Price of Form: NIL RU a SUS GEE Aix Latest For the Academic Year 2023-24 Pratap [PemEERTT I] Admission No. (For Office Use) [Student SRN Nowscssnsssuseeae ) To The Principal/Head Master Sir/Madam, | request you to admit my son/daughter/ward to class under the CHEERAG Scheme. The required particulars are given below: —— _ 1, | Name of the student in full [First Name Middle Name Surmame (in Block letters) | 2 | Name of father/parents | 3 | Date of birth —_In figures =, oo [wm Wy _ i 1 | 4 | Student/parents Residential address with address proof “a — = 5 | Aadhar Number/ PPP No. and Blood group | ofehitd { Annual Income of the parents 6 _| (Both father & Mother} _ 7_| Telephone No. (If any) and e-mail id office Residence Mobile. E-mail: | Emergency contact no. 8 |The student belongs to economically | Yes/No a weaker section (EWS). The certificate | If Yes, enclose relevant certificates. | issued should not be older than 6 months as on 1" April of the year of admission _ | Name of the Govt. School with address in which student studying presently _ 10 | Name of Block of Govt. School in which student studying presently | _ DECLARATION BY PARENT/GUARDIAN a) | hereby declare that the information given about my son/daughter/ward (name of the child) —_______furnished by me is true and correct. b)_ 1am also aware that if the information furnished above is found to be false or incorrect at any stage, the admission will be cancelled and the child will be withdrawn from the school. nature of the Parent/Guardian Date, RECEIPT (School Name) received an admission form from Master/Miss son/daughter of - for admission to class | have personally verified the copies of the required documents/enclasures which are attached herewith. Date:- (Dealing Clerk/ Incharge)