Shri B.S. Mootha Girls Senior Secondary School Recent Photo (Affiliated to the Central Board of Secondary Education, New Delhi) (Vide CBSE / AFF / 1930041 - TN.: 06942) (Managed by Shri Rajasthani Jain Samaj Educational Trust, Chennai-600 017) 80, Brindavan Street, West Mambalam, Chennai - 600 033. Phone : 2481 2044, 2372 4911 APPLICATION FOR ADMISSION – XI Registration No : Application No. : Class to which admission is sought : Admission No. : SSM 1. Full Name of the Student : ........................................................................................................................................................... according to the Mark Sheet/TC 2. Date of Birth : (a) In Figures : ........................................................................................................................................................... (b) In Words 3. : ........................................................................................................................................................... (Photo Copy of the Birth Certificate must be enclosed) (a) Nationality : ............................................................ (b) State to which student belongs : .............................................................. (c) ST /SC / OBC / MBC / BC / FC / Jain : .................................................................. Cast / Surname : ............................................... (Community Certificate attested by a Gazetted Officer to be enclosed for SC / ST / OBC / MBC / BC) Endorsement by Sec./Correspondent (d) 4. Mother Tongue : .................................................................................. Blood Group : ................................................... Bio-Data of Parents Father Particulars Mother (a) Name (b) Educational Qualification (d) Annual Income (e) Address : Res : Off : (f) Phone No. : Res : Off : Mobile : 5. Name & Address of Local Guardian (if any) ........................................................................................................................................... ....................................................................................................... Phone ........................................................................................... 6. (a) Name of school last attended : ..................................................................................................................................................... Town : ...................................................... District : ..................................................... State : ..................................................... (b) Affiliation / Recognition / Approval No. .............................................................................................. of the School last attended. 7. 8. Courses Offered (Note 5 elective offered) Group I Group II English English Maths Business Studies Physics Accountancy Chemistry Economics Biology/Computer Science Maths / Computer Science / Entrepreneurship Details of Board / Examination / Marks Name of the Board – CBSE / State Board / Matriculation / ICSE : Roll No.: ................................................................................... Year of Passing : ........................................................................... TC No. & Date : ........................................................................... Marks obtained in Std. X English Exam Language Maths Science Social Science Any Other Remarks Note : Admission will be confirmed only on production of Original TC duly endorsed by the concerned educational authority DECLARATION BY THE PARENT 1. (a) I hereby declare that the date of birth of my daughter ............................................................................................. furnished by me in Column No. 2 is correct and that I will not demand any change in it at a later date. (b) Transfer Certificate – Original / Photo copy to be submitted. (c) I have enclosed the Photo copies of the following Certificates : (d) 1. Birth Certificate ( ) 2. Community certificate ( ) 3. Report Card of Std. 10th ( ) 4. Transfer Certificate ( ) 5. Conduct Certificate ( ) 6. Board Marksheet ( ) I shall abide by the rules and regulations of the school. Date : ............................................ 2. Signature of the Parent / Guardian We also assure that other information given in this application are true & correct. We have read the rules and regulations of the school and agree to strictly adhere to them. Signature of the Student Signature of the Father / Mother / Guardian Signature of the Father / Mother / Guardian Date : ............................................ Note: 1. The Management reserves the right to decline / cancel admission to any candidate without assigning any reason. 2. Registration of the candidate’s name is NOT a guarantee for admission. For Office use only Admit to class : XI / XII Group: I / II / Elective ..................................................................... Date : PRINCIPAL Name : .................................................................................................................. Admitted to Class......................................................... Admission No. : ..................................................................................................... Date :............................................................................ Name entered in the Admission Register Book No. : ........................................................................ Page No.: ........................................ ASSISTANT IN-CHARGE CO-ORDINATOR Admission is subject to availability of seats and fulfillment all the criteria.