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Application for SCHOOL : Class 1

SESSION-2024
Application Id:
BHU0326909109

1. Personal Information:
Name: GARGI PATHAK Date of Birth: 24 November 2017
Registered Mobile No. : 8887008767 Registered Email Id : dravinmishra30@gmail.co
Gender: Female Category : GENERAL/UNRESERVED
Are you a Divyang candidate No
?:
Father's Name: Dileep Kumar Pathak Mother's Name: Deepika Mishra
BHU Employee Ward: No Employee Id: N/A

2. Permanent Address:
Address Line 1: Civil Line Road Vikas Nagar Robertsganj Sonbhadra Up, Civil Line Road , Sonbhadra
PIN Code: 231216 State: Uttar Pradesh
Alternate Mobile No: 7460048145

3. Communication Address:
Address Line 1: Civil Line Road Vikas Nagar Robertsganj Sonbhadra Up, Civil Line Road , Sonbhadra
PIN Code: 231216 State: Uttar Pradesh
Alternate Mobile No: 7460048145

4. Bank Details:
Bank Name: Punjab National Bank Branch Name: Lahurabir IMA Building
Bank A/C No: 3695000102067728 Bank IFSC Code: PUNB0369500
Account Holder Name: Dravin Kumar Mishra

5. Payment Details:
Order ID: order_NoD7EeL79SKWcP Payment Date Time: 19-03-2024 05:47 PM
Amount: 750 Payment ID: pay_NoD7bPX2MdPIFI

Declaration/ Undertaking by the Candidate:

I hereby declare that all the particulars given in this application form by me are true and no fact has been suppressed or tempered. I have read the
bulletin for the School Admission 2024 and the terms and conditions given therein and satisfied myself that I fulfill all the admission eligibility req
any information furnished by me is found wrong, my candidature for the admission test be cancelled outright without giving any opportunity and
disciplinary action be also taken against me.

Countersigned by the Parent/ Guardian :

Date: 19-03-2024, Application Last Edited on: 19-03-2024 17:43:54

Printed on : 19-03-2024 05:47 PM

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