D.A.V. Centenary Public School, Haldwani

Affiliated to CBSE, New Delhi 110055. Affiliation No. 3530055, School Code: 81062

PROVISIONAL ADMISSION APPLICATION FORM

Class To Which Admission to be Sought

STREAM

SUBJECT

Applicant Passport Size Picutre

Father Passport Size Picutre

Mother Passport Size Picutre

Guardian Passport Size Picutre

1. PERSONAL (CAPITAL LETTERS)

Name

Date Of Birth

Mobile

Nationality

Religion

Category

Language

Gender

Blood Gr

BCCL Employee/Non-BCCL/Staff ward

Permanent Address

Same as Permanent

Present Address

2. Parent/Guardian Detail

Single Parent

Father's Name

Mother's Name

Education Qualification
(Mention Highest)

Occupation

Name Of the organisation ( Where Working)

Designation

Address

Mobile No.

Annual Income

3. Board Detail

Name of the School Last Attended with Address

Name of the Board

Registration No.

Board Roll No.

Year of Passing/Appearing

Sibling(Own Brother/Sister Only)

If sibling in the same school, give the detail of sibling

Sibling Name

Class

Section

Admn. No

4. Marks (10^th Class)/ Pre Board

Select Percentage Or Grade ( Marks of 3 subjects - English, Maths, Sc/S.St)

Medium of Exam

Please attach a xerox copy of marksheet in support of the same

Final Submission

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