Reg.

No: ________________ (for office use only)

Serial No.: X17P/01552
Candidate's Name: AYESHA MAIRAJ
Date of Birth: 10,Mar 2013
Age: 4 Year(s) 0 Month(s) 21 Day(s)
Religion: Islam Affix Passport Size
Photograph of the
Gender: Female Candidate (should have
Address: 8131,GALI NO-3,CHIMNI MILL BARA HINDU RAO Rani Jhansi been taken on or after 1-
Road 12-2016)

Locality: Bara Hindu Rao

Others Locality: N/A
Pin Code: 110006
Aadhaar No. of the Child: 625573938328
Contact No.: 9211588776
For how long have you
been residing at this 47 - N/A (year - month)
address :

Father's Details Mother's Details

Name : Mr. MAIRAJUL HAQ Name :Mrs. SHAHNAZ
Occupation :Service Occupation :Housewife
Dept./Organization RESTORENT
Office Address :N/A
Designation MANAGER
Email : N/A
Office Address : 5334,GALI NO 7, OLD SEELAMPUR
If alumni mention
PUR GANDHI NAGAR, Delhii
the year of passing N/A
Email : Mairaj_ansari007@yahoo.com :
If alumni mention the
N/A
year of passing :

Parent's Name : MAIRAJUL HAQ

Parent's Email : Mairaj_ansari007@yahoo.com
Parent's Contact Number : 9211588776
 CERTIFICATE FROM THE PARENT
I/We hereby declare that I/we have read and understood the contents of this form and the general information. I/We declare that
I/we abide by the same. I/We hereby certify that the above information provided by me/us is correct and I/we understand that if the
information is found to be incorrect or false, the ward shall be automatically debarred from selection/admission process without
any correspondence in this regard, at any point of time before/after admission. I/We also understand that the application /
registration / short listing do not guarantee admission to my ward. I/We accept the process of admission undertaken by the school
and I/we will abide by the decision taken by the school authorities.

Mother's Signature Father's Signature

Mother's Name : _________________________ Father's Name : ____________________
Date: _________________________

Affix 4" X 6" size photograph of the family,with both the parents and the candidate in the
centre(in case of sibling studying in this school, then he/she will be in winter uniform in
the family photograph).Photograph should have taken on or after 1-12-2016

List of enclosures : (tick mark / mention the photocopy of the self attested documents)

1. i) Birth Certificate. ii) Copy of the Aadhaar card of the Child.

2. Residence Proof : (any two of the following):

i) Ration card issued in the name of parents (Mother/Father having name of the child)
ii) Domicile Certificate of child or of his/her parents.
iii) Voter I-card (EPIC) of any of the parents.
iv) Electricity Bill / MTNLTelephone Bill / Water Bill / Passport in the name of any of the parents or child.
v) Aadhaar Card / UID Card issued in the name of any of the parents.
vi) Driving Licence
i) _______________________________ ii) __________________________________

3. Proof of religion (only for Christians)

i). Baptism Certificate ii) Letter from the Parish Priest / Pastor

4.Proof of Sibling (all siblings)

i) Oct-Dec, 2016 Fee Slip ii) I-card.
iii) Report Card (2015-16)

5.Proof of Alumni
i) Mark Sheet (Std. 12) ii) DOXA Membership Card