2/11/23, 4:22 PM Print Receipt

Registration form for Session 2023-24

Form No. SMCS/UKG/0084

Student Photo Father's Photo Mother's Photo

Name of Student : SAMAYRA LAKHWAN

(As per the Birth Certificate)

Date of Birth : 20/10/2018

Birth Place : Delhi Nationality: Indian

Gender : Male Blood Group: B+ve

Religion : Hindu Category: OBC

Applied Class : PRE-PRIMARY Student Aadhar Card No: 679237076531

Name of the school holly heart

presently studying in :

Contact Number : 8744005656

Father Name (As per Amit Singh

Aadhar Card) :

Father's Qualification : MBA

Father's Occupation / Doing job in manesar in "Sona mandhira pvt" ltd in export department as Assistant manager
Profession (Give full details) :

Office Address & Plot no 30 IMT Manesar

Telephone No. :

Father Annual Income : 594000 Father's Aadhar No: 849817804059

Father's PAN Card No. : DMOPS3597H Father Email Address: amit5757singh@gmail.com

Father's Mobile No : 8744005533

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Mother's Name (As per Mamta

Aadhar Card) :

Mother's Qualification : house wife

Mother's Occupation / B.ed

Profession (Give full details) :

Office Address &

Telephone No. :

Mother's Annual Income : Mother's Aadhar No.: 640916835222

Mother's PAN Card No. : Mother Email ID:

Mother Mobile No : 8744005656

Residential Address : House no 49A Gali no 4 amabedkar nagar sec 9

Telephone No. : Emergency Mobile No. (s): 8744005656

Is Father Alumni of St. Michael's Sr. Sec. School : No

Is Mother Alumni of St. Michael's Sr. Sec. School : No

Year of Passing :

Sibling (Real brother/sister only studying in St. Michael's Sr. Sec. No

School, Gurugram) :

Details of Siblings

SL NO. NAME CLASS ADMISSION NO

Is Single Parent? : No Is Staff Ward?: No

Name of the Staff : Designation of Staff:

Children of transferable Government employees : No

(if yes, please specify government department) :

Payment Details

Payment Type: UPI Payment Id: PAY_LF6JG0KPM3CFXR

TransactionId: 16816 Amount: 25.00

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2/11/23, 4:22 PM Print Receipt

DECLARATION FROM THE PARENTS

I/We hereby certify that the above information provided by me / us is correct and I/we understand that if the information is found to
be incorrect or false or incomplete, the ward shall be automatically debarred from selection / admission process without any
correspondence in this regard. I/we also understand that the application / registration does not guarantee admission to my ward.
I/we accept the process of admission undertaken by the school which is a Christian Minority Institution and I/we shall abide by the
decision taken by the school authorities.

Date :

Signature of Parent

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