cvchennai Annanagar Application

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http://www.cvchennai.psiog.com/Annanagar/preview.php

10-02-2015 11:29 AM

Admn.no:

Sl.no:CVA2113/15-16
RFN-1423546878 / 10-02-15 11:11:18 AM

(for office use only)

1.Name of the Pupil

S. KAVANISH KANNA

2.Gender

Male

3.Date of birth

03-11-2011

4.Applying under RTE?

No

(a).Name

V.SATHYANATHAN

(b).Educational Qualification

M.PHARM, Ph.D.

(c).Occupation/Designation

PRINCIPAL

(d).Office address

TIRUMALA COLLEGE OF PHARMACY (INTEGRATED

CAMPUS), BARDIPUR (V), DICHPALLY (M),

5. Parent's Details
(i) Father's

NIZAMABAD,TELANGANA-503 230
Phone No.

08461245740

(e).Father's Mobile No.

0965224424

(a).Name

S.K.DEVIPRIYA

(b).Educational Qualification

MD SIDDHA

(ii) Mother's

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(c).Occupation/Designation

SIDDHA PHYSICIAN

(d).Office Address

AROGYA SIDDHA HOSPITAL, MUGAPPAIR INDUSTRIAL

ESTATE, MUGAPPAIR EAST, CHENNAI

Phone No.

04443550990

(e).Mobile No.

9600157185

6.Residential Address

NO. 8582, 10TH MAIN ROAD, TNHB, AYAPAKKAM, CHENNAI

Pincode

600077

Distance from school in Kms

3-4 Km

Landline No

Nil

E-mail Id

drsathyaphyto@rediffmail.com

Alternate E-mail Id

devifeb14siddha@gmail.com

7.Total monthly income of the parents

110000

8.Nationality

INDIAN

9.Religion

HINIDU

10.Mother Tongue

SOWRASHTRA

11.Does he/she belongs to FC or OC/BC/MBC/SC/ST. If

so attach certificate attested by the competent authority

FC or OC

(a).Name

Nil

(b).Residential Address

Nil

Landline No.

Nil

Mobile No.

Nil

Email Id

Nil

Alternate E-Mail Id

Nil

(c).Office Address

Nil

12.Name of the pre-school attended

Nil

13.Mention Vaccination administered on the child

CHICKEN POX, FLU, HBV AS ON DATE

14.Physical disabilities, if any

NIL

15.Any serious illness suffered

NIL

Siblings

No

Guardian's (in case where parents are not available

locally)

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16.Name of brothers/sisters, if any in this school and the

class in which studying(only biological sibling)

Nil

Father

No

Alumni Father Branch Name

Nil

Mother

No

Alumni Mother Branch Name

Nil

17.Whether parents are alumni of any of the Chinmaya

Vidyalayas

Please enclose the following

(i)Birth Certificate-Attested Photocopy(Original to be produced at the time of verification)
(ii)Proof of Residence (Only Ration Card/ Aadhar card)
(iii)Community Certificate

I hereby certify that the above particulars are correct.

Signature of
Parent/Guardian

Date:

Note: This application is subject to the terms and conditions stipulated in the prospectus which will be given to you at the time of
registration
FOR OFFICE USE ONLY

1)Whether Birth Certificate has been submitted

Yes/No

FOR OFFICE USE ONLY

1.Admission Granted
2.Provisional Admission Granted
3.Admit to

4.Fees Paid
5.Bank
6.Date
7.Office Manager

8.Date

9.Principal/Correspondent

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