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APPLICATION FORM FOR ADMISSION TO P.M. 1ST YEAR (EQUIVALENT TO CLASS IX COURSE)

SESSION.....................................
Paste a recent
Admitted/Not Admitted self attested
(To be ticked) passport size
photograph
Form No:

Director/Teacher in-charge
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INSTRUCTION TO CANDIDATES:
(1) Applications not in prescribed format not correctly filled up or in respect of which the required certificates are
not attached will be rejected.
(2) The Institute reserves the right to cancel the admission at any stage, if it is detected that the admission is against
rule or have been secured through fraudulent means.
(3) Original certificates must be produced at the time of admission. Duly attested copies of the certificates and 6
(six) numbers of recent passport size photographs should be enclosed along with the Application Form.
(4) Applicants found eligible and willing to take the admission will have to report to the Admission Committee with
(i) Transfer certificate from school last attended (ii) Original Certificate as mentioned in Sl. No. 18 of this form.
1. Name of the candidate in full:
(In block letters as entered in the Transfer Certificate)

2. Birth details:

a) Date of birth: D D M M Y E A R

b) Mother tongue:

3. Father’s Name and Address:

Town/Vill:

Circle:

District:

PIN:

Telephone/Mobile No.:
4. Name of local Guardian:
(If different from SL. No. 3 above)

5. Permanent address:
(Ref. Sl. No. 4)

6. Mother’s name:

7. Address for communication:

8. Religion:

9. Category Caste/Tribe:

10. Occupation of Father/Guardian:

11. Nationality:

12. State of domicile:

13. Academic particulars in respect of class viii examination:

(a) Name and address of the school
last attended:

(b) Name of the Board to which the

school is affiliated:

(c) Year of Passing: D D M M Y E A R

(d) Previous Exam details:

Subject studied Grade/Total Marks Grade/percentage of marks secured

14. Candidate’s active Telephone/Mobile No. :

15. Candidate’s active E-mail ID:

16. Knowledge of Bhoti/English/Hindi: Write: Bhoti/English/Hindi Speak: Bhoti/English/Hindi

(Tick whichever is applicable) (Tick whichever is applicable) (Tick whichever is applicable)

17. Achievement in extracurricular activities (if any):

(i)

(ii)

(iii)

18. Syllabus for PM 1st Year:

1. Compulsory Subjects (All subjects are compulsory)

(a) Sanskrit (b) Bhoti (c) Boudh shastra

2. Optional Subjects:

(i) (a) Social Science (b) Science (choose any one)

(ii) (a) Hindi (b) English (choose any one)

3. Additional Subjects:

(a) Computer Education

19. Details of enclosures to be attached along with the application Form (Mandatory):
a. Self Attested copy of the mark sheet of class viii examination.
b. Self Attested copy of birth certificate.
c. Self attested passport size photograph to be duly affixed in the space indicated.
d. 6 (Six) numbers of passport size photograph.
e. Self Attested copy of SC/ST/OBC/Other certificate if applicable.
f. Self Attested copy of Aadhaar Card.
g. Blood Group Certificate.
h. Self Attested copy of bank passbook.
 D E C LA R AT I O N

(a) By the candidate:

I do hereby state that I have filled this form myself and to the best of my knowledge and belief. The particulars
given above are true and correct. I also undertake, if I qualify for admission, to abide by all the conditions, rules and
regulations of the Institute in force at present and also those which may hereafter be introduced by the administration
of CIHCS. I will of nothing unworthy being a student either inside or outside the institution or anything that interfere
with the discipline. I am aware that the competent authority of the institute has the full authority to expel me for my
disinterest in studies, misbehavior and continuous failure in examination. I also undertake that I shall not fail to pay
all the fees and other dues to the institution in time.

Place: …………………………
Full Signature of Applicant
Date: ……………………….....

Signature of the Parent/Guardian:

(b) By the parent/guardian:

I do hereby declare that the aforesaid applicant is my son/daughter/ward. I also undertake that I shall be
whole responsible to the authorities of CIHCS, Dahung in disciplinary matters in regards to my son/daughter/ward if,
any.

Place: …………………………

Signature of the Parent/Guardian

Date: ………………...………..

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