747T-1:514 (\921 2015-16)
Admission Form (Session 2015-16)
611 (PATRACHAR VIDYALAYA)
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DIRECTORATE OF EDUCATION, GOVT. OF NCT OF DELHI
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P.V. No. (To be given by the Patrachar Vidyalaya)
31T-471T ftbT/ (IMPORTANT INSTRUCTIONS
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Please fill the Admission Form after reading the instructions given in the Prospectus.
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Paste 4 x 3 cm Size Photograph on the Identity Card and Mark his/her signature in the space provided. Student
should fill up the columns in the I-card.
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Choose subject carefully. Change of subject is not allowed at a later stage.
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resides (North, East, South, West, Central)
2. ft-t114
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3. flIcll TT TT 97/ Mother's Name in CAPITAL LETTERS
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4. ftaT TT
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5. 7-41 tRT/ Date of Birth
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6. f11/ Gender
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7. ?P1/ Category
Paste Self Attested
8. 71117rdT/ Nationality
Black & White
9. fill. / Disabled
Photograph with
10. 111771/ Mother Tongue
11. 0/ Religion
Computerized
Name and Date
12. 3111:14 14 /* TOT/ Your Previous Qualification
13. WV Subjects
1.
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Medium
14.
facIVE/ Detail of Fee
1. Branch Name
2.
3.
4.
5.
6. Additional Subject
2. Journal No.
3. Date
4. Amount
15. f" .-4171 TT IF id-r/ Address of Residence (in CAPITAL LETTERS)
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Pin Code /R 13
174TP=1/ Telephone No
R/Mobile No
16. Email Id
17. VI 4TRT 3IT1
Parental annual Income Rs.
p.a.
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Detail of Examination passed on the basis of which admission is beintz sought
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DECLARATION BY THE APPLICANT (TO BE FILLED BY THE APPLICANT)
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(I hereby declare that I have carefully read and understood all the conditions of the eligibility and I
fulfill the criteria for the course for which I'seek admission. I have furnished all the necessary
information/ document correctly. I have filled the form in my own writing. I understand that my
candidature is liable to be cancelled by the Patrachar Vidyalaya, if any information/ document is
found to be misleading or incorrect at any stage. I undertake to abide by the rules as laid down in the
prospectus.
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Signature of the Student
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Counter Signature of the Parents/ Guardian
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Signature of Admission Incharge