ELIGIBILITY FORM (Haryana School Games 2023-24) Summary

(The form would not be accepted if any column left unfilled) Sheet Sr. No.

Age Group ______________ Boys/Girls ______________

Venue ___________________ From ____________ to ____________ Game/Event _________________

1. Name of Block / District ______________________________________________

2. Name of participant
(in BLOCK LETTERS)
3. Father’s Name
4. Mother’s Name
5. Home Address
______________________________________________ Paste Latest Colored
Passport Size
______________________________________________ Photograph
______________________________________________
Attested by
______________________________________________ School Head

6. Contact No ______________________________________________
7. Date of Birth: (i) in Fig.

(ii) in words _____________________________________________________________________

8. Age in completed years as on 31st December 2023 :- __________ Year ___________ Month ___________ Days

9. Bank Account No. _______________________ IFSC Code _____________ Bank Name _____________________
10. Name of the School :- _________________________________________________________________________
11. Admission No._________________________ 12. Date of Admission in School __________________________

13. Present Class _________ 14. SRN of student _____________________ Aadhar No._______________________

15. Year of passing 5th ___________ 8th ___________ 10th ___________ 16. Percentage of attendance : _________
17. Two Prominent marks on the body :- (i) __________________________________________________________
(ii) ___________________________________________________________
18. Signature of the Student :-

19. Sports fund paid so far for the year 2023-24 :-

a) Strength of students from 1st to 5th ___________ fund/amount Rs.@5* = Total Rs. _____________
b) Strength of students from 6th to 8th ___________ fund/amount Rs.@10* = Total Rs. _____________

c) Strength of students from 9th to 10th ___________ fund/amount Rs.@30* = Total Rs. _____________
d) Strength of students (i) 11th to 12th Art ___________ fund/amount Rs.@60* = Total Rs. _____________
(ii) 11th to 12th Com. __________ fund/amount Rs.@72* = Total Rs. _____________

(iii) 11th to 12th Science________ fund/amount Rs.@90* = Total Rs. _____________

Declaration:-1. Certified that the above participant is a regular student of this institution for the academic year 2023-24.
2. Certified that I have personally verified the admission records maintained in the school and found correct.
3. I will be personally responsible if any attached documents or filled up particulars found duplicate or incorrect.
In this situation department can take necessary action against me

Signature Team Incharge Signature AEO / AEEO Signature Head of School

With Phone No. with seal