Class&Sec: XI(G)

Adm No: 11347

SAI International School
CBSEBoard Registration Verification Formn
Dear Parent,
The information below has been token from the school records of your ward; it needs to be scrutinized minutely
and validatedfor board requirements. After authentication by you, the data will be uploaded for CBSE registration
ond will not be changed under any circumstances in the future. In case you want to make any changels), please
write in a red ink pen & ottach a copy of the proof along with an application addressed to the principal.
Name of child, mother's name andfather's name will remain same as specified in class-X mark sheet/ board
certificate.
For Row No.7: Aproof of caste certificate needs to be attoched along with this form or else it will be considered as
General
Row No 10:(Annual income), Row No 11: (Onily child) & Row No 17: (Minorty) options need to befilled in by parents
only.
Row No.18: Aadhar card number of the child needs to be
verified & if not
written please write & attach a photo
copy of the same along with this form. It will make it easy in downloading the documents from Digi locker in future.
The form after verification and
signature needs to be deposited in hard /soft copy to the class teacher on or before
06-09-2021 (Monday) without fail.
You con pay the registration fee online through pay fee once the final amount is informed.

1 Admission No. 11347

2 Name of the student
CHINMAYA KUMAR MOHANTY
3 Mother's Name PUSPANJALI SWAIN
4 Father's Name BASANTA KUMAR MOHANTY
5 Gender MALE
6 Date of Birth TL 0 6-2005
as per 10h certificate)
7 Caste (Geheral/ se 1SF 10BC) GENERAL
8 Handicap (Spastic/
Dyslexic/ Blind NA
Handicapped/ Dea)
Subjects English Core, Physics,
Chemistry, Biology.
10 Annual Income of parents
Physical Education, Painting
15LAKH
11 Only Child (Yes/No) YES
12 Class X Board Roll No. 12113840
13 Year of passing
class X 2021
14 Name of Class X Board CBSE
15 Name of class X Board Exam AISSE CBSE
16 Date of Admission in School 11-05-2021
17 Minority (Yes/No)
18 Aadhar Card No. (of student)
NO
822195843808
Note: Please ensure all clearances for
your ward is made before the CBSE Board registration.
I hereby agree that the information
provided above are correct in all respects and can be sent for registration
with the CBSE Board.

Baant Kuma Mdhann Pparjali suwnin

Signature of Father Signature of Mother
Chinmaya Kumar Mohanty.
Signature of Student