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REGISTRATION FORM FOR ADMISSION UNDER BPL/EWS CATEGORY FOR THE SESSION 2019-2020
STATE ADMINISTRATION, HARYANA

General Details of the Child

Registration ID 1376412396

First Name Yogita

Middle Name

Last Name

Class Class 12

Gender female

Date of Birth 01/08/2003

Mobile No. 9991475420

Email Address shivsingh.com@gmail.com

Student Registration Number 0383200060

Previous School Attended Type Private Unaided School

Previous School Attended Name SHANTI NIKETAN PUBLIC SCHOOL

Details of Parents/Guardian

Father's Name Satpal singh

Fathers's Mobile No. 9991475420

Fathers's Profession Other

Category & Address Details

 Applied Category EWS

EWS Income Certificate Number INC/2019/373

EWS Income Certificate Issuing Date 08 / 04 / 2019

Residential Address H no143 Vpo daroli

Block Adampur

Pin Code 125052

Selected Schools

Range Priority No. School ID School Name

Within Your 1 06120100219 VM VISHVAS SCHOOL ADAMPUR

Block

Within Your 2 06120100222 NORTHERN INTERNATIONAL SCHOOL M

Block ADAMPUR

Within Your 3 06120100404 MOGA DEVI MINDA MEMORIAL SCHOOL

Block BAGLA

Within Your 4 06120100223 GD INTERNATIONAL SCHOOL M ADAMPUR

Block

Within Your 5 06120100209 SRI KRISHAN PRANAMI M ADAMPUR

Block

☑ I Satpal singh, father of Yogita hereby declare that the information given above is true and correct to the best
of my knowledge and belief. I have read and understood all the provisions of the notification in this regard. In
case any information is found false or incorrect on verification, the admission of my ward may be cancelled and I
will be liable for the action to be taken against me as per law.