SUMMARYSHE

HARYANA SCHOOL GAMES 2023-24 ETSR.NO:-

ELEGIBLITY FORM
{The form would not be accepted if any column left unfilled.}
Venue From_ to Game/Event

1. Name of the Block/District:-

2. Name of Participant Paste latest

(in block letters) coloured
photo
3. Father’s Name Attested by
schoolHead
4. Mother’s Name

5. Home Address

6. Contact Number

7. Date of Birth:(i)in fig.

(ii)Inwords

8. Agein completed years as on 31stDecember2022:- Year _Month Days

9. Bank AccountNo.:- IFSCCode:-

BankName

10. Name oftheschool:-

11. AdmissionNo.
12. DateofAdmissioninSchool:-
13. PresentClass.:-
14. SRNofstudent AADHAARNO.
15.Year of passing 5th:-…………… 8 th h:-…… ……10 th:-……………
16. Percentage of attendance in present class:-
17. Two Prominent marks on the body:-(i)
(ii)
18. Signature of the Student:-
19. Sports fund paid for the year 2023-2024:-
a).Strengthofstudentsfrom6thTo8th fund/AmountRs@10*.TotalRs.
b).Strengthofstudentsfrom9thTo10Th fund/AmountRs@30*TotalRs
c).Strengthof students(i)11th-12thArts: fund/Amount Rs.@60*TotalRs
(ii) 11th,12thCommerce.- fund/amountRs.@72* TotalRs
(iii) 11th–12thScience:-_ fund/amountpaidRs@90*. TotalRs

Totalfund/AmountpaidwithproofRs. DDNo. Date

NameoftheBank

Declaration :- 1. Certified that the above participant is a regular student of this institution for the academic year 2023-24.
2.CertifiedthatIhavepersonallyverifiedtheadmissionrecords maintainedintheschool andfoundcorrect.
3.Iwillbepersonallyresponsibleifanyattacheddocumentsorfilledupparticularsfoundduplicateorincorrect.Inthissituationdepartmentcantakene
cessaryactionagainstme.

Signature Signature
School Team Incharge SignatureAEO/AEEO Head of School
WithPhoneNo. with seal