N. C. JINDAL PUBLIC SCHOOL Please affix recent Passport Size Photograph here Punjabi Bagh, New Delhi-110 026 REGISTRATION FORM ISSUE OF THE REGISTRATION FORM DOES NOT ENSURE ADMISSION Academic Session 2015-2016 Registration No. ................. (To be filled by Office) Registration for Class................................ 1 Name of the Student (in Block Letters) 2 Date of Birth (Enclose Proof) Stream ................................................................... (For class XI only) DD MM YY (In Words) 3 Place of Birth 4 Mother Tongue 5 School last attended 6 Sex 7 Class to which admission is sought 8 Father’s Name (in Block Letters) Male Female i) Designation/ Occupation ii) Office Address iii) Residential Address Pin Code iv) Tel. No. (Residence) v) Tel. No. (Office) vi) Mobile No. vii) E-mail Address 9 Mother’s Name (in Block Letters) i) Designation/ Occupation ii) Office Address (if any) iii) Residential Address Pin Code iv) Tel. No. (Residence) v) Tel. No. (Office) vi) Mobile No. vii) E-mail Address 10 Neighbourhood/Locality * Code For office only. Point (40) (Please refer to point no. 30 of the Prospectus and Footnote.) 11 Yes Sibling (30) Name If yes, give details Class 12 No Section School Alumni (Enclose Proof of Class X/XII Pass Certificate Or Studied at least for five years evidence) Admn. No. Father Yes No Mother Yes No (10 + 10) 13 Girl Child Yes No (5) 14 Single Child / First Child Yes No (5) (Please enclose affidavit to this effect) GRAND TOTAL (100) Please register my son/daughter/ward named above in your school. I shall produce the required original documents at the time of admission. UNDERTAKING I ............................................................. Father/Mother/Guardian of ..................................................................... hereby declare that information given above by me is based on facts and authentic record. Admission of my child may be cancelled if any information is found to be false. Date : ........................................ Signature of Parent/Guardian (Please enclose the photocopies of supporting documents alongwith the registration form. The originals will be checked at the time of admission). *Locality A B C D E F G H 40 35 30 25 20 15 10 05 Code Points N.C. JINDAL PUBLIC SCHOOL PUNJABI BAGH, NEW DELHI-110026 RECEIPT Registration No. ......................... Form No. ......................... Name of the Student...................................................................................................................................... Son/Daughter of Sh. / Smt............................................................................................................................. Class to which admission is sought......................... Pre-School DATE............................... ADMISSION INCHARGE / SUPDT.