CHILD's

Maheshwari Public School, Jawahar Nagar Recent

(Governed by: The Education Committee of The Maheshwari Samaj (Society), Jaipur) Affiliated Passport Size
to Central Board of Secondary Education, Delhi. Sector-4 ,Jawahar Nagar, Jaipur - 302004 Photograph
Phone: 0141-2651854 & E-mail: mpsjaipur@gmail.com & WebSite: www.mpsjaipur.com of the Student

Provisional Admission/Provisional Renewal Form Session: 2018 - 2019

Class : 2

Student Details
Enrollment Number: MPSJNJ16675/16
Aadhaar No.: 361987620379
Category:
Blood Group:
Name of the student: Nishkal Khandelwal
Residential Address: C-36 , Laxminarayan Puri Surajpole Gate Jaipur
Date of Birth:: 03-Apr-2010
House:
Pincode: 302003
LandLine: 1412661363
Phone: 9636161688
Email: poemash@gmail.com
Mark of Identification:
Mother Tongue: Hindi
Disability(if any):
Nationality: INDIAN
Sibling (if any): No
Name of Sibling:
Sibling Enrollment No.:
Games Preferences: Games and activity allocation will be done as per availability and at schools discretion.
Priority 1: Basket Ball
Priority 2: Skating
Activity Preferences: Games and activity allocation will be done as per availability and at schools discretion.
Priority 1: Dance
Priority 2: Theatre
Transport: Self
Vehicle Type: Three Wheeler
Vehicle No: RJ14 PB 5159
Driver Name: Jagdish beniwal
Driver Mobile: 9414921868
Mother Details
Mother's Name: Kavita Khandelwal
Occupation Type: SELF EMPLOYED
Occupation Details:
Office Address:
Phone:
Mobile: 9828683003
Aadhaar No.:
PAN:
Email: kj83003@gmail.com
Annual income(in Rs): 1,50,000
Vehicle owned by parent: Four Wheeler
Residential Status: Own House
Mode of conveyance: Own Arrangement
Mother Signature :
Father Details
Father's Name: Ashish Khandelwal
Occupation Type: BUSINESS
Occupation Details:
Office Address:
Phone:
Mobile: 9636161688
Aadhaar No.:
PAN:
Email: poemash@gmail.com
Annual income(in Rs): 3,00,000
Father Signature :
Guardian's Details
Guardian's Name: Keshav das gupta
Occupation Type: Business
Occupation Details:
Office Address:
Phone:
Mobile: 9351156959
Aadhaar No.:
PAN:
Email:
Annual income(in Rs):
Guardian's Signature :
I agree to terms and conditions.
The Principal
Maheshwari Public School, Jawahar Nagar

Dear Sir/Madam

Please grant renewal of my ward Master Nishkal Khandelwal to class 3 in

your school.
It is agreed upon that in case my ward is found fit for admission, I shall :

Obey all the rules mentioned in the school diary/fact book and as amended time to time.
Deposit all fees and dues in the stipulated period announced or revised from time to time.
Personally see that my ward attends the school regularly and punctually in the prescribed uniform, maintains perfect
discipline in the school and follows all the instructions issued by the school from time to time.
Ensure that my ward attends important school functions i.e. Independence Day, Republic Day, Foundation Day,
annual Function and Teacher's Day compulsorily or where ever invited.
Enjoin upon my ward to take part in all the curricular and co-curricular activities including the school picnics
compulsorily and shall not tender any excuses for seeking exemption from them.
Attend all the Parent Staff Meets conducted by the school form time to time.
Accept the decision of the Principal with regard to school discipline as final and binding.
Accept the rules applicable for parents/students which are subject to change by the Principal at any time.

shall also take care that my ward does not :

Disobey/answer back his teachers & seniors.

Damage/spoil school property like furniture & walls etc.
Bring/Fire crackers in the school premises.
Bring/Splash colours in the school premises.
Bring mobile device or any valuables in the school premises.
Wear any rings, bracelets, ear rings or any other items of jewellery in the school premises.
I understand that failure to comply with the above may result in disciplinary action against my ward or may lead to his
expulsion from the school with or without due notice to me.
I also understand that admission is granted upto Class VIII and renewal of admission in class IX and XI entirely
depends upon the overall performance / discipline of my ward in previous classes and it will be at the sole discretion
of the Principal.
I further understand that submission of the provisional renewal form / provisional admission form is not an right what
so ever may be for renewal / admission in next session.

I have read the FactBook / School Diary of the current session and I bind myself to adhere to the rules therein or as modified
from time to time. The information given in this application form is correct & complete. I clearly understand that any false
information given may make my ward ineligible for appearing at the tests & examinations.

Date : Parent's / Guardian's Signature :

Note:- In case of any discrepancy in Student's name, Father's name, Mother's name, Blood Group and DOB please contact
school office.

Kindly submit the Hard copy of Renewal Form along with Aadhaar Card Xerox copy by 31-January-2018.