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01309122353 Berubari High School

Nageshwari, Kurigarm
Establish- 1969 Photo
EIIN- 122353
E-mail:berubari.b.l.school@gmail.com

J.S.C Information Form/2022


(mKj Z_¨ Bs‡iwR‡Z eo Aÿ‡i cyiY Ki‡Z n‡e)

1. Student Name :................................................................................................................................


(PEC mb` Abyhvqx)
2. Fathers Name :................................................................................................................................
(NID Abyhvqx)
3. Mothers Name :.................................................................................................................................
(NID Abyhvqx)
4. Address : Vill:.........................................................Post:........................................................
: Upa/P.S:...................................................Dist:.......................................................
5. Date of birth :.................................................................................................................................
6. Male/famale :.................................................................................................................................
7. Class Roll :......................................................... ..Sction:..........................................................
8. Religious :.................................................................................................................................
9. Mobile No :.................................................................................................................................

student Signature Guardian Signature


Date:..................... Date:.....................

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