SETH MR JAIPURIA SCHOOL, Lucknow

VINEET KHAND, GOMTI NAGAR, LUCKNOW-226010
APPLICATION FORM
2009-2010

ADD PHOTO
Regn.No
Admission No
Scholar No
Class
House
   
1. Name of Candidate (Surname First)
(Block Letters)
 
2. Gender
 
3. Class to which admission is sought
 
4. Date of Birth Place of Birth
 
5. Name of Father and Permanent Home Address : Phone No :
 
6. Name of Local guardian and Address : Phone No :
 
7.Father's official designation & Address (if in service/business) : Phone No :
 
8. Mother's official designation & address (if in service)
 
9. Nationality  Religion
 
10. Whether belonging to O.B.C./Scheduled Caste/Scheduled Tribe :
 

11. Name and Class of brother and/or sister if any enrolled in Seth M.R. Jaipuria School, Lucknow (Please do not enter name of cousins)

 
12 .School last Attended
 
13. Date of leaving last school
 
14. Reasons for leaving
 
15. Last class attended
 

I have read the rules & regulations of the school and agree to abide by the same. I note that FEES PAID are not refundable under any circumstances. I also note that T.C. and C.C. from the school last attended will have to be submitted by me at the time of admission in case my ward is to be admitted eventually.
Date:
 
Encl : Two passport size photographs  
 
and a copy of birth certificate from birth/death Signature of Parent (Father / Mother)  
 
registering authority/bonafide certificate  
(For Office Use only)
 
Office Supdt. Principal