MTB JNANA JYOTHI VIDYANIKETHAN CBSEAffiliated to central Board of Secondary Eduction, New Delhi

M T BOULDING RUE RILLIANCENo. 707, Maheshwari Temple Road, Maheshwari Nagar, Mahadevapura, Bangalore - 560 048

(M) 7349519927 | E-mail: mtbjiv@gmail.comAffiliation No. 830418 | Dise Code - 29200309650 | School No. - 41265

ADMISSION FORM

Affix Child’s

passport size

photo here

Application No. Grade Applied for: Date of Admission :

Student’s Name (in Block Letters) :(As in Birth Certificate or Transfer Certificate)

Gender :M/F Mother Tongue : Date of Birth :

Nationality: Religion: Caste:

Mother’s Name :

Qualification :

Occupation/Designation :

Aadhar No :

Pan Card No. :

Caste :

Father’s Name :

Qualification :

Occupation/Designation :

Aadhar No :

Pan Card No. :

Caste :

Name of the BBMP Ward and No. :

Address for Communication :

Official Address :

Ph :

Annual Income :

E-Mail :

Contact No. :

Mention whether Transportation facility is required or not.If required please mention the area and point,to pick up the student

Area :

Permanent Address :

Official Address :

Ph :

Annual Income :

E-Mail :

Contact No. :

Yes / No

Pick up / Drop Point :

Aadhaar No :

Name of the BBMP Ward and No. :

Name of the School Board

CBSE/ICSE/STATEClass

GradeObtained

Year of Completion

Second Lang :

Third lang :

Hindi

Hindi

Kannada

Kannada

Is there any Learning Disability Yes/No) :(If Yes, Kindly attach the reports certified by a doctor)

Any medical problems(Provide details)

Note:

a)

b)

c)

d)

e)

III Language is compulsory up to VIII Standard and II Language up to X Standard.

Option for II and III Languages to be made at UKG / I Standard level only as per Government rules

No single subject should be chosen for second and Third Language.

Parents have to take the full responsibility of their wards’ progress.

Parents have to give in writing to Principal / Management in case the child is undergoing any treatment for any specific medical

conditions.

Documents to be Submitted at the time of admission

S.No.

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Documents

Admission From along with 3 Stamp Size Photos & 2 Passport Size

Transfer certificate (T.C) - Original

Birth Certificate (B.C) / Aadhar Card Copies

Caste Certificate (C.C) from concerned authority

Required DD - No.

Yes/No

Note:

In case TC/BC/CC is not given on time, Management reserves the right to cancel the Admission at any point of time.

Date: Signature of the Parent/Guardian

FOR OFFICE USE ONLY

Registered to ___________________________________________ Standard

The Registration Fee of Rs. ________________________________________

has been paid vide Receipt No.______________________________________for Academic Year 20 -20

Date:__________________________________________________________

Signature of the PrincipalDate:

Bank : Amount :

DECLARATION

We, Smt________________________________________________and Sri______________________________________________

Parents of Master / Kum______________________________________________________of Grade__________________________

do hereby give an undertaking to abide the following rules and regulations laid down by the School Management.

We shall Co-operate with the school authorities, Principal, Administrator and the concerned class / Subject teachers fordevelopment of our ward.

Communication / Correspondence with the Class / Subject teachers will be at the specified school working hours, through the Principal / Administrator / PRO Only,

Our relationship with all the staff of the School will be courteous and polite at all times.

We will respect and participate in all school activities to ancient Indian culture and will not object in any way to them.

We will take care not to send mobile phone or i-pad and also make sure that our ward does not wear any valuable ornaments.

We shall attend all the meetings convened by the Management (Management reserves the right of taking suitable action, in case two parent Teacher meetings (PTM) are skipped consecutively by the parent)

We shall strictly abide by all the rules and regulation of the School. The Management reserves the right to cancel the admission of the ward on non-compliance of rules and regulations of the School.

We fully agree that the Management reserves the right to cancel / withhold our ward’s admission, without any notice, in case of any misbehavior, misconduct or insubordination of our ward.

We totally agree to the contents given in Guidelines to Students, Suggestions to Parents & Safety Measured the terms provided in school Dairy..

1.

2.

3.

4.

5.

6.

7.

8.

9.

(Mother’s Signature) (Father’s Signature)

Mother’s Photo Students’s Photo Father’s Photo

Cell No. Cell No.