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qaerd.rRomn.l'ro.........fif,p- gRf,ol ri. /soorr'ro. ".......L35'3
2. fi-d /3fiqrs-d' ol qIEI / Father's /Guardian's Name ."."'N't"PKt?' 'BHU"D'q'S
3. qrdl ol qq / rulotner's Nanne ".'.' .....'.'."4/':"E'5'T'H'R"'Rfl'M1""'

Whether,the candidate belongsto Scheduled Caste i Scheduied Tribe/ OBC .........'......"""""':19"""'

6. fr--dldq q q-d-d sder al frlt o.er rftrq
crasJir::.17.:..3s.1'?=... ...;|I},.....CL.Yl.2.?":""ffi"'
Date of first admtssion in Vidyalayawitn
z. in+i frfU q-art lifr-fiu rfu€i b u5wn (3T-ol q /(erqi d) oS- lo - tq qtr
Date of birth (in Christian Era) q5;cor{-ng to admission
Register(infig,'.j,,r'".i,"'il;,Thl.E:...aiiofiix,:,.I|,:,l7:,.l,V..l,N,E.:r.y..E!,6H,I.....,.
L cfnl{a{Fl/PlaceofBirth '..'...............-
o oen M ura i eleqqrq fuqI t (Gia) tl /
Class in which the pupil last studied (in fig 99.-..X.... C.RT.s. s. e )....3.e t.n ;)fl .

10. siftq r{-d/q}d qiffio q{len qfroTlq

School/ BoardAnnual Examination last .C.w.*s. z. 2.....,?pm e /..
11. {
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. Whetherfailed, if so onceltwice in the

12. ftqq lsuojeaitudiefl

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Whet[er qualiiied for promotion to I i7l.d ..kter!%11.,.>.
to which class (in words)
14. f6-€ qfi-i iro rgm d +q (..!/.....?ets.
Month upto which the PuPil has Paid
15. {f@ 5tu \q c-ffd 'r",,o'
Any fee concession availed of, if so, ' 1
, .

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17. g,u ffi R:i suReld r_6t t

18. qqr q"q.{fi.{ff.}-ee/rcrael'Tr{s rdT (ft-q-iq fufl qry)

Whether NCC Cadet/Boy Scout/ GirlGuide (details rnay be given) """""""""""""'-;i
dHI fu{ d qnr ftql, qqtflq tra M ffi i crq'
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20. uqi{l €ilSqq /GeneralConduc1...............................::. h.ao.r/..:.....
21. {armidqq t ft\ eil}q-{ ?bt frlU
22.
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