PRABHU DAYAL PUBLIC SCHOOL

0001 to 1000

SHALIMAR BAGH, DELHI-110088

APPLICATION FOR REGISTRATION / ADMISSION

Affix
photograph
of the
candidate here

Affix photograph
of the candidate
with parents

Date

Registration No.

Class

Date of Admission

1.

Name of Candidate (in Block letters)

2.

Mother's Name

3.

Father's Name

Receipt No.

4. (a) Residential Address

(b) Distance from Residence to School (in kms)

5.

PIN CODE

Phone No. (Residence)

D
6.

Date of Birth

7.

Gender
(M/F)

Mobile No.

Nationality

(1)

Admission No.

8.

(Yes/No)

(a) Whether belongs to SC/ST/OBC

(If yes, attach copy of the certificate)

(Yes/No)

(b) Whether belongs to Minority Community

(Sikh, Jain, Muslim, Christian, Buddhist)
If yes, mention the community ______________
c)

Whether belongs to Economically Weaker Section

(Yes/No)
(If yes, attach Affidavit of Total Income of both the parents from all sources).

(d) Whether belongs to Disadvantaged Group

(If yes, attach certificate)

(Yes/No)

(e) Whether Parent is an alumini of this school

(If yes, attach relevent copy of the certificate)

(Yes/No)

9.

Class to which registration / admission is sought ______________________________________________________

10

Name of the school last attended (if applicable)

11.

Is that school recognised

12. (a)

(b)

YES / NO

Whether the candidate is single child

(If yes, attach affidavit)

YES / NO

Whether child has single parent

YES / NO

(If yes, attach affidavit)

13. Name (s) of real brothers / sisters already studying in this school (if any)
(I)

Name of Brother / Sister

Class _________________

(I)

Name of Brother / Sister

Class _________________

14. Mother's Qualificaiton :

_________________________________ Occupation (if working) ______________________

Office Address

Telephone Number (Office)

Annual Income

________________________________________________________________________________
(2)

15. Father's Qualificaiton : __________________________________________________________________________

Occupation

__________________________________________________________________________

Office Address

Telephone Number (Office)

Annual Income _________________________________________________________________________________

16.

Guardian's Name & Qualification : ________________________________________________________________

(if guardian is applying for registration/admission)
Occupation

__________________________________________________________________________

Office Address

Telephone Number (Office)

Annual Income _________________________________________________________________________________

I Certify that the above particulars are correct.

Date :

Signature of Father/Mother/Guardian

UNDERTAKING
1. I undertake the responsibility for the payment of fee bills of my ward as per schedule

2. I accept that the decision of the Principal with regard to School discipline will be final and binding on me and my
ward.

3. The date of birth mentioned in this form is correct to the best of my knowledge / Municipal Corporation records
and I will have no claim for a change in the above said date of birth.
4. I declare that all the above entries made by me are correct and if found incorrect registration/admission of my
ward may be cancelled.

Date :

Signature of Father/Mother/Guardian

(3)

FOR OFFICE USE ONLY

All entries have been made in the Admission Register after verification.

____________________

Date : ______________________

Admission Clerk

ADMISSION CONFIRMED

____________________
Principal

Note :Attested copies of the following certificates to be attached at the time of registration :
1.

Date of Birth of the Child.

2.

Residence proof (Ration Card / Voter I.Card / Passport / Telephone (MTNL) Bill ).

3.

Income certificate from appropriate authority (in case of E.W.S.).

4.

Certificate of class X/XII in case of Alumini.

5.

Copy of the latest fee receipt (in case of brother / sister studying in the school).

6.

Copy of the Court's order (in case of divorcee).

7.

In case of single parent, relevent document is to be attached.

(4)