St.

Aloysius Convent Pre - Primary School,

Bhusawal[For Students of Std Senior KG]
Record for Official Purpose

Std Division Roll No GR No

Student’s Surname
Student’s Name
Father’s Name
Mother’s Name
Residential Address

Mobile Number Alternate Number

Religion Caste
Mother Tongue Date of Birth
Date of Birth in Words
Aadhar Number Gender
Minority Religion (Muslim/ Christian/ Sikh/ Buddhist/ Jain/ Parsi/ NA)
Divyang Medium of Instruction: English / Marathi

Place of Birth Taluka

District State Country

Mother’s Signature Father’s Signature

Declaration By Parents : The information filled up by you will be entered in the official
school general register. Kindly ensure to fill all the details correctly without any errors.
No Changes in any record shall be made after submission of this form. Signatures of
the parents will be referred to as all the information stated above is true and correct,
and no changes will be made in any record thereafter.