SRI BHAVISHYA JUNIOR COLLEGE

COLLEGE CODES : 05147 & 05152, 05161 STUDENT AADHAR NO:

D D M M Y E A R
1) Admission Join Date 2 0 2 2 SECTION

2) SSC / ICSE / CBSE / T.S/ ROLL NO : *

Candidate’s Name
3) (in Block letters) As per
S.S.C
latest
Father’s Name Digital
4)
As per S.S.C Photograph
Mother’s Name
5)
As per S.S.C
6) Nationality INDIAN
7) Mother Tongue

8) Sex (Put a tick ( ü) mark) M F

9) Father Occupation :
10) Mention Caste (OC/BC-A/ BC-B/ BC-C/ BC-D/ BC-E/ SC/ ST) : Signature of the Candidate online purpose black
pen only
11) Mention Sub Cast Name with in the box

12) EMAIL ID Complusary *

13) Religion Mention: (HINDU / MUSLIM / CHRITIAN)
D M YEAR
14) Date of Birth (As per S S C) 15) Physically Handicapped NO YES
1)
16 Identification Marks
2)
Name of the Institution last studied
17)
(SSC) institution Name & address

18) Class in which Student admitted (Put a tick (Right) mark) JR INTER / SR INTER
19) Medium ENGLISH 20) Second Language (Part – II) SANSKRIT
21) Mention Group (Part–III) (MPC / BIPC)
Permanent Address * DOOR.NO : FLAT NO:
22) STREET : VILLAGE :
MANDAL : PANCHAYATI AREA NAME:

WARD NO : TOWN NAME : DIST:

STATE : AP TS PIN CODE :
FIRST OPTION PHONE NO NO
23) Mobile Number of Parent (1) * + 9 1 CHANGE OF ACADEMIC YEAR
24) Mobile Number of Parent/Guardian (2) * + 9 1 COMPLETED

25) Mother Aadhar Card UID No *

26) Sachivalyam place * Sachivalyam code: *
27) New White Ration card no *
28) Mother Bank account No *
29) Bank Ifsc code no: Bank Branch area Name
30) CASTE CERTIFICATE NO : (Below the Bar code)

Signature of the Candidate Signature of the Parent/ Guardian

APPLICATION FORWARD EMAIL ID: sribhavishyaboard@gmail.com (only pdf format) (or) send to whatsup 9177280487