ࡱ> 0rRoot Entry`Q1@PageMakerObjectPooloQOQPrivateDatarQrQ  !"#$%&'()*+,-./0123456789:;<=>?@ABCDEFGHIJKLMNOPQRSTUVWXYZ[\]^_`abcdefghijklmnopqrstuvwxyz{|}~2  k@@3V@Vj(8+MP2D+0m88 88 hL   kZ 4&@ } @ Pd 0  @@ L  & ^U N & &4    $7 MS  B@ & >  ; G3Ld 26 kZ 3L  1 @ @  @   @} .+@BP &@@H&%CK0&@@&R&<< MdnGMMdStamp size photograph dCnGMMd@@ &00V&x6x6!&Z&11@t:R@@ nGMMd&GMMdGMMdnGMMddnGMMd300dDefault@@Defaultd:MdnGMMd!&d(xKdl .& }UFEX@nGMMdnGMMd nGMMdCnGMMd;Z  Q@   @@@ A & @r@@e@@`of4&dddGMMd]nGMMddnGMMdentsJEEVANDEEP PUBLIC SCHOOL Day Cum Residential Co-educational Senior Secondary School [Affiliated to CBSE, New Delhi] Bara Lalpur, Chandmari, Varanasi-07, U.P., India Ph.: 0542-2290862, 2290864; Website: www.jctvaranasi.org, e-mail:jps_india@sify.com :iGMMdiGMMd/&~#~#d iGMMdiAdmission Form Day Scholar  Day Boarder  Boarder i(xKdddB/8"X B7(MMd@)!&KQY@iDefaultIR&""PZ&P1P1 @ :@X xGMMd nGMMd(xGMMdnGMMd nGMMdeiGMMd"iGMMd iGMMdd"3 9 &&&d iGMMd4@r@exGMMd nGMMd(xGMMdnGMMdxGMMd nGMMd(xGMMdnGMMdx xGMMd nGMMd(xGMMdnGMMd Signature of Administrative Officer/transport officer Boarde!&dnGMMd&xGMMd nGMMd(xGMMdnGMMd"0"0"8B:%Y@_@ I@ #InGMMd @@`D_____________ Class ________@ @@"@$@,@@6@@:@<@=@?OU g@@im@t@@@@@(@6DIM@mx@@@@ @@@ . C@b#@@ @@ @. C@V b@@@F@  L X@@F@@e@1 @@F@@e@1 @@@@B@d(xKdddT(xKdddught : : _______________________R`bp3;R3 B 31R#3TR3@@3BP3@@3Q` p& A &1Q#&9Q!&c&c&c&cp&c@ &c&=S2&GMMd7 @ IGMMdGMMdnGMMd_________________________________ 2. CDdGMMdnGMMdR#@:@r@@eJ (xKddd (xKddd  (xKddd (xKddd (xKddd H(xKddd (xKddd@`@ ____________________:(xKddd________________________________________________A 0@MdGnGMMd  @d@`nGMMdiGMMdiGMMd iGMMdiiGMMdiGMMdiGMMdddKl .& Md]nGMMd  @dnGMMd/nA 0MdGMMdxGMMd xGMMdxGMMd xGMMdxGMMd xGMMdxGMMdijH(xKddd%(xKddds@v@y@,&m! @@1nGMMdEnGMMdnGMMdnGMMdnGMMd@@e@@`@xGMMdnGMMdnGMMd'xGMMdznGMMdnGMMd nGMMdnGMMd nGMMdnGMMdnGMMd#nGMMdnGMMdnGMMdnGMMdJEEVANDEEP PUBLIC SCHOOL [Affiliated to CBSE, New Delhi] Bara Lalpur, Chandmari, Varanasi-07, U.P., India Ph.: 0542-2290862, 2290864; Website: www.jpsvaranasi.com (To be filled on confirmation of Admission & payment of fees)MMd n(xKddd(xKdddC(xKddd (xKdRegistration No.:..................... Admn. No. .....................GMMdnGMMdd?884ADISTILL.PPDA4ter.175lpi.2400dpi15.075.00.045.0175.0175.0175.0175.0XOnlyOne60.045.0!!!lmnopq!@@et@ ;l . & (xKdBdddCEViddEVE Ciddd(xKddd&((&ACKNOWLEDGEMENT aDMIT CARD R.NO. _________ Form No.______ 1. Name : _____________________________________ 2. For Admission to : _____________________________________ 3. Date of Test/interview (both) : _________________Time ________________ Authorized Signature Time ________________ Signature Principal ?884ADISTILL.PPDA4ter.175lpi.2400dpi15.075.00.045.0175.0175.0175.0175.0XOnlyOne60.045.0.175lpi.2400dpi15.075.00.045.0175.0175.0175.0175.0XOnlyOne60.045.0&@@&C&C&1nGMMd`nGMMdnGMMd(xKdddGMMd n's c@ ccCnGMMdnI(xKdddGMMdnGMMd@@F@@v@D@X@`nAffix a recent passport-size colour photograph of the candidate@@Document Master U U Document Master U U CEViddEVE Cidd(xKddddd_____________ D(xKdddU P1 m   d  d  d Master [ fU1  &    dU U R  &@B& R  &@@A&s =&cp&c@ &c&c&c&c&cP&c &S&c&c8&c@&&C0&@@ &c&sZ&c@&&C0&@@ &c&s &c@&'Ss&@@ &C&@B &QO&@B& (xKddd'(xKdddl (xKdddK (xKddd(xKdddars Report Card............ Medical CertificateGMMdnGMMd~nGMMdnGMMdnGMMdnGMMdnGMMdnGMMd$nGMMdnGMMdnGMMdnGMMdnGMMd3nGMMdnGMMd(xKdddNoneRegistrationPaperBlackRedGreenBlueCyanMagentaYellow For Admission to : _____________________________________ 3. Date of Test/interview (both) : _________________Time ________________ Authorized Signature b@&C&(xKddd"(xKddd(xKddd(xKddd K<O|<||d&<dRB<BBd~r<rr~d~<~d ~ <  ~dd(xKddd=\ % B_______________________ Residential Address ____________________________________________________________________ ___________________________________________________________________________________________ ___________________________________________________________________________________________ TRANSPORT FORM Transport required : YES / NO Admission no. ________________________________________________________________________ Name ____________________________________ Class _____________________________________ From Where _________________________________________________________________________ Allotted R. No. _______________________________________________________________________ Signature of Guardian/Parent(xKddd(xKddd(xKdddd(xKddd(xKddd(xKddd!!"#$%&'! !012345!89:;<=K!>?@ABC! LMNOPQ! RSTUVW! 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P/]B gHX  RP&@@&B &s&s +&CP&@B&c&C &@B&CX&@B& C&@B&SE&@B& C&@B& C&@B&C(&@B&C&@B& cx&c 0& sP&C&@B&c@&C &@B&s?&cp&sc&c0& C&@B&C&@B&C&@B&C&@B&C&@B&C-&@B&c& c & CP&@B&%s &ch&Ch&@B&C&@B&u3&&s3&&uS%&AS&C&sK] &cK&cK&"sKv &CK!&sKw &CK&C&c&bx&:b &:B &c&b&r &R&C&C&C& 6 CEViddEVE Cidd CWddWCLWddLW Cx(Wddx(WxdU U (xKddd"(xKddd`(xKddd(xKdddR  &@B& R  &@@A&s =&cp&c@ &c&c&c&c&cP&c &S&c&c8&c@&&C0&@@ &c&sZ&c@&&C0&@@ &c&s &c@&'Ss&@@ &C&@B &QO&@B&__________________________________________________________________________ ___________________________________________________________________________________________ ___ c& c & C&@B &:SK&@B &S$&@B & s &s&cH&SX &@B &/s&C&@B &s&Cp&@B &C&@B &c&C&@B &c`&c@ & C(&@B &s&c0&cp@&C@ &@B &,S7&@B &+s &S&@B & c&C&@B &C&@B &@Sx&@B &%S &@@ & LMCnGMMdnGMMdnGMMdnGMMdnGMMdnGMMdnGMMdnGMMdnGMMdnGMMdnGMMdnGMMdnGMMdnGMMdnGMMdnGMMdnGMMdf CrWddrWC[Wdd[W Cx(Wddx(Wx............$ T0X H@ FAmdB &@@&R &@B&'c&vS\ &@B&C8&@B&/s &0s\ > &-S< &@B&-c &(s\ B &*S( &@B&$s+ &C\ &@B&$C &@@&C&@@&C&@@&C&c&Q%&@@&hild? 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Registration for the Academic Year : _____________________________________ 2. Class to which registration is sought : _____________________________________ 3. Name of the Candidate : _____________________________________ 4. Date of Birth : Date _________ Month ______ Year ______ 5. Age in years & months (as on 01 Apr) : _____________________________________ 6. Sex (Please ) : Male  Female  7. Parents Name & Address : _____________________________________ _____________________________________ _____________________________________ Pin : _____________________________________ 8. Telephone : Office ________________________________ Residence _____________________________ 9. Name & Address of the school Last Attended : _____________________________________ _____________________________________ a) Affiliated to (The Board) : _____________________________________ b) Medium of Instruction : _____________________________________ 10. Standard (class) last attended : _____________________________________ 11. Whether promoted or not : _____________________________________ I enclose a DD ........................... / cash Rs. 500/- to cover the Registration Charges. Place .............................. Signature ........................................... Date ............................... Relationship........................................ N.B. Enclosed with the Registration form are : a) True copy of the mark Sheet or Progress Report of the current year or the previous year. b) Valid proof of Age (Photocopy) (for upto class I) Note : If the form is downloaded, Rs. 700 to be deposited by cash / DD For Office Use Marks scored in written Test : .................. Cleared Admission test for class : ................... Chief Co-ordinator Fee Paid : Amount .......................... Vide Reciept No. .................. Dated ............ Account Officers Admitted in Principal Note : a) Transfer Certificate (TC) on confirmation of admission. b) Admission form will have to be filled in and all payments made on confirmation of admission. c) Five Passport size Photos. Y*0*\~XKYNy,,dY + "fddk m    d5vddt Zd,(xKddd&(xKddd (xKddd_(xKddd9(xKdddG@(xKddd (xKddd4 (xKdddK(xKddd| (xKddd (xKddd @(xKddd@(xKddd@(xKddd(xKddd  !!"#$%&'!*+,-./! !012345!89:;<=K!>?@ABC! LMNOPQ! RSTUVW! EFGHIJ!XYZ[\]e!^_`abc!fghijk!rstuvw!z{|}~!!!!!lmnopq!First Name Middle Name Last Name Date of birth (dd/mm/yyyy) Day   Month   Year     Date of birth (in words) Age of the child as on (01 Apr) Year Month Days Class for which admission is (enter in words) Residential Address City State Pin Code Telephone (R) (O) E-mail School in which child is presently studying Class in which child is presently studying Medium of Instruction Nationality Mother tongue Hobbies Have you applied for the admission of any other child? YES / NO If YES, Name of child(ren) and Class MMdnGMMdnGMMdnGMMddRB<BB~ hdRD&C&C&C&S &C&WS&&@@&VC&&@B&US&&@@&XS&&@@&C&@@&C&@@&C&@@&C&@@&C&@@&C&@@&C&@@&cq&'So&@@&R  &@@A&B i@ &@@A&s  &c@ &c&S&c&#s &c@&&C0&@@ &c&&s; &c@&&C0&@@ &c&c&c@&&C0&@@ &c&s&c@&(S5&@@ &c&%c&c@&&C0&@@ &c|&sA&c@&c&cP&c &s&C!&@@ &c&s &c@&&C0&@@ &c&c&c&&C0&@@ &c&c&c&&C0&@@ &c&s3&c@&&C0&@@ &c& s&c@&(Cs&@@ &c&c&c&(Cs&@B &c&+s&c@&&C0&@B &c&c&c&&C0&@B &c&cP &c@&&C0&@B &c&cp &c@&&C0&@B &c0&c &c@&&C0&@B &c0&c &c@&&C0&@B &ch&`CH&@B &%ch &6S{&@B &%ch &5C&@B &ch&*S&@B &ch&^S"&ch&8S&@@&GSh&@@@&Rh &@@ &ch&sI &c@&C&@B &ch&!s &c@&c&C &@@&ch&Dsl&7Ss&@B &ch&c&c&c&c&cP&c &C&@@ & ch`&c&c&c&cP&c &c&c!&#$&ch&c&c&c&c&cP&c &c& S!,&@@@&CSh &ch&cS#&ch&!SL &C&!RN v&@@&v3&&jS &@B&c&u3h$&gShD &c&{3h$&PSh&c&r3h$&YSh&c&t3h$&IShg&c&r3h$&o3h$&Sh&c&q3h$&FSh&c&v3h$&z3h$&QSh&c&z3h$&aSh&c&TSh&c&u3h$&hSh &c&r3h$&t3h$&+Sh &c&s3h$&q3h$&[Sh&c&jSh?"&c&nSh{"&C&C&c&4B( &c&R5u&C&c&,B8p &./! $ (xKdddT (xKddd0 (xKdddH (xKddd (xKdddF (xKdddA (xKddd (xKdddm (xKdddNoneRegistrationPaperBlackRedGreenBlueCyanMagentaYellowDocument Master U U Document Master U U d&;C3;dd3;Cc;ddc;cCR ;dd(R ;RC2 ;dd*2 ;2 ! PARENTS DATA Details of Parents Father Mother Name Qualification Profession Annual Income Office Name Designation Office Address Phone (R) (O) Mobile No. E-mail No. of children Name Age Sex Occupation Details of Siblings Name 1 2 Name of School currently studying in 1 2 Class I hereby certify that the information given above are true and correct. I hereby agree and give consent to abide by the rules and regulations of the School. I/We also understand and agree that the registration of my child does not guarantee him / her admission to the School and that the Registration Fee is neither transferable nor refundable. List of Documents Attached (to be filled by parent) Please tick. Photocopy of Birth Certificate  Photocopy of Transfer Certificate  Photocopy of last Report Card  ......................... ......................................................... ......................................................... Date Guardian/Fathers Signature Mothers Signature  [ fU1  &    dTRANSPORT FORM Transport required : YES / NO Admission no. ________________________________________________ Name ____________________________________ Class __________________ From Where _________________________________________________________________________ Allotted R. No. _______________________________________________________________________ Residential Address ____________________________________________________________________ ___________________________________________________________________________________________ ___________________________________________________________________________________________ Note : 1. R. No. to be informed in General Office (School) for record papers. 2. Indemnity Bond to be obtained from Parent/Guardian. (xKddd(xKddd(xKddd,(xKddd.(xKddd/(xKddd](xKddd(xKddd(xKddd(xKddd(xKdddd 1  A A DISPLAYDISPLAYNone``@@xGMMd(xKdddContents^tIndex ,^>;^>^=.^> , C:\PM65\RSRC\USENGLSHxAddU U  dbU ..--__d h   h$&U }({  d)w ?dd2    ;dd S&c&5C &@B&c&/SP &c&nSh{"& FOR OFFICE USE ONLY Admitted.............................. Class............................ Section........................ w.e.f........................ Enclosures: - Photographs................................... Transfer Certificate........................... Birth Certificate........................... Indemnity Bond.............................. Previous Years Report Card............ Medical Certificate...................... 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