Saint Kabir Polytechnic College

1. Full Name of Student:	______________________________
2. Date of Birth (in words)	______________________________
(in figures)	______________________________
Authority	______________________________
3. Name of father	______________________________
4. Father's Occupation	______________________________
a) Army/ Air force/ Navy	______________________________
b) Rank	______________________________
c) Serving/ retired	______________________________
d) other	______________________________
5. Address
a) Official	______________________________
b) residencial	______________________________
6. Father's income (from all sources) per year	______________________________
7. a Class last studied	______________________________
b) School in which last studied	______________________________
c) Medium of instuction	______________________________
d) Was the school is recognized	______________________________
e) Examination body to which school is affiliated	______________________________
8. Result of last examination passed(percentage)	______________________________
9. Field to which the admission is sought	______________________________
13.Hobbies: Art,Music,playing and etc.	______________________________

Declaration by the parent

I hereby declare that date of birth my son/ daughter is ___________ and other particular are correct and I would not demand any change in them at any subsequent date.

Signature of parent

Order of the principal

Admit ______________________ in class __________________

Signature of Principal

Office remarks

Admitted in ___________________________ and Dues paid vide Receipt no_________ Dated _______

Office seal

Signature of supdt.