For Office Use Only:
App. No. .......... Reg. No. ............
Date ..............
Maharajganj, Ghazipur (U. P.)
Phone: +91 9721452881
Web:, email:
1.   Candidate's Image * :
  Candidate's Name * :
A. Date Of Birth *: Gender *:
B. Name & address of the school in which now studying:
Board: Medium: Class in which now studying:
(Please attach the photocopy of the mark sheet of the last examination attended and annual result of the previous class duly attested by the head of the institution or a gazetted officer)
C. Admission sought in Class *: Select Stream *:
Mathematics as optional subject (For PCB, COMMERCE & HUMANITIES) *: 5th Optional Subject *:
Class 9th Year of Passing * : Class 10th Half Yearly Percentage * :
Class 10th Preboard 1 Percentage * : Class 10th Preboard 2 Percentage * : MATHEMATICS opted for in class X (Only for CBSE students) * :
D. Nationality: Religion : Blood Group:
  Aadhaar No.:
  Caste : In case OBC specify tribe: Mother Tongue:
2.   Father's Name:
    Qualification: Occupation: Contact No.:
3.   Mother's Name:
    Qualification: Occupation: Contact No.:
4.   Combined Annual Income
5.   Address : (i) Present (Mailing):
    PO Dist. State PIN
    Mobile No *. Alternate No. Email *.
6.   Sibling studying in the institution (Name and Adm. No.):
    (Please note that it is in the interest of the parents/guardians, not to depute a person other than a relative as local guardian.)

I accept that the above data provided is true to my knowledge. I understand that I am sharing this data for the purpose of provisional admission to Class XI in your esteemed institution. I also understand that the final admission of my ward in the chosen stream will only happen once the Board Results are out and he/she has passed with requisite marks. All data given here as verified and found true. Any misrepresented data or unverified marks will lead to cancellation of admission and refund of the fees. Please Note: Math (Main & Optional)will only be given to students who had Standard Maths in Class X.