G0VERNMENT OF KERALA

DIRECTORATE OF GENERAL EDUCATION (HIGHER SECONDARY WING)

APPLICATION FOR ADMISSION TO THE HIGHER SECONDARY COURSE (2O21-2O22)
APPLICATION NO: 2111107611

Name: MUHAMMED SINAN K Guardian Name: SAIDALAVI K

Mother's Name: SAREENA C Father's Name: SAIDALAVI K

Date of Birth: 25-01-2006 Sex: Male

Aadhaar No: 576XXXXXX251 Enrolement No: -

Board Passed: Yes Scheme: SSLC (2020-2021) Register Number: 506357

Month of Pass: 3 Year of Pass: 2021

Category Name: Muslim OEC: No

Caste: MUSLIM Religion: Islam

Resident State: Kerala Resident Local Body: Elamkulam

Resident District: Malappuram Resident Taluk: Perinthalmanna

Permanent Address: KANDAPPATH HOUSE, KOTTAPPARAMBU Communication Address : KANDAPPATH HOUSE, KOTTAPPARAMBU

CHERUKARA PO, MALAPPURAM 679340 CHERUKARA PO, MALAPPURAM 679340

1
Blind: No Deaf No OH: No

IEDC : - MR/Brain Diseases: No Health Club: No

Linguistic Minority:

Jawan Priority:

NTSE Qualified:
No

No

No
Minority Language:

NCC or Scout / Guide(Puraskars)

Science Club:

O
No

No 2 Jawan Killed In Action:

Scout / Guide Participation :

Social Science Club:

No

No

No

2
Forestry Club: No Environment/Nature Club: No IT Club: No

Maths Club: No Debating Club: No Philatery Club: No

Oratory Club:

Red Cross:
No

No
Lit Con(School Magazines):

Student Police Cadet:

- No

No
Lit Con (Periodicals):

Swim:
No

Yes

P
Little KITES Members With A Grade: No

SPORTS AND YOUTH FEST SL-I D-I / A D-II / B D-III / C DLP STATE FAIRS A-Grade B-Grade C-Grade D-Grade E-Grade

A
Sports Fest 0 0 0 0 0 State Science Fair 0 0 0 0 0

Youth Fest 0 0 0 0 0 State Social Science Fair 0 0 0 0 0

C
E-Mail ID: - State Maths Fair 0 0 0 0 0

Phone Number: 7025732489 State IT Fair 0 0 0 0 0

Chance Number:

SSLC School:

PAPER NAME
1

s
11045 ST MARY'S HSS,PARIYAPURAM,MALAPPURAM

h
State Work Experience Fair 0 0 0 0

State Level First(SL-I), District First or A-Grade(D-I / A), District Second or B-Grade(D-II / B), District Third or C-Grade (D-III / C), District Level Participation(DLP)

CANDIDATE GRADE DETAILS

MARK GRADE GRADE POINT
0

First Language- I NA A+ 9

First Language- II NA A+ 9

English NA C+ 5

Hindi NA B+ 7

Social Science NA C 4

Physics NA A+ 9

Chemistry NA C+ 5

Biology NA B+ 7

Mathematics NA A 8

Information Technology NA A+ 9

IT Services : NIC Kerala Page 1 / 2 IP : 102.67.14.236 - Date & Time : 25/12/2021 06:42:42 PM
 CANDIDATE OPTION DETAILS (THIRD SUPPLEMENTARY)

Pref School Code Course Pref School Code Course Pref School Code Course Pref School Code Course

No. Code No. Code No. Code No. Code

1 11016 39 3 11014 39 5 11014 10

2 11014 37 4 11016 11 6 11014 11

CLAIMED CERTIFICATE DETAILS

CERTIFICATE NAME CERTIFICATE NO CERTIFICATE DATE ISSUING AUTHORITY

Swimming P/195/2021 23-08-2021 ELAMKULAM GRAMA PANCHAYAT

.......................................................................................................................................................................................................
DECLARATION
I SAIDALAVI K, Parent of Master/Kumari MUHAMMED SINAN K do hereby declare that all the information furnished in the
application are true to the best of my belief. I know that the allotment got by any false information furnished in the application will
results in the cancellation of Allotment and Admission.

Name and Signature of Parent/Guardian

Place :
Date : 25-12-2021
2 1
2 O
-
A P
s C
h

IT Services : NIC Kerala Page 2 / 2 IP : 102.67.14.236 - Date & Time : 25/12/2021 06:42:42 PM