The PSBB Millennium School PASTE

PHOTOGRAPH
9, GST Road, St Thomas Mount HERE
Chennai TN 600016
admissions.gbkm@psbbmillenniumschool.org

Registration Form
AP P L IE D FO R G ST C A M P US

Registration No Academic Session Application Date

R240116568 2024-25 26/JAN/2024 07:36:41

Candidate's Name
SUBHASHREE H.M.

Gender Date of Birth Age as on Staff Child

FEMALE 20/NOV/2013 10 YEARS NO

Mother Tongue Religion Caste Nationality

TAMIL HINDU OBC INDIAN

Aadhaar Card Number

Class to which admission is School last attended (if any) Last class attended
sought BISHOP DEVADASS AMBROSE CLASS V
CLASS VI VIDYALAYA,THANJAVUR

Medium of Instruction Prefered Language 1 Prefered Language 2

ENGLISH 2 1

Parent Information

Mother Father

Name HEMA MALINI R MUTHUSELVAN C

Date of Birth 15/FEB/1984 26/MAR/1985

Education PH.D. BE

Mobile Number 7483075040 8925530812

Email hemaaramanathan@gmail.c hemamalini.r@hyatt.com

om

Aadhaar

Occupation HYGIENE MANAGER RF ENGINEER

Designation HYGIENE MANAGER RF ENGINEER

Name of the Organization PARK HYATT CHENNAI ERICSSON GLOBAL

Office Address 39, VELACHERY MAIN RD, MEDICAL COLLEGE ROAD,

NEAR RAJ BHAVAN, LITTL THANJAVUR

Annual Income (in Lacs) 9.60 11

 Residential Address
SRI RENGA NIVASAM, NO. 19/65, LIC COLONY, 6TH CROSS (RIGHT SIDE),, MEDICAL
COLLEGE ROAD, THANJAVUR

City State PIN

THANJAVUR TAMIL NADU 613007

Residential Phone No. Emergency Phone No. Email for comunication

7483075040 9042117568 hemaaramanathan@gmail.com

Marital Status
DIVORCED

Distance to School from Residence Mode of Transport

1 PRIVATE ARRANGEMENT

Does your child have any major If "YES", please specify

ailment/allergy? -
NO

Sibling in School
NO

If "Yes/Applied", then please specify the of sisters and brothers in chronological order (oldest to youngest)

SN Name Age Gender Class / Section USN / STS Number

a.

b.

c.

d.

I, the parent (father/mother) /guardian of SUBHASHREE H.M. seeking his / her admission to CLASS VI hereby solemnly
declare that the information furnished above is absolutely true and that if found factually incorrect at any time after
the admission or during his / her stay in school, I shall abide by the orders of the school for withdrawal of my
son/daughter/ward without any plea or protest. I also understand and accept that submission of online registration
form and track sheet does not guarantee admission.

Date: 26/Jan/2024 07:36:41 Signature of Mother/Father/Guardian

Please note the following:

1. This form must be accompanied by:

1. One photocopy of the Birth Certificate and original Birth Certificate for verification.
2. One recent passport size photograph of the child pasted in the space provided.
3. Proof of Residence - A Photocopy of the following : Aadhar Card, Ration Card, Voters Card, Eb Card, Gas
Bill, Rent Agreement (Original required for verification).
4. Community Certificate, if applicable
5. An amount of Rs. 500/- must be paid towards processing fee at the time of submission of filled in forms.
.
6. Copy of previous class studied/studing to be submitted - Report Card, ID Card, Transfer Certificate - if
issued, School Fee Receipt
2. Please do not attach any other annexures.
3. Parents must accompany the child for the meeting with the Principal and Staff at the time of interaction.
4. Forms with False/Incomplete/Vague information will not be considered.