepancy. As I understand it, no changes, whatsoever, will be made once the registration process
is complete.

Parent’s Name : ___________________________________ Signature : ________________

DECLARATION
I parent of ____________________________________ hereby, declare that my ward will show good
behaviour & will regularly attend school. If his / her attendance is less than 75%, then I understand that
action can be initiated by the Board. I will not hold the school responsible for it.

Parent’s Name : ___________________________________ Signature : ________________