4/1/24, 10:59 AM Print Form | School Admission 2024-2025

Online Enrollment No. :5618 Registration No. :

LAXMAN PUBLIC SCHOOL

Hauz Khas Enclave, Delhi - 110016
Ph:- 46071197, 46067622
Website:- www.laxmanpublicschool.com
APPLICATION FORM (SESSION : 2024-2025)
Please refer to Annexure - I for more details.

1. Application Form for Class : XI

2. Applicant's Name (Full Name) : CLIFFORD KUJUR
3. Applicant's Aadhar No. (if available) : 783412400532
4. Date of Birth (Figures) : 07-02-2009
In words : SEVENTH FEBRUARY TWO THOUSAND NINE
Age as on 31-03-2024 : 15 YEARS 1 MONTHS 24 DAYS
5. Gender : Boy
6. Category : ST
7. Minorities : None
8. Blood Group of the Child : AB+
9. Name of the School last attended with address : ST. MARYS HIGH SCHOOL, MT. ABU, RAJASTHAN
Recognised by : CISCE
Recognition No. :
Affiliated to(CBSE/ICSE/Others) : ICSE
Affiliation No. :
10. Class last attended : X
11. Medium of instruction : ENGLISH
12. Proficiency in Sports / Music / Arts (if any) :-
13. Mother Tongue : HINDI
14. Nationality : INDIAN
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15. Particulars of Parents : :-

a) Father's Name (Full Name) : RAJESH PETER KUJUR
Occupation/Designation : GOVERMENT SERVICE
Education/Professional Qualification : B.COM LLB
Office Address : C-5, PARK VIEW APARTMENT, 34/1, MEHRAULI, NEW DELHI-
110030
Telephone No. : 8130375204
E-mail : RAJESHPETER4242@GMAIL.COM
b) Mother's Name(Full Name) : ANJELA KUJUR
Occupation/Designation : GOVERNMENT TEACHER
Education/Professional Qualification : MA
Office Address : C-5, PARK VIEW APARTMENT, 34/1, MEHRAULI, NEW DELHI-
110030
Telephone No. : 9076984764
E-mail. :
Guardian's Details (if any) :
Name :
Designation :
Contact No. :
E-mail :
Address :
16. Present Residential Address :- C-5, PARK VIEW APARTMENT, 34/1, MEHRAULI, NEW DELHI-
110030
Mobile / Telephone No. : 9076984764
Father's Mobile No. : 8130375204
Mother's Mobile No. : 9076984764
17. Permanent Residential Address : C-5, PARK VIEW APARTMENT, 34/1, MEHRAULI, NEW DELHI-
110030

18. State the distance from your residence to the school (Km) : 4 KM
19. Sibling in Laxman Public School, if any (brother / sister only) Yes/No : No
Name of Sibling Class & Section Admission No.

20. School Alumni (only Class XII Pass from Laxman Public School)
Year of Passing Class XII
Parents Alumni Status(Yes / No)
(attached Proof)
Father No
Mother No

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Transport Required (Yes/No). Please note : No pooled Taxi or RTV allowed.Transport once provided will not be
21. : No
discontinued mid session.
Transport facility is subject to availability of seats on that route.
22. Medical information: (Yes/No). Does the child have any special medical needs? : No
If yes give details and attach Medical fitness certificate signed by a registered medical practitioner:

23. General Information:-

I) What type of education do you think is relevant and meaningful for your child’s holistic growth?

II) What made you opt for Laxman Public School as one of your preferences for your child’s schooling?
I PREFER LAXMAN PUBLIC SCHOOL BECAUSE IT IS A REPUTED INSTITUTION AND I BELIEVE THAT IT WILL HELP IN MY
CHILD'S OVERALL DEVELOPMENT.

24. Documents enclosed herewith:-

S.No Name of Document(s)

1 BIRTH CERTIFICATE OF THE CHILD / TRANSFER CERTIFICATE(TC)
2 PROOF OF RESIDENCE: AADHAR CARD
3 REPORT CARD OF THE LAST CLASS ATTENDED
4 OTHERS(CATEGORY/MINORITY/NON-SCHOLASTIC ACHIEVEMENT)
5
6

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UNDERTAKING FROM PARENTS / GUARDIAN

We hereby certify that the above information provided by us is correct. We understand and accept that if any information is found to be incorrect or false, our
ward shall be automatically debarred from selection/ admission process without any correspondence in this regard. We also understand that the application
registration/ short-listing does not guarantee admission of our ward. We accept the process of admission undertaken by the school and we will abide by the
decision taken by the school authorities. We undertake to submit all the required documents in original for verification by the school at the time of admission.
We also undertake and promise that we will pay the school fees within the given time period for the entire duration of my ward's schooling years.

As per the Rule 167 of the DSEAR Rules 1973 - “If a student omits or fails to pay the fees & contributions due to a School together with the fine
due thereon by the last working day of the month in which they are due, his/her name shall be struck off the rolls of the school on the last
working day of the month & may be re-admitted on payment of all school dues including , fresh admission fee”.

We also undertake the responsibility to ensure that our ward participates in all the Academic, Cultural, Sports, Extra curricular activities and events organized
by the school throught the academic sessions.

We are submitting the Transfer Certificate at the time of admission / we will submit the Transfer Certificate by ______________ date.

__________________ __________________ ______________________

Signature of the Mother Signature of the Father Signature of the Guardian(if any)
INSTRUCTIONS
The School provides transport facility. (Subject to availability of seat/school buses plying in the area of your residence). If using the school transport, it will be
the responsibility of the parent/guardian to drop & collect the child from the specified bus stop. Transport once provided will not be discontinued during
the academic session.

-------------------------------------------------FOR OFFICE USE ONLY------------------------------------------------

Documents received as per enclosures

mentioned

Received By Date Signature Verified By Signature

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Overall Grade

Signature of Headmistress/Co-ordinator

Admission :- Granted / Not Granted Signature of HOS

Date :-

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ANNEXURE - I
A. List of supporting documents (self attested photocopies) to be attached with this Application Form. Original documents
to be produced by parents at the time of admission:
1. Birth Certificate of the child / Transfer Certificate (TC) of the school last attended (Original TC, countersigned by Education
Department, to be submitted at the time of admission).
2. Report card of the last class attended (For KG onwards).
3. UDISE details for transfer cases within Delhi.
4. Proof of Residence of the parents (any one) – Voter Identity Card /Aadhaar Card/ Ration Card/ Passport / Electricity Bill /
MTNL Telephone Bill / Water Bill / Rent Agreement.
5. Proof of Sibling (if applicable) – latest receipt of payment of fee of LPS
6. Proof of Alumni (if applicable) – CBSE XII Pass Certificate from LPS

ADMISSION PROCESS 2024-2025

B. Instructions and procedure for filling in the Admission form
General Instructions
The form to be filled online and submitted, and a print taken of the same to be deposited at the fee counter along with
Registration Fees.
The Registration fees of Rs. 25/- is to be paid in cash at school fee counter.
For Class XI admission, Please attach additional form of stream selection - non receipt of this additional form will be treated
as incomplete form - and the form will not be accepted.
Forms with hand written modifications/corrections will not be accepted. Incomplete forms are liable to be rejected without any
intimation.
Registration process will not be complete unless a printed copy of the completed form along with the mentioned documents
(self attested) is submitted to the school. Registration does not guarantee admission for the child in the school.
School will assign Registration Number to every form submitted to the school. For any further communication with parents,
the school will cite only the Registration Number given on this form.
You are advised to submit only one filled in form to avoid cancellation.
Father's Name / Mother's Name / Child's Name must be written in full. No abberivations to be used.
In case of OBC/SC/ST, Please attach relevant certificates.
For Admission to class XI, please attach a copy of the class X Admit Card / Marksheet of the concerned board.
The admission process has been carefully designed to provide equal opportunity to all and to maintain transparency.

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