MATHAGRAMASTHA HINDU SABHA'S

Shree Damodar Higher Secondary School of Science

Email: mhsdhsss@gmail.com

Post Box No.53, Margao - Goa

Phone No: 0832-2715271

Registration Form

Note: All ‘*' marked fields are mandatory.

Student Details as per School Leaving Certificate

Title

First Name *

Middle Name

Last Name *

Father Name *

Mother Name *

D.O.B *

Age Age

Place of Birth *

Gender

State *

Country *

Email *

Permanent Address *

Aadhaar Card

Enter valid Aadhaar Number

Nationality *

Category *

Student Photo *

Maximum file size 1MB , Format should be .png or .jpg or .jpeg

Admission sought in Class *

Education Details

Institution Details

Name of Board *

Name of the Last School *

Institution Address *

Seat.No *

Centre *

Year of Passing *(DD/MM/YYYY)

Marks Obatained SSC

Subject Name *

Max Mark *

Mark Scored *

Total Marks Total Marks

Percentage Percentage

Parent/Guardian Details

Parent/Guardian *

Parent/Guardian Name *

Guardian's Contact Number

Father’s Mobile Number *

Mother Tongue*

Mother's Mobile Number*

Student Bank Details

Bank A/C No

MICR Code:

IFSC Code:

Select Your Subjects

Mandatory Subjects

Language II Subjects

Optional I Subjects

Optional II Subjects

School Assessment Subejcts

Your application has been submitted successfully.

Please take printout of this form & carry the same while visiting school for further admission process.

MATHAGRAMASTHA HINDU SABHA'S

Shree Damodar Higher Secondary School of Science

Email: mhsdhsss@gmail.com

Post Box No.53, Margao - Goa

Phone No: 0832-2715271

Registration Form

Form.No.: {{aplform.AplnNum}}

Std.XI-XII DIV : {{aplform.semNm}} Roll No. _________________ Admission Receipt No. _________________

Form of Application for Admission 20 - 20

Date: {{todayDate|date:'dd-mm-yyyy'}}

To,
The Principal
I hereby apply for admission to STD XI/XII - SCIENCE
I submit that all information given herein by me is true and correct to the best of my knowledge and belief.

I have read and understood the disciplinary and general rules given in the Prospectus and agree to abide by the same.

Date / /20

(1)Optional Sub.(i) : {{aplform.optlang1.text}}

(ii) : {{aplform.optlang2.text}}

(Signature of the Applicant)

(2)Second Lang. : {{aplform.secondlang.text}}

Student Details

Gender

Male

Female

Others

Name of student

Father's name

Mother's name

Date of Birth : {{aplform.DOB}}

Age : {{aplform.age}}Years

Place of Birth : {{aplform.CnBpl}}

State : {{aplform.CnAdStat}}

Nationality	{{aplform.Natnl}}	Belonging to {{aplform.Cmnm}}
Local Address		{{aplform.CnAdL1}}
Permanent Address		{{aplform.PemAdd}}

Students Aadhaar Card No.: {{aplform.NatID}}

Student's Bank Details,(if He/She has)

Bank A/C No.: {{aplform.bkacno}}

MICR Code: {{aplform.micrcd}}

IFSC Code: {{aplform.ifsccd}}

Education Details:

Name of the school last attended	{{aplform.Inst}}
Address of the School	{{aplform.InstAdL1}}

{{$index+1}}. {{sub.CnSubj}} : {{sub.Scored}}

Seat.No	Centre	Month & Year of Passing	Total Marks	Percentage
{{aplform.RegNo}}	{{aplform.centre}}	{{aplform.YrofPass}}	{{aplform.totmark}}	{{aplform.percnt}}

Parent/Guardian Details:

a. Name of the {{aplform.parnt}}: {{aplform.FatNa}}
b. Relationship_________________ Landline Number: {{aplform.FatAdTel}} Father's Phone No.(office):_________________________ Mobile: {{aplform.FatAdMob}}
Mother's Mobile No.: {{aplform.MotAdMob}} Guardian Mob.No.:_________________________
c. Office Address:_____________________________________________________________________
d. Mother Tongue: {{aplform.MothTng}}

a. Name of the {{aplform.parnt}}: {{parguarNm}}
b. Relationship:_________________ Landline Number: {{aplform.MotAdTel}} Father's Phone No.(office):_________________________ Mobile: _________________________
Mother's Mobile No.: {{aplform.MotAdMob}} Guardian Mob.No.:_________________________
c. Office Address:_____________________________________________________________________
d. Mother Tongue: {{aplform.MothTng}}

a. Name of the {{aplform.parnt}}: {{aplform.GrdnNa}}
b. Relationship:_________________ Landline Number: {{aplform.GrdnAdTel}} Father's Phone No.(office):_________________________ Mobile: _________________________
Mother's Mobile No.: _________________________ Guardian Mob.No.: {{aplform.GrdnAdMob}}
c. Office Address:_____________________________________________________________________
d. Mother Tongue: {{aplform.MothTng}}

Subjects once chosen shall not be allowed to change:

A.SUBJECTS
{{$index+1}}. {{mdry.text}}

B.SCHOOL ASSESSMENT SUBJECTS
{{$index+1}}. {{sasmntsub.text}}

Declaration of Parents

To,
The Principal,
Shree Damodar Higher Secondary School of Science,
Margao - Goa.
Dear Sir,

1. I have read and understood the rules of the Higher Secondary School regarding discipline attendance etc. and I undertake to see that, my ward abides by them. I understand that my ward has to submit to the general discipline of the school and that the Principal's decision on all the matters of discipline shall be final and binding on my ward.

2. Name of the ward ___________________________________________________________________

3. Exact relationship : Son / Daughter

4. Information about health problems,if any__________________________________________________

5. Name /Address & Phone No.of Doctor treating the ward ______________________________________

Your's faithfully,

_____________________________________
Signature of the Guardian/Parent

Principal's Remark and Decision

(Signature)
Principal