Code: 21CP034

PAL PARAMEDICAL INSTITUTE& HOSPITAL Incorporated With: CIPS

Healthcare

Add ress: Itarhi Block Buxar (Bihar) 802123

College
Mob: 6206049137, 9472164547 Email: palclinicsm@gmail.com
ADMISSION APPLICATION FORM

SESSION: 20 2 1 20 2 4
Name of Course
G.N. M1
Subject/ Branch

Name of Student
(In Capital Letters)
(As per 10th Class)
ANTA Kui|alRr
Date of Birth
(As per 10th Class)
Father's Name
(As per 10th Class) RAMOE oP AL
Mother's Name
(As per 10th Class) GiTTA DEV
MANDATORY FIELDS

Category GENOBcscST SUB CATEGORY

Sex MALE FEMALE
Nationality INDIA State / Union teritory of India BTHAR
Aadhar Card No.
5 3 934 5 2 9 &3 3
Permanent Address
VILLSARAST PO TA
RH 8UAR PIN CODE 8o 2 1 23
Mail ld

Mobile No.
8102377319
Mobile No.
Parent's Guardians 2 + 1 38 4 4 S
S.No. Name of Year of
Exam Roll No. Board/ University Subject Marks Max.
Passing Obt. Marks %

. 10"0015 20 13
8-S.E. B. Padrna other 365 Soo 73
2.194h 10o05 2015 8S-E-8-Padha Science. F319 50 62-3
PHYSICS CHEMISTRY BIOLOGY MATHS
MARKS Marks Marks
Max. %Marks Max.
OBTAINED Obt. Obt. Marks % Marks
Obt
Max.%
Marks
4 loo4 55 1o 055 3 1 o 8
 DECLARATION BY THE STUDENT
the
and regulations of the College and
Anita Kumafu solemnly declare that I have read all the rules
admission in the college and that all the information
university | Faculty to the best of my knowledge. I declare that I qualify for the or incorrect information
is found, I Will
TUrnished by me are true and accurate to the best of my knowledge. If any false statement
court of
as final and not approach any
to have my admission cancelled. I will accept the decision of the College administration
Stand
law for the same. be
matter Wil
Institute during the training period, the
Inany form I hereby agree that in case of any dispute between me and the
referred to the director of the Institute and Her/His decision will
befinal
Ishall not indulge in any political activities, student union/association/action committee.
and not transferable in any circumstances.
Tunderstand
that the fees paid by me is neither refundable not adjustable
Iwill notindulge in ragging.

PlaceSaYaR fi Ahita Komai

Dateo1/ 21 (Signature of Student)

DECLARATION BY PARENT/ GUARDIAN

financial
VNOD KUm AR the Parent/Guardian of the applicant hereby declare
I to the
that I am aware of the
tuition and other fees payable to
obligations of admitting my child ward to Pal Paramedical Institute & Hospital. agree pay all
endorse the declaration made my child/ward. I am ware that
the academic year from the time to as per rules. I also a firm and
transferable.
changes/fees paid by me child/ward are strictly not refundable or not

Date l 071 2 1 Place S a a s t e

(Signature of Guardian)

UNDERTAKING

hita (Kumai hereby declare that I have read the prospectus thoroughly and understood rules and
regulations/terms and the condition of Pal Paramedical Institute & Hospital. I have obtained to consent/permission of parents and
once paid is not refundable or transferable in any form. am aware that
the
guardians join
to the course. I have noted that the fee I
Institute does not guarantee any employment in center/state government semi government of autonomous, private voluntary
organization. I have not that the fee once paid is not refundable or transferable in any condition.

Date 04/o _ 2 1 Place Sarafi AnitaRuma?i

(Signature of Student)

FOR OFFICE USE ONLY

Anita Kumaoi

Paste your recent photo Your Full Signature Signature of the

admission Incharge
 GOVERNMENT DF BIHAR

5TH-IV
T4T T TH
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(FaER TT)
ATT T4T
:040778302101604550 tHI:07/12/2016
THTUT-Y HEYT :4292

THTTOTT fT T T f TVT4T/Tt aaT TATRT Sri/Smt./Kumari Anita Kurnari

fT/TT/ET TT uT Father/Husband/Sri Ramdeo Pal TTH/TTT SARASTI TTE ITARHI

fEST T (TT-1)/ faST Ti (7TTI-2) 3TTHTT 47 iftm |

T aa: /Tdt/t aaT

ft/TTdt/THTA AaT FAT Ua 3HT AT TTa/TE SARASTI TE ATf4 ITARHI

FYT:
 OL EXAMINATION
BIHARSCHOC
sCHOOL E
BIHARS
OARD,RD, PATI
PATNATNA
345 475 MARKS SHEET
HTEZ4c5 faaIG Ttten, 2013(Ti96) SECONDARY SCHOOL EXAMINATION, 2013
(ANNUAL)
SI. No.
0937397
IH Name

ANITA KUMARI
HIT H
Mother's Name
GEETA DEVI
f i ITA Fathers Name
RAMDEO PAL
faET School
SN PRO BALIKA H/S ITARHI
Ri S Roll Code YT HO Roll No. yuiy Ho Reg. No.
f f e Date of Birth
75033 0015 75033-10585-12 08/06/96

SUBJECT FULL PASS MARKS OBTAINED

MARKS INTERNALASSESSMENT
MARKSTHEORYSCENCE SoCIAL SC. ASSESSMENT TOTAL MARKS IN WORDS
ASSESSMENTLTACTIVITYPROJ WORKK

M.I.L. HINDI 100 30 0772 072 SEVEN TWO

S.I.L. SANSKRIT 100 30 087 087 EIGHT SEVEN

MATHEMATICS 100 30 070 070 SEVEN ZERO

SCIENCE 100 30 050 017 067 SIXSEVEN

SOCIAL SCIENCE 100 30 051 009 009 069 SIX NINE

500 150 AGGREGATE RESULT 1st Div- 300

365 2nd Div-225
3rd Div- 150

ENGLISH 100 30 043 043 1ST DIVISION

Patna,Dated 5th June, 2013

A Secretary
 BIHAR SCHOOL EXAMINATION BOARD, PATNA
35 faqrIUI5I MARKS STATEMENT
i k g e ytlT, 2015 INTERMEDIATE EXAMINATION, 2015

ai 7 0 FO M.S. No. OND S064505

FTH Name
ANITA KUMARI EA

f97 31 H Father's Name

RAMDEO PAL

Ria os RollCode DHIC Roll No.

14020 ARS 10005

ato i e Enlistment No. O Faculty

14020-R-0161/13 SCIENCE

HETaTo College
+2 S.N.R. PROJECT GIRLS H.S. ITARHI BUXAR

HTGTC MARKS OBTAINED OoLE

SUBJECT NAME F.Marks P.Marks

Theory PracucalTh PE Subject Total
1. 3H4r cOMPULSORY:
RBNON-HINDI 050 015 032
ALTERNATIVE ENGLISH 050 015 030 062

100 030 050 050

ENGLISH

2 f n oPTIONAL
100 033 047 027 074
PHYSICS
0OL
033 032 023 055
CHEMISTRY 100

052 026 078D

BIOLOGY 100 033

3.3tfaRADDITIONAL
EXAME
AT

ARSCHODLM

AGGREGATE MARKS: THREE HUNDRED NINETEEN 319

HITI

uRUT RESULT1ST DIVISION

Dated: 20-05-2015
PATNA-800 001 Secretary
 HOOLEXAMINATIONBOARDPATNATET T
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This is to certify that ANITA KUMARI

75033 0015 75033-10585-12

Roll Code Roll No. Registration No.

GEETA DEVI
Son/Daughter of Smt.

RAMDEO PAL
& Shri

fT- 4faf 8TH JUNE, 1996 INDIAN

born on Nationality
f R fquie TAT HfAf ET H, 2013 TAfTa arffes Hzft% qtaT
Annual Secondary Examination of the Bihar School Examination Board held in March, 2013

ferer SN PRO BALIKA H/S ITARH

From School

FIRST
under division

HINDI ENGLISH
Passed in the following subjects
SANSKRITT
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This is to certify that ANITA KUMARI

Roll Code 14020 Roll No. 10005

Enlistment No. 14020-R-0161/13

Son/Daughter of Shri RAMDEO PAL

INDIAN Passed intermediate SCIENCE

TTeHT 2015
Nationality Examination 2015

+2 S.N.R. PROJECT GIRLS H.S. ITARHI BUXAR

from

FIRST
ut 3titi gUE
in Division

Examination Subject: R. B. NON-HINDI

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Anita kumai
83
INCOME TAX DEPARTMENT GOVT OF INDIA

nen N a

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08/06K99 gnature
 ABBREVIATIONS USEDIN THE PASS BOOK
bank HT
madhya bihar gramin HHITET
Clearing Clg.

Transfer

HEDEYK BIHACcOUNTS PARTICULARS Ch.

BO: 1TAR Cheque
AT 1TARHI B7R PO ITARH BUXAR 802123 {Phone: 122596
Com.
Commissio
AICR Cede: TT
IFSC Cods: PUÓMBGO6 Intt.
Interest

Discount Disc.
Hode of ogeration SELF sts.
Custonerd . D!1147306 Outstation Cheques/Bills Purchased DD
Account No. 784215 00002607 INR
SS ANITA KUMARI D/W
S/0,D/0,8/0: RAM DEV RAL Dividend Warrant
SRI NIFAS RADHIKA PROJECT BAIKAUCHH V1ALAY
VILL+PO. 1fARHI,DIS?. BUXAR Returningtt Rtg
1TARHI 1TARH! BUXAR
INDIA Incidental Charges /C
BIHAR
Pin 802123 34TTTTTT
L01.
Carried Over C/O
amonthita B/F
Please get your Pass Book completed pnce Brought Forward 1
fron bank official . Please do not accegt any tanua
statesent oi aceount LD.D.
entry in your conputer generated Local Cheque/Demand Draft
ttt- 0UR ATH/DEBIT CARDS CAN ALSO BE USED AT ATYS
& NES RITH NOMINAL IMANAGER
ara IDATE IT, SBI Draft : Dft

Cash Cash

or
honour pay Outstation Bill/Cheque O.B.C.
Under Centralised Banking Solution
f8ank shallonly
System,balance to the previous day
up
the cheques of
the customers against clear made in the account
to the drawls of the day already
and having regard