Form Serial No.
DAV PUBLIC SGHOOLS
Na me& Add
trIIABKH6ND zoNE (F)
Managed by DAV college Managing commiftee, New Delhi - ss
e Schanl
Class ;'ffi
, I'RegistrationNo.
To be filled by Office
Admission No.
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oJrh*r ilo: Date .
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U,l Name of the applicant
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Famers Name I
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Mother's Name t gEEE
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1. Permanent Address Locality Codg
1 (20)
L
(See Locality Code
Overtaag
Present Address
email
2. Sibling Reat brother/sister onty 2 Qa)-
Yes No
Fick the appropriate]
lf sibling in the same scfrool, Sibling Name
give details of sibling
Class & Section
3. SchoolAlumni 3 (5+51
fiick lhe appropriateJ
lf Yes, year of passing
(a) Father Yes No
(b) Mother Yes No
4. Child with Special Needs
Yes
4 (5)
[Endose authenticated documents] No
5. Ed ucational Qualification Post Graduation Graduation Sr. Secondary Secondary School 5 (20)
fick highest qualification only] OR OR School Examination Examination
Professional Degree Equivalent (10+2) oR (1oth) oR
Equivalent Equivalent
(a) Father
(b) Mother
6. Gender
Girl 6 (5)
7. Parents Occupation 7 (10+10)
Father
[For occupation code, see overlea{t
Occupation Code tick, if Govt. servant
Designation
Organisation Name
Organisation Aid.
Mother
[For occupation code, see overleafJ
Occupation Code tick, if Govt. servant
Designation
Organisation Name
Organisation Add.
Single Parent
Fick one, only if applicable)
Father
I II Mor I
Morher
I I--l
8. Nationality Religion
General lnstructions
1.
2.
3.
4.
Use only black ball pen to fill the form
Do not enter registration number yourself
Do notfill anything in the lastcolumn ofthe form r..\, rr'rr .*.*
UFe appropriate tick mark as [/] in the relevant box given in the sections 2, 3, 4,5,6 and 7
l
5. Use the codes given below to fill in the section 1 (Locali$ Code) and section 7 (Occupation Code)
Occupation Gode
Code Occupation Code Occupatian Code AccuQafrori,':.
ADV Advocate DOC Doctor NWS Jour.nalisUAlR/
AWS Airways EDU Educationist Print Media
ARC Architect EMB Embassy EqpJoyee MER Merchant Navy
DEF ArmylNavylAir Force- FIN Financial Or$anhation' ' '' *' 3 OTH Others
Defence Services Employee PVT Private Sector Employee
BNK Bank Employee HTL Hotel PUB Public Sector Employee
BUS Business CIV Civil Services RWS Railway Employee
CAC Chartered Accountant INT nternational Organisation
I SCT Scientist*
[To be filled up By students of Class-Xl]
For Science Stream : Compulsory - English, Physics, Chemistry
Elective : fiick Mark any two of the subjects opted] - (1) Biology; (2) Maths; (3) Economics; (4) Computer; (5) Hindi
(Combination is depend on the availability of seats only).
For Commerce Stream : Compulsory - English, Accountancy, Business Studies, Economics
Elective : [Trck Mark any one of the subjects opted]- (1) Maths; (2) Hindi.
rVofe : PHE will be given as s,xffi subl'ecf.
Residence Localitv Code List of Supporting Documents to be produced
by the Parenb at the Time of Admission
Cade Distance Range - Locality
1. Date of Birth Certificate of the Child,
o [0-3 kmJ
2. Medical Certificate of the Child (for Children with Special Needs).
A [Above 3 km upto 5 kmJ 3. Pass out Certificate of Father I Mother (School, Graduation,
Postgrad ucation etc.).
B [Above 5 km upto 8 km] 4. Proof of Residence
[Above B km upto 10 km] 5. Proof of Sibling (Wherever Applicable).
D [Above 10 kmJ
6. Proof of Alumni (Wherever Applicable).
CERTIFICATE FROM THE PARENTS
I/we hereby certify that the above information provided by me/us is correct and l/we understand that if the information is
found tq be incorrect or false, the ward shall be automatically debarred from selection/admission process without any
correspondence in this regard llwe also understand that the application/registration/short listing does not guarantee
admission to my ward. l/we accept the process of admission underbken by the school and l/we will abide by the decision
taken by the school authorities.
r I hereby declare that the particulars given in respect of my son/daughterlward are true to the best of my knowledge
and I shall not request the authorities for any alteration in date 0f birth etc. given above.
o My ward will attend the class regularly and as per CBSE norms he/she will fulfill the criteria of attendance i.e.75%.
e My ward will pass subjectly as well as aggregate in all the examinations held during the session.
r He or she, if found in any indisciplinary activi$ in the School his/her T. C. should be sent to my residence.
Signature of the mother Signature of the father
Name of the mother Name of the father
Date : Date :
slFTgTrcrfr * q,qol a,*dnt d+ qiI Tffut
Certified that father/mother of MasterlMiss Class isa
regular employee of the under area
and is entitled to fee payable at the rate chargeable from the wards of company employees.
Dy.P.M./Sr. P.O. Dy. CMHSOM ManagerlArea Personnel Manager/Authorised Signatory
SEn with Seal Srgn with Seal S,gn with Seal
FOR OFFICE USE : ADMITTED TO
Class Section on Scholar's Regn. No.
?lnrb Prinainal
