Child Information

Full Name ______________________________________________________

Date of Birth ______________________________________________________

Aadhaar ID _____________________________________________________

Gender Male Female

Father’s Information

Father Name _____________________________________________________________________

Aadhaar ID _______________________________ PAN No __________________________

Occupation _________________________________ Education ____________________________

Guardian's Information

Guardian Name ________________________________________________________________

Aadhaar ID _______________________________ PAN No __________________________

Occupation _________________________________ Education ____________________________

Application Form Application No.

Year 2017-18

Paste Photo Here

Mother’s Information

Mother Name _________________________________________________________________

Aadhaar ID _______________________________ PAN No __________________________

Occupation _________________________________ Education ____________________________

Admission Information

Admission Class _________ Medium Option (1) __________________ Medium Option (2) _________________

If BPL then BPL card no ______________________________________

School Selection

Sr. School Name Board Medium Std. Distance (km.)

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Address

House No. _______________________________ Society ______________________________________

Locality_________________________________ Landmark _______________________________________

District _________________________________ Taluka _________________________________________

Village __________________________________ PIN Code ________________________________________

Contact Information

Mobile No ___________________________ 2nd Mobile No _______________________________________

Parent’s Email Address ____________________________________________________________________

Bank Account Information

Child A/c No __________________________________ IFSC Code __________________________

Child A/c No IFSC Code Parent ______________________ IFSC Code _________________________

Aadhaar No Linked to Account ______________________ Bank Name________________________

Annual Income __________________________

Application has to be submitted to nearby Receiving Center.

_______________________ _____________________________

Date Mother/Father/Guardian’s Signature

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Receipt

Received from__________________________for RTE 2017-18 Application No __________________

_____________ _________________________ ___________________________________

Date Receiving Center Name Sign and stamp of person receiving application

Note: If you (Parent) are not able to fill online application form then print this form, fill all details and submit to receiving center. Take Receipt from receiving center. Thereafter receiving center personnel submit the form online and provide an Application form no. Application form no will be required for entire process of admission.

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Required Documents

Sr. Document

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