Mar Gregorios Memorial Senior Secondary School

SECTOR - VI, BHILAI (CHHATTISGARH)

(An English Medium School affiliated to C.B.S.E.)
Phone: (0788) 228-4646, 228-3849, Email address: mgmsssbhilai@gmail.com

APPLICATION FOR ADMISSION - YEAR: 2022-23

Application No : MGM/274/2023-2024

PARTICULARS OF THE CANDIDATE

1 . Name of the Candidate (in block letters) (As

per the SSC Certificate) : Arpit
2 . Class : XI
3 . Date of Birth (As per the SSC Certificate) : 01-12-2005
4 . Gender : Male
5 . Communication Mobile No : 7470983883
6 . Religion : Christian
7 . Caste : st
8 . Mother Tongue : hindi
9 . Communication Email Id : arpitekka8@gmail.com
10 . Aadhar Eid/Uid Number : 361504557084
11 . Age (as on 31st March 2023) : 17

FATHER'S DETAILS

1 . Name of Father's (in full) (As per the SSC

Certificate) : Bhushan Ekka
2 . Employer's Name : Bhushan Ekka
3 . Mobile No : 8889498883
4 . Email Id : bhushanekka71@gmail.co
m
5 . Occupation : Govt.Sector
6 . Monthly Income : 65000
7 . Father Aadhar Number : 690938110722
8 . Phone No (office) : 9479237959

MOTHER'S DETAILS

1 . Name of the Mother's (As per the SSC

 Certificate) : Sudha Anita Ekka
2 . Employer's Name : -
3 . Mobile No : 9407783774
4 . Email Id : Sudhaekka79@gmail.com
5 . Qualification : UG
6 . Occupation : Home Maker
7 . Monthly Income : -
8 . Mother Aadhar Card No : 472443383471
9 . Phone No (office) : -

ADDRESS DETAILS

1 . Permanent Address : street-9 street on-031 house

on.-B1
2 . Present Address : street-9 street on-031 house
on.-B1

OTHER DETAILS

1 . Transportation Requirement : No
2 . Medium of the instruction : -
3 . Participation in extracurricular activities (e.g.
Music, Dance, Drawing, Painting etc.) : Dance
4 . Examination passed (specify the Board) : CBSE
5 . School last attended : MGM PUBLIC
SCHOOL,SHANTI
NAGAR, BHILAI (C.G)

MARKS OBTAINED IN CLASS 9TH EXAM

Subject Name Percentage

English 34.5
Mathematics 29.3
Hindi/ Sanskrit 34.5
General Science 33
Social Science 34.5
Overall Percentage/ Grade 33

SIBLING DETAILS ( DOES STUDENT HAS ANY SIBLING IN THE SCHOOL )

 Sibling Name Class & Section
- -
- -

GROUP DETAILS

1 . Preferences 1 : 7. English ,
Accountancy,Business Stud. ,
Economics , Informatics
Practices(IP) ( Commerce / IP)
2 . Preferences 2 : 6. English ,
Accountancy,Business Stud. ,
Economics , Maths (
Commerce / Maths)
3 . Preferences 3 : 1. English , Physics ,
chemistry ,Maths , Computer
Science ( Maths / CSC)
4 . Optional subject : Physical Education

DOCUMENT UPLOAD DETAILS

1 . Student Image Upload : Attached

2 . Mother Image Upload : Attached
3 . Father Image Upload : Attached
4 . Xth Mark Sheet (UPLOAD ORIGINAL
SCAN COPY) : Attached
 DECLARATION BY THE PARENT/GUARDIAN

I hereby state that my ward ______________________________________________stays with me and that I am

responsible for his/ her proper studies, good conduct and regular payment of the school fees. I undertake to
furnish such report and information concerning him/ her as may be called for at any time by the Principal. If I
withdraw my child before completion of the course, I shall pay all dues as per the directives/rules and regulations
of the school. I also undertake that my ward will follow all the rules and regulations of the school and obey all
orders/directions of the school authorities from time to time. I understand, that violations from the above
undertaking will be resulted to disciplinary action against my ward for which we will be held responsible for the
same.

Date____________________ Signature of candidate Signature of

Parent/Guardian
Place____________________

1. Name_______________________

Signature____________________
(Admin Office)

2. Name_______________________

Signature____________________

Remarks_____________________
(Accounts/Fees Department)

3. Name_______________________ 4. Name_______________________

Signature____________________ Signature____________________
(Shift Incharge) (Teacher Assigned)

Class & group admitted____________________ Admission No. ________________House _____________

Fees Receipt No.______________ Date ____________ Date of admission___________________

SCHOOL SEAL PRINCIPAL