MUKUNDAPURAM PUBLIC SCHOOL Form No. Affiliated to ICSE, New Delhi, Reg No. KE-94/2006 Nadavaramba P. O., Thrissur, Kerala - 680 661 Ph: 0480 2830438, 8129530100 Email: [email protected] Website: www.mukundapuram.com Academic Year: (Affix Latest Passport size Photograph) APPLICATION FOR ADMISSION 1. Name of pupil (in English) : (in Malayalam) : 2. Sex : 3. Standard to which Admission is sought : 4. Date of Birth (in Figures) : (in words) M F (Please Tick) : 5. Age (completed years as on 1st June of Current year) : 6. Nationality 7. Religion 9. Specify whether the pupil belongs to Scheduled Caste / Scheduled Tride / Other Backward Class : 10. Parent’s Data Mother Father 8. Caste Residential Address Name: Age: Occupation: Mob: PIN Ph: 11. Details of Study in the last School attended. Name of School Date of Admission Date of Leaving Std. on Admission Std. on Leaving Promoted or not Number and date of Transfer Certificate 12. Name and address of Guardian , if any PIN Ph: 13. Name, Membership Certificate Number and Signature of MECS Member, if recommended by such a member DECLARATION I ............................................................................................. Parent / Guardian of .................................................................. have read the Prospectus and am satisfied with the rules and Regulations of the School and agree to abide by them. Place : Signature: Date : Relationship: Please attach (1) True Copy of the Marksheet or Progress Report issued by the last School attended and (2) Attested Copy of the Birth Certificate. (for pre-primary Junior, pre-primary senior & Std.1) (For Office Use) Date of Receipt of the Form Amount Collected Rs. Admitted to Standard: Initial of Office Asst. Receipt No. Admission Number: Date: Date: Signature of Principal