G0VERNMENT OF KERALA

DIRECTORATE OF GENERAL EDUCATION (HIGHER SECONDARY WING)

APPLICATION FOR ADMISSION TO THE HIGHER SECONDARY COURSE (2O22-2O23)
APPLICATION NO: 2209144926

Name: SHAFANA SHERIN.K Guardian Name: BAPPU.K

Mother's Name: SUBAIDA Father's Name: BAPPU.K

Date of Birth: 23-12-2005 Sex: Female

Aadhaar No: 578XXXXXX676 Enrolement No: -

Board Passed: Yes Scheme: CBSE Register Number: 24149716

Month of Pass: 5 Year of Pass: 2022

Category Name: Muslim OEC: No

Caste: MAPPILA Religion: Islam

Resident State: Kerala Resident Local Body: Ananganadi

Resident District: Palakkad Resident Taluk: Ottappalam

Permanent Address: KUNNATH HOUSE PATHAMKULAM Communication Address : KUNNATH HOUSE PATHAMKULAM

P.O,PATHAMKULAM P.O,PATHAMKULAM

2
ANANGANADI,PALAKKAD,KERALA 679522 ANANGANADI,PALAKKAD,KERALA 679522

Blind: No Deaf No OH: No

IEDC :

Linguistic Minority:

Jawan Priority:
-

No

No
MR/Brain Diseases:

Minority Language:

NCC or Scout / Guide(Puraskars)

O
No

No 2 Health Club:

Jawan Killed In Action:

Scout / Guide Participation :

No

No

No

2
NTSE Qualified: No NMMSSE Qualified: No USSE Qualified: No

LSSE Qualified: No Student Police Cadet: No Red Cross: No

Forestry Club:

Maths Club:
No

No
Environment/Nature Club:

Debating Club:

- No

No
IT Club:

Philatery Club:
No

No

P
Oratory Club: No Science Club: No Social Science Club: No

Little KITES Members With A Grade: No

A
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

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

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

E-Mail ID: Subivappu@gmail.com State Maths Fair 0 0 0 0 0

Phone Number:

Chance Number:

SSLC School:
9544817532

12345 Others

h s State IT Fair

State Work Experience Fair

0

0
0

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

0

PAPER NAME MARK GRADE GRADE POINT

English 55 C1 5

Language 60 B2 6

Mathematics (Standard) 35 D1 3

Science and Technology 41 C2 4

Social Science 53 C1 5

IT Services : NIC Kerala Page 1 / 2 IP : 223.227.113.213 - Date & Time : 24/07/2022 01:02:18 PM
 CANDIDATE OPTION DETAILS (MAIN)

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 9033 39 5 9152 39 9 9135 39 13 9083 36

2 9034 39 6 9153 39 10 9093 39

3 9043 45 7 9162 11 11 9013 11

4 9082 39 8 9137 39 12 9044 10

CLAIMED CERTIFICATE DETAILS

CERTIFICATE NAME CERTIFICATE NO CERTIFICATE DATE ISSUING AUTHORITY

Qualifying Exam 24149716 24-07-2022 Self

.......................................................................................................................................................................................................
DECLARATION
I BAPPU.K, Parent of Master/Kumari SHAFANA SHERIN.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

2 2
O
Place :
Date : 24-07-2022

- 2
A P
s C
h

IT Services : NIC Kerala Page 2 / 2 IP : 223.227.113.213 - Date & Time : 24/07/2022 01:02:18 PM