1. Full Name :
2. Sex :	Blood Group :
3. Date of Birth :
4. Birth Certificate (Mention Source) :
5. Caste / Sub Caste :
6. Nationality :
7. Mother Tongue :
Language spoken at home :
8. School Last Attended :
9. Class :
10. Promoted to :
11. Class to which admission wanted :
12. Subject offered as 1st Language :
Additional Subject :

1. Full Name of Father :
2. Education Qualification :
3. Occupation :
4. Residential Address :
5. Full Name of Mother :
6. Education Qualification :
7. Brother/Sister Studying at J.C. High School.	Name :   Class : Name (2nd) :   Class :

I declare that the caste certificate and birth certificate is correct and I shall not ask for its alteration at any time.