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307693195FORM 2 .pdf


Original filename: 307693195FORM_2.pdf
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Birla Bharati Students
Students from other Institute
(Tick where appropriate)

Recent
passport size
coloured
photograph
of applicant
Affiliated to Central Board of Secondary Education
Taratolla, Santoshpur Road, Bidhangarh, Kolkata – 700 066
: 2491 0540
Fax : 2491 4423

Application Form for Admission ( +2 course )
PLEASE READ THE INSTRUCTIONS CAREFULLY BEFORE FILLING IN THE FORM
FILLING THE FORM DOES NOT ENSURE ADMISSION AS THE SEATS ARE LIMITED.
PROVISIONAL ADMISSION TO CLASS XI WILL BE CONFIRMED ONLY IF THE CANDIDATE
PASSES IN THE CLASS X BOARD EXAMINATION.
APPLICATION FORM SHOULD BE FILLED IN BLOCK LETTERS AS NEATLY AS POSSIBLE.

1.

Name of the student __________________________________________________________________

2.

Stream of Admission
(Mark according to preference)

3.

Nationality ________________________ Religion _____________________ Sex _______________

4.

Date of Birth (in figures)

Science

Commerce

Humanities

Date ____________ Month ______________________ Year __________

(in words) _______________________________________________________________
5.

Mother’s Name ______________________________________________________________________
Occupation ____________________________________ Qualification _________________________

6.

Father’s Name _______________________________________________________________________
Occupation ____________________________________ Qualification _________________________
Address (Residence) _________________________________________________________________
(Office)

_________________________________________________________________

Telephone No. Res ________________ Mobile _____________________ Office _______________
7.

Local Guardian’s Name, Address & Phone No. if any ________________________________________
___________________________________________________________________________________

8.

a) Name of the last school Attended ______________________________________________________
b) Medium _________________
c) Affiliation of the school (Tick where appropriate)
CBSE

ICSE

STATE BOARD

Other Board

9.

Second Language :

HINDI

BENGALI

10. Co-curricular Activities Participated in ___________________________________________________
11. Mode of Conveyance to be used by the child :
Car

Public Bus

School Bus

Other ________________(specify)

12. Documents to be Submitted: (for Non Birla Bharati students only)
Attested Xerox copy of class X report card.
Attested copy of Birth Certificate.
13. Subjects to be opted for:
SCIENCE
1________________________ 2 _______________________ 3 __________________________
4________________________ 5 _______________________ 6 __________________________
COMMERCE
1________________________ 2 _______________________ 3 __________________________
4________________________ 5 _______________________ 6 __________________________
HUMANITIES
1________________________ 2 _______________________ 3 __________________________
4________________________ 5 _______________________ 6 __________________________

I solemnly declare that the particulars given are true and correct to the best of my knowledge and
belief and am aware that any untrue information may invite disqualification / expulsion of my ward, even if
admitted.
______________________
Date

______________________________
Signature of Parent

ADMIT CARD
Applicable for Non Birla Bharati Students Only
Stream _____________________________________________________
Registration no. ______________________________________________
Name of the student ___________________________________________
Father’s Name ________________________________________________
School & Board Name __________________________________________

Photograph


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