KERALA SAMAJAM MODEL SCHOOL

GOLMURI, JAMSHEDPUR - 831009

Class & Section VI C

Admissio No. 3745/2014

Photograph

Name of the Candidate AARUSHI

Date of Birth 6/3/2010

Gender Female

Religion HINDUISM

Category GENERAL

Father's Name CHANDAN RAJU

Fahter's Mobile Number 9430776851

Father's Qualification
Father's Occupation
Father's Annual Income 0

Father's Office/Business Address

Mother's Name LAXMI DEVI
Mother's Mobile Number 7549148568

Mother's Qualification
Mother's Occupation
Mother's Annual Income 0
Mother's Office/Business Address
Residential Address [Link]-411A, ECC FLAT, KADMA

Admission No. of Brother/Sister

Declaration: I solemnly declare that the particulars given above are true and correct to the best of my knowledge. I am
fully acquainted with the rules and requlations of the school and promise to abide by them. I have gone through the
School Prospectus thoroughly. I shall accept terms and conditions. working hours, dress code. fees of the school if
changed. modified/altered at any time during the course of stay of my ward in this institution.
I agree to the removal of the name of my child from the rolls of the school at any thime in the school year if his/her presence in the
school becomes detrimental to the school or to other students and I will abide by the decision of the Principal regading such
matters. I also agree that date of birth once submitted, will not be changed hereafter.

Signature of Parent/Guardian

For Office Use

Approved by
Registratio No. 3745/2014

Date of Admission 21/01/2014

Chairman Principal
List of document submitted:
-
Sign . of accountant
 KERALA SAMAJAM MODEL SCHOOL
GOLMURI, JAMSHEDPUR - 831009

Class & Section VI C

Admissio No. 3762/2014

Photograph

Name of the Candidate ABHIGYAN PRASAD

Date of Birth 7/30/2010

Gender Male

Religion HINDUISM

Category
Father's Name DHIRAJ PRASAD

Fahter's Mobile Number 9546525521

Father's Qualification Post graduate
Father's Occupation Chartered Accountant
Father's Annual Income 700000

Father's Office/Business Address

Mother's Name ANJU PRASAD
Mother's Mobile Number 8409676102

Mother's Qualification Post graduate

Mother's Occupation SELF EMPLYED

Mother's Annual Income 500000
Mother's Office/Business Address
Residential Address D-5, 4TH FLOOR, HEAVEN TOWER, JAIPRAKASH UDYAN, ADITYAPUR

Admission No. of Brother/Sister

Declaration: I solemnly declare that the particulars given above are true and correct to the best of my knowledge. I am
fully acquainted with the rules and requlations of the school and promise to abide by them. I have gone through the
School Prospectus thoroughly. I shall accept terms and conditions. working hours, dress code. fees of the school if
changed. modified/altered at any time during the course of stay of my ward in this institution.
I agree to the removal of the name of my child from the rolls of the school at any thime in the school year if his/her presence in the
school becomes detrimental to the school or to other students and I will abide by the decision of the Principal regading such
matters. I also agree that date of birth once submitted, will not be changed hereafter.

Signature of Parent/Guardian

For Office Use

Approved by
Registratio No. 3762/2014

Date of Admission 21/01/2014

Chairman Principal
List of document submitted:
-
Sign . of accountant
 KERALA SAMAJAM MODEL SCHOOL
GOLMURI, JAMSHEDPUR - 831009

Class & Section VI C

Admissio No. 3804/2014

Photograph

Name of the Candidate ABHISHEK MOHAN

Date of Birth 3/16/2010

Gender Male

Religion HINDUISM

Category GENERAL

Father's Name HEMAN P M

Fahter's Mobile Number 8210771675

Father's Qualification
Father's Occupation
Father's Annual Income 0

Father's Office/Business Address

Mother's Name USHA HEMAN
Mother's Mobile Number 8603852005

Mother's Qualification
Mother's Occupation
Mother's Annual Income 0
Mother's Office/Business Address
Residential Address HOUSE NO.115,ROAD NO. 9 ,ADITYA GARDEN,ADITYAPUR

Admission No. of Brother/Sister

Declaration: I solemnly declare that the particulars given above are true and correct to the best of my knowledge. I am
fully acquainted with the rules and requlations of the school and promise to abide by them. I have gone through the
School Prospectus thoroughly. I shall accept terms and conditions. working hours, dress code. fees of the school if
changed. modified/altered at any time during the course of stay of my ward in this institution.
I agree to the removal of the name of my child from the rolls of the school at any thime in the school year if his/her presence in the
school becomes detrimental to the school or to other students and I will abide by the decision of the Principal regading such
matters. I also agree that date of birth once submitted, will not be changed hereafter.

Signature of Parent/Guardian

For Office Use

Approved by
Registratio No. 3804/2014

Date of Admission 22/01/2014

Chairman Principal
List of document submitted:
-
Sign . of accountant
 KERALA SAMAJAM MODEL SCHOOL
GOLMURI, JAMSHEDPUR - 831009

Class & Section VI C

Admissio No. 3812/2014

Photograph

Name of the Candidate ABHIVATSAL

Date of Birth 9/17/2009

Gender Male

Religion HINDUISM

Category GENERAL

Father's Name MUKESH DEBUKA

Fahter's Mobile Number 9431344587

Father's Qualification
Father's Occupation
Father's Annual Income 0

Father's Office/Business Address

Mother's Name NEELAM DEBUKA
Mother's Mobile Number 8340611217

Mother's Qualification
Mother's Occupation
Mother's Annual Income 0
Mother's Office/Business Address
Residential Address SHAKTI NALANDA TOWER, 1/1, RELIANCE FRESH, MANGO, NEAR

Admission No. of Brother/Sister

Declaration: I solemnly declare that the particulars given above are true and correct to the best of my knowledge. I am
fully acquainted with the rules and requlations of the school and promise to abide by them. I have gone through the
School Prospectus thoroughly. I shall accept terms and conditions. working hours, dress code. fees of the school if
changed. modified/altered at any time during the course of stay of my ward in this institution.
I agree to the removal of the name of my child from the rolls of the school at any thime in the school year if his/her presence in the
school becomes detrimental to the school or to other students and I will abide by the decision of the Principal regading such
matters. I also agree that date of birth once submitted, will not be changed hereafter.

Signature of Parent/Guardian

For Office Use

Approved by
Registratio No. 3812/2014

Date of Admission 22/01/2014

Chairman Principal
List of document submitted:
-
Sign . of accountant
 KERALA SAMAJAM MODEL SCHOOL
GOLMURI, JAMSHEDPUR - 831009

Class & Section VI C

Admissio No. 3716/2014

Photograph

Name of the Candidate AKSHARA KUMARI

Date of Birth 9/19/2010

Gender Female

Religion HINDUISM

Category GENERAL

Father's Name BINAY KUMAR JHA

Fahter's Mobile Number 9113729046

Father's Qualification
Father's Occupation
Father's Annual Income 0

Father's Office/Business Address

Mother's Name PINKY JHA
Mother's Mobile Number 9031395610

Mother's Qualification
Mother's Occupation
Mother's Annual Income 0
Mother's Office/Business Address
Residential Address [Link]-50, NEW BARADWARI, SAKCHI

Admission No. of Brother/Sister

Declaration: I solemnly declare that the particulars given above are true and correct to the best of my knowledge. I am
fully acquainted with the rules and requlations of the school and promise to abide by them. I have gone through the
School Prospectus thoroughly. I shall accept terms and conditions. working hours, dress code. fees of the school if
changed. modified/altered at any time during the course of stay of my ward in this institution.
I agree to the removal of the name of my child from the rolls of the school at any thime in the school year if his/her presence in the
school becomes detrimental to the school or to other students and I will abide by the decision of the Principal regading such
matters. I also agree that date of birth once submitted, will not be changed hereafter.

Signature of Parent/Guardian

For Office Use

Approved by
Registratio No. 3716/2014

Date of Admission 21/01/2014

Chairman Principal
List of document submitted:
-
Sign . of accountant
 KERALA SAMAJAM MODEL SCHOOL
GOLMURI, JAMSHEDPUR - 831009

Class & Section VI C

Admissio No. 3859/2014

Photograph

Name of the Candidate AKSHRA KUMARI

Date of Birth 4/8/2010

Gender Female

Religion HINDUISM

Category SC

Father's Name SURENDRA PASWAN

Fahter's Mobile Number 9771491381

Father's Qualification
Father's Occupation
Father's Annual Income 0

Father's Office/Business Address

Mother's Name SANGITA PASWAN
Mother's Mobile Number 7992264792

Mother's Qualification
Mother's Occupation
Mother's Annual Income 0
Mother's Office/Business Address
Residential Address H.N_5, J.P. NAGAR, NEAR VIVEKANDA SCHOOL, BHUIYADIH

Admission No. of Brother/Sister

Declaration: I solemnly declare that the particulars given above are true and correct to the best of my knowledge. I am
fully acquainted with the rules and requlations of the school and promise to abide by them. I have gone through the
School Prospectus thoroughly. I shall accept terms and conditions. working hours, dress code. fees of the school if
changed. modified/altered at any time during the course of stay of my ward in this institution.
I agree to the removal of the name of my child from the rolls of the school at any thime in the school year if his/her presence in the
school becomes detrimental to the school or to other students and I will abide by the decision of the Principal regading such
matters. I also agree that date of birth once submitted, will not be changed hereafter.

Signature of Parent/Guardian

For Office Use

Approved by
Registratio No. 3859/2014

Date of Admission 11/02/2014

Chairman Principal
List of document submitted:
-
Sign . of accountant
 KERALA SAMAJAM MODEL SCHOOL
GOLMURI, JAMSHEDPUR - 831009

Class & Section VI C

Admissio No. 3429/2013

Photograph

Name of the Candidate ALHAZAR NASIB KHAN

Date of Birth 6/25/2009

Gender Male

Religion ISLAM

Category GENERAL

Father's Name MOHAMMAD ATIF KHAN

Fahter's Mobile Number 9431111117

Father's Qualification
Father's Occupation
Father's Annual Income 0

Father's Office/Business Address

Mother's Name SHABNAM AFROZ
Mother's Mobile Number 9608911117

Mother's Qualification
Mother's Occupation
Mother's Annual Income 0
Mother's Office/Business Address
Residential Address D-15, DANISH APPARTMENT, RAZZAQUE COLONY, DHATKIDIH

Admission No. of Brother/Sister

Declaration: I solemnly declare that the particulars given above are true and correct to the best of my knowledge. I am
fully acquainted with the rules and requlations of the school and promise to abide by them. I have gone through the
School Prospectus thoroughly. I shall accept terms and conditions. working hours, dress code. fees of the school if
changed. modified/altered at any time during the course of stay of my ward in this institution.
I agree to the removal of the name of my child from the rolls of the school at any thime in the school year if his/her presence in the
school becomes detrimental to the school or to other students and I will abide by the decision of the Principal regading such
matters. I also agree that date of birth once submitted, will not be changed hereafter.

Signature of Parent/Guardian

For Office Use

Approved by
Registratio No. 3429/2013

Date of Admission 28/01/2013

Chairman Principal
List of document submitted:
-
Sign . of accountant
 KERALA SAMAJAM MODEL SCHOOL
GOLMURI, JAMSHEDPUR - 831009

Class & Section VI C

Admissio No. 3781/2014

Photograph

Name of the Candidate ANEEK DUTTA

Date of Birth 3/26/2010

Gender Male

Religion HINDUISM

Category GENERAL

Father's Name ARUP KUMAR DUTTA

Fahter's Mobile Number 9801491149

Father's Qualification
Father's Occupation
Father's Annual Income 0

Father's Office/Business Address

Mother's Name TINKU DUTTA
Mother's Mobile Number 879726882

Mother's Qualification
Mother's Occupation
Mother's Annual Income 0
Mother's Office/Business Address
Residential Address 1, NEELKANTH TOWER, POFF ROAD, DIMNA ROAD, MANGO

Admission No. of Brother/Sister

Declaration: I solemnly declare that the particulars given above are true and correct to the best of my knowledge. I am
fully acquainted with the rules and requlations of the school and promise to abide by them. I have gone through the
School Prospectus thoroughly. I shall accept terms and conditions. working hours, dress code. fees of the school if
changed. modified/altered at any time during the course of stay of my ward in this institution.
I agree to the removal of the name of my child from the rolls of the school at any thime in the school year if his/her presence in the
school becomes detrimental to the school or to other students and I will abide by the decision of the Principal regading such
matters. I also agree that date of birth once submitted, will not be changed hereafter.

Signature of Parent/Guardian

For Office Use

Approved by
Registratio No. 3781/2014

Date of Admission 21/01/2014

Chairman Principal
List of document submitted:
-
Sign . of accountant
 KERALA SAMAJAM MODEL SCHOOL
GOLMURI, JAMSHEDPUR - 831009

Class & Section VI C

Admissio No. 3865/2014

Photograph

Name of the Candidate ANIK OJHA

Date of Birth 4/27/2010

Gender Male

Religion HINDUISM

Category GENERAL

Father's Name SADHAN OJHA

Fahter's Mobile Number 9955350410

Father's Qualification
Father's Occupation
Father's Annual Income 0

Father's Office/Business Address

Mother's Name ASHA OJHA
Mother's Mobile Number
Mother's Qualification
Mother's Occupation
Mother's Annual Income 0
Mother's Office/Business Address
Residential Address 36, BAGAN AREA-3, KASHIDIH, SAKCHI

Admission No. of Brother/Sister

Declaration: I solemnly declare that the particulars given above are true and correct to the best of my knowledge. I am
fully acquainted with the rules and requlations of the school and promise to abide by them. I have gone through the
School Prospectus thoroughly. I shall accept terms and conditions. working hours, dress code. fees of the school if
changed. modified/altered at any time during the course of stay of my ward in this institution.
I agree to the removal of the name of my child from the rolls of the school at any thime in the school year if his/her presence in the
school becomes detrimental to the school or to other students and I will abide by the decision of the Principal regading such
matters. I also agree that date of birth once submitted, will not be changed hereafter.

Signature of Parent/Guardian

For Office Use

Approved by
Registratio No. 3865/2014

Date of Admission 17/02/2014

Chairman Principal
List of document submitted:
-
Sign . of accountant
 KERALA SAMAJAM MODEL SCHOOL
GOLMURI, JAMSHEDPUR - 831009

Class & Section VI C

Admissio No. 3690/2014

Photograph

Name of the Candidate ANMOL SINGH DHILLON

Date of Birth 2/27/2010

Gender Male

Religion SIKHISM

Category GENERAL

Father's Name JAGDISH SINGH

Fahter's Mobile Number 7209286617

Father's Qualification
Father's Occupation
Father's Annual Income 0

Father's Office/Business Address

Mother's Name GURPREET KAUR
Mother's Mobile Number
Mother's Qualification
Mother's Occupation
Mother's Annual Income 0
Mother's Office/Business Address
Residential Address [Link]-209, MANIFIT BASTI, NEAR JEMCO, GURUDWARA ROAD,

Admission No. of Brother/Sister

Declaration: I solemnly declare that the particulars given above are true and correct to the best of my knowledge. I am
fully acquainted with the rules and requlations of the school and promise to abide by them. I have gone through the
School Prospectus thoroughly. I shall accept terms and conditions. working hours, dress code. fees of the school if
changed. modified/altered at any time during the course of stay of my ward in this institution.
I agree to the removal of the name of my child from the rolls of the school at any thime in the school year if his/her presence in the
school becomes detrimental to the school or to other students and I will abide by the decision of the Principal regading such
matters. I also agree that date of birth once submitted, will not be changed hereafter.

Signature of Parent/Guardian

For Office Use

Approved by
Registratio No. 3690/2014

Date of Admission 21/01/2014

Chairman Principal
List of document submitted:
-
Sign . of accountant
 KERALA SAMAJAM MODEL SCHOOL
GOLMURI, JAMSHEDPUR - 831009

Class & Section VI C

Admissio No. 3728/2014

Photograph

Name of the Candidate ANURAG AGARWAL

Date of Birth 12/2/2009

Gender Male

Religion HINDUISM

Category GENERAL

Father's Name MAHENDRA AGARWAL

Fahter's Mobile Number 8797799906

Father's Qualification
Father's Occupation
Father's Annual Income 0

Father's Office/Business Address

Mother's Name SANGEETA AGARWAL
Mother's Mobile Number 8709935231

Mother's Qualification
Mother's Occupation
Mother's Annual Income 0
Mother's Office/Business Address
Residential Address MEHENDRA AGARWAL, RAJENDRA NAGAR, KUWAR SINGH ROAD,

Admission No. of Brother/Sister

Declaration: I solemnly declare that the particulars given above are true and correct to the best of my knowledge. I am
fully acquainted with the rules and requlations of the school and promise to abide by them. I have gone through the
School Prospectus thoroughly. I shall accept terms and conditions. working hours, dress code. fees of the school if
changed. modified/altered at any time during the course of stay of my ward in this institution.
I agree to the removal of the name of my child from the rolls of the school at any thime in the school year if his/her presence in the
school becomes detrimental to the school or to other students and I will abide by the decision of the Principal regading such
matters. I also agree that date of birth once submitted, will not be changed hereafter.

Signature of Parent/Guardian

For Office Use

Approved by
Registratio No. 3728/2014

Date of Admission 21/01/2014

Chairman Principal
List of document submitted:
-
Sign . of accountant
 KERALA SAMAJAM MODEL SCHOOL
GOLMURI, JAMSHEDPUR - 831009

Class & Section VI C

Admissio No. 3913/2014

Photograph

Name of the Candidate ANUSHREE AGARWAL

Date of Birth 7/27/2010

Gender Female

Religion HINDUISM

Category GENERAL

Father's Name RAJU AGARWAL

Fahter's Mobile Number 9334805370

Father's Qualification
Father's Occupation
Father's Annual Income 0

Father's Office/Business Address

Mother's Name CHANDAN NAREDI
Mother's Mobile Number 7209772872

Mother's Qualification
Mother's Occupation
Mother's Annual Income 0
Mother's Office/Business Address
Residential Address 147, DALDA LINE, SAKCHI

Admission No. of Brother/Sister

Declaration: I solemnly declare that the particulars given above are true and correct to the best of my knowledge. I am
fully acquainted with the rules and requlations of the school and promise to abide by them. I have gone through the
School Prospectus thoroughly. I shall accept terms and conditions. working hours, dress code. fees of the school if
changed. modified/altered at any time during the course of stay of my ward in this institution.
I agree to the removal of the name of my child from the rolls of the school at any thime in the school year if his/her presence in the
school becomes detrimental to the school or to other students and I will abide by the decision of the Principal regading such
matters. I also agree that date of birth once submitted, will not be changed hereafter.

Signature of Parent/Guardian

For Office Use

Approved by
Registratio No. 3913/2014

Date of Admission 18/02/2014

Chairman Principal
List of document submitted:
-
Sign . of accountant
 KERALA SAMAJAM MODEL SCHOOL
GOLMURI, JAMSHEDPUR - 831009

Class & Section VI C

Admissio No. 3737/2014

Photograph

Name of the Candidate ARYAN GHOSH

Date of Birth 7/25/2010

Gender Male

Religion HINDUISM

Category GENERAL

Father's Name ANIRBAN GHOSH

Fahter's Mobile Number 9122872287

Father's Qualification Graduate
Father's Occupation PRIVATE SECTOR
Father's Annual Income 300000

Father's Office/Business Address 201, Pancharenu Apartment, Bistupur

Mother's Name RUPA GHOSH

Mother's Mobile Number 9122697878

Mother's Qualification Graduate

Mother's Occupation HOUSE WIFE

Mother's Annual Income 0
Mother's Office/Business Address 201, Pancharenu Apartment, Bistupur
Residential Address 201, PANCH RENU APPARTMENT, SOUTH PARK BISTUPUR

Admission No. of Brother/Sister

Declaration: I solemnly declare that the particulars given above are true and correct to the best of my knowledge. I am
fully acquainted with the rules and requlations of the school and promise to abide by them. I have gone through the
School Prospectus thoroughly. I shall accept terms and conditions. working hours, dress code. fees of the school if
changed. modified/altered at any time during the course of stay of my ward in this institution.
I agree to the removal of the name of my child from the rolls of the school at any thime in the school year if his/her presence in the
school becomes detrimental to the school or to other students and I will abide by the decision of the Principal regading such
matters. I also agree that date of birth once submitted, will not be changed hereafter.

Signature of Parent/Guardian

For Office Use

Approved by
Registratio No. 3737/2014

Date of Admission 21/01/2014

Chairman Principal
List of document submitted:
-
Sign . of accountant
 KERALA SAMAJAM MODEL SCHOOL
GOLMURI, JAMSHEDPUR - 831009

Class & Section VI C

Admissio No. 3784/2014

Photograph

Name of the Candidate ARYAN KUMAR

Date of Birth 7/5/2010

Gender Male

Religion HINDUISM

Category GENERAL

Father's Name SHYAM KUMAR

Fahter's Mobile Number 9430308397

Father's Qualification
Father's Occupation
Father's Annual Income 0

Father's Office/Business Address

Mother's Name NITU KUMARI
Mother's Mobile Number 9204494447

Mother's Qualification
Mother's Occupation
Mother's Annual Income 0
Mother's Office/Business Address
Residential Address DEO-KUNJ APARTMENT,NH-33,FLAT NO-124,MANGO

Admission No. of Brother/Sister

Declaration: I solemnly declare that the particulars given above are true and correct to the best of my knowledge. I am
fully acquainted with the rules and requlations of the school and promise to abide by them. I have gone through the
School Prospectus thoroughly. I shall accept terms and conditions. working hours, dress code. fees of the school if
changed. modified/altered at any time during the course of stay of my ward in this institution.
I agree to the removal of the name of my child from the rolls of the school at any thime in the school year if his/her presence in the
school becomes detrimental to the school or to other students and I will abide by the decision of the Principal regading such
matters. I also agree that date of birth once submitted, will not be changed hereafter.

Signature of Parent/Guardian

For Office Use

Approved by
Registratio No. 3784/2014

Date of Admission 21/01/2014

Chairman Principal
List of document submitted:
-
Sign . of accountant
 KERALA SAMAJAM MODEL SCHOOL
GOLMURI, JAMSHEDPUR - 831009

Class & Section VI C

Admissio No. 3914/2014

Photograph

Name of the Candidate ATHARVA RAJ

Date of Birth 8/5/2010

Gender Male

Religion HINDUISM

Category GENERAL

Father's Name NALIN BILOCHAN KUMAR

Fahter's Mobile Number 9006622528

Father's Qualification
Father's Occupation
Father's Annual Income 0

Father's Office/Business Address

Mother's Name SANYUKTA KUMARI
Mother's Mobile Number 8210480345

Mother's Qualification
Mother's Occupation
Mother's Annual Income 0
Mother's Office/Business Address
Residential Address FLATNO.401,RAKESH TOWER,PURULIAROAD,MANGO

Admission No. of Brother/Sister

Declaration: I solemnly declare that the particulars given above are true and correct to the best of my knowledge. I am
fully acquainted with the rules and requlations of the school and promise to abide by them. I have gone through the
School Prospectus thoroughly. I shall accept terms and conditions. working hours, dress code. fees of the school if
changed. modified/altered at any time during the course of stay of my ward in this institution.
I agree to the removal of the name of my child from the rolls of the school at any thime in the school year if his/her presence in the
school becomes detrimental to the school or to other students and I will abide by the decision of the Principal regading such
matters. I also agree that date of birth once submitted, will not be changed hereafter.

Signature of Parent/Guardian

For Office Use

Approved by
Registratio No. 3914/2014

Date of Admission 18/02/2014

Chairman Principal
List of document submitted:
-
Sign . of accountant
 KERALA SAMAJAM MODEL SCHOOL
GOLMURI, JAMSHEDPUR - 831009

Class & Section VI C

Admissio No. 3956/2014

Photograph

Name of the Candidate AWISHI KAUR

Date of Birth 8/13/2010

Gender Female

Religion SIKHISM

Category GENERAL

Father's Name VIKRAMJEET SINGH

Fahter's Mobile Number 7004704196

Father's Qualification
Father's Occupation
Father's Annual Income 0

Father's Office/Business Address

Mother's Name PREETY KUMARI
Mother's Mobile Number 9523206367

Mother's Qualification
Mother's Occupation
Mother's Annual Income 0
Mother's Office/Business Address
Residential Address [Link]-221, LANE NO-7, KASHIDIH, SAKCHI

Admission No. of Brother/Sister

Declaration: I solemnly declare that the particulars given above are true and correct to the best of my knowledge. I am
fully acquainted with the rules and requlations of the school and promise to abide by them. I have gone through the
School Prospectus thoroughly. I shall accept terms and conditions. working hours, dress code. fees of the school if
changed. modified/altered at any time during the course of stay of my ward in this institution.
I agree to the removal of the name of my child from the rolls of the school at any thime in the school year if his/her presence in the
school becomes detrimental to the school or to other students and I will abide by the decision of the Principal regading such
matters. I also agree that date of birth once submitted, will not be changed hereafter.

Signature of Parent/Guardian

For Office Use

Approved by
Registratio No. 3956/2014

Date of Admission 23/06/2014

Chairman Principal
List of document submitted:
-
Sign . of accountant
 KERALA SAMAJAM MODEL SCHOOL
GOLMURI, JAMSHEDPUR - 831009

Class & Section VI C

Admissio No. 3933/2014

Photograph

Name of the Candidate AYAN SINGH

Date of Birth 8/1/2009

Gender Male

Religion HINDUISM

Category GENERAL

Father's Name ARUN KUMAR SINGH

Fahter's Mobile Number 8210115176

Father's Qualification
Father's Occupation
Father's Annual Income 0

Father's Office/Business Address

Mother's Name ANKITA SINGH
Mother's Mobile Number 6203533545

Mother's Qualification
Mother's Occupation
Mother's Annual Income 0
Mother's Office/Business Address
Residential Address NEW SITARAMDERA SLAG ROAD, BAGAN AREA, AGRICO

Admission No. of Brother/Sister

Declaration: I solemnly declare that the particulars given above are true and correct to the best of my knowledge. I am
fully acquainted with the rules and requlations of the school and promise to abide by them. I have gone through the
School Prospectus thoroughly. I shall accept terms and conditions. working hours, dress code. fees of the school if
changed. modified/altered at any time during the course of stay of my ward in this institution.
I agree to the removal of the name of my child from the rolls of the school at any thime in the school year if his/her presence in the
school becomes detrimental to the school or to other students and I will abide by the decision of the Principal regading such
matters. I also agree that date of birth once submitted, will not be changed hereafter.

Signature of Parent/Guardian

For Office Use

Approved by
Registratio No. 3933/2014

Date of Admission 21/02/2014

Chairman Principal
List of document submitted:
-
Sign . of accountant
 KERALA SAMAJAM MODEL SCHOOL
GOLMURI, JAMSHEDPUR - 831009

Class & Section VI C

Admissio No. 3713/2014

Photograph

Name of the Candidate BHAIRAV AGARWAL

Date of Birth 5/30/2010

Gender Male

Religion HINDUISM

Category GENERAL

Father's Name MALIRAM AGARWAL

Fahter's Mobile Number 9334180004

Father's Qualification Plus Two / Intermediate
Father's Occupation BUISNESSMAN
Father's Annual Income 600000

Father's Office/Business Address Hno 42, New Lay Out, Sitaramdera

Mother's Name RANI AGARWAL

Mother's Mobile Number 9304033350

Mother's Qualification Plus Two / Intermediate

Mother's Occupation HOUSE WIFE

Mother's Annual Income 600000
Mother's Office/Business Address Hno 42, New Lay Out, Sitaramdera
Residential Address [Link]-42, NEW LAYOUT, SITARAMDERA, AGRICO

Admission No. of Brother/Sister

Declaration: I solemnly declare that the particulars given above are true and correct to the best of my knowledge. I am
fully acquainted with the rules and requlations of the school and promise to abide by them. I have gone through the
School Prospectus thoroughly. I shall accept terms and conditions. working hours, dress code. fees of the school if
changed. modified/altered at any time during the course of stay of my ward in this institution.
I agree to the removal of the name of my child from the rolls of the school at any thime in the school year if his/her presence in the
school becomes detrimental to the school or to other students and I will abide by the decision of the Principal regading such
matters. I also agree that date of birth once submitted, will not be changed hereafter.

Signature of Parent/Guardian

For Office Use

Approved by
Registratio No. 3713/2014

Date of Admission 21/01/2014

Chairman Principal
List of document submitted:
-
Sign . of accountant
 KERALA SAMAJAM MODEL SCHOOL
GOLMURI, JAMSHEDPUR - 831009

Class & Section VI C

Admissio No. 3703/2014

Photograph

Name of the Candidate DISHA GURANANI

Date of Birth 8/27/2010

Gender Female

Religion HINDUISM

Category GENERAL

Father's Name AJAY GURNANI

Fahter's Mobile Number 9162134534

Father's Qualification
Father's Occupation
Father's Annual Income 0

Father's Office/Business Address

Mother's Name HARSH GURNANI
Mother's Mobile Number 9162134908

Mother's Qualification
Mother's Occupation
Mother's Annual Income 0
Mother's Office/Business Address
Residential Address [Link]-30, NEHRU COLONU, NEW KALIMATI ROAD, SAKCHI

Admission No. of Brother/Sister

Declaration: I solemnly declare that the particulars given above are true and correct to the best of my knowledge. I am
fully acquainted with the rules and requlations of the school and promise to abide by them. I have gone through the
School Prospectus thoroughly. I shall accept terms and conditions. working hours, dress code. fees of the school if
changed. modified/altered at any time during the course of stay of my ward in this institution.
I agree to the removal of the name of my child from the rolls of the school at any thime in the school year if his/her presence in the
school becomes detrimental to the school or to other students and I will abide by the decision of the Principal regading such
matters. I also agree that date of birth once submitted, will not be changed hereafter.

Signature of Parent/Guardian

For Office Use

Approved by
Registratio No. 3703/2014

Date of Admission 21/01/2014

Chairman Principal
List of document submitted:
-
Sign . of accountant
 KERALA SAMAJAM MODEL SCHOOL
GOLMURI, JAMSHEDPUR - 831009

Class & Section VI C

Admissio No. 5127/2018

Photograph

Name of the Candidate FARAZ RAZA ANSARI

Date of Birth 1/28/2009

Gender Male

Religion ISLAM

Category
Father's Name NAYEEM ANSARI

Fahter's Mobile Number 9065345558

Father's Qualification
Father's Occupation
Father's Annual Income 60000

Father's Office/Business Address

Mother's Name FIROZA KHATOON
Mother's Mobile Number 9065345558

Mother's Qualification
Mother's Occupation
Mother's Annual Income 0
Mother's Office/Business Address
Residential Address [Link]-314, B BLOCK, PANI TANKI ROAD, GOLMURI

Admission No. of Brother/Sister

Declaration: I solemnly declare that the particulars given above are true and correct to the best of my knowledge. I am
fully acquainted with the rules and requlations of the school and promise to abide by them. I have gone through the
School Prospectus thoroughly. I shall accept terms and conditions. working hours, dress code. fees of the school if
changed. modified/altered at any time during the course of stay of my ward in this institution.
I agree to the removal of the name of my child from the rolls of the school at any thime in the school year if his/her presence in the
school becomes detrimental to the school or to other students and I will abide by the decision of the Principal regading such
matters. I also agree that date of birth once submitted, will not be changed hereafter.

Signature of Parent/Guardian

For Office Use

Approved by
Registratio No. 5127/2018

Date of Admission 25/04/2018

Chairman Principal
List of document submitted:
-
Sign . of accountant
 KERALA SAMAJAM MODEL SCHOOL
GOLMURI, JAMSHEDPUR - 831009

Class & Section VI C

Admissio No. 3964/2014

Photograph

Name of the Candidate HARSHIT KUMAR

Date of Birth 6/1/2010

Gender Male

Religion HINDUISM

Category OBC

Father's Name DHARAMBEER KUMAR

Fahter's Mobile Number 9431523401

Father's Qualification
Father's Occupation
Father's Annual Income 0

Father's Office/Business Address

Mother's Name SUNITA DEVI
Mother's Mobile Number 8434888612

Mother's Qualification
Mother's Occupation
Mother's Annual Income 0
Mother's Office/Business Address
Residential Address [Link]-15, BHIYADIH WOOD STALL, AGRICO, EAST SINGHBHUM

Admission No. of Brother/Sister

Declaration: I solemnly declare that the particulars given above are true and correct to the best of my knowledge. I am
fully acquainted with the rules and requlations of the school and promise to abide by them. I have gone through the
School Prospectus thoroughly. I shall accept terms and conditions. working hours, dress code. fees of the school if
changed. modified/altered at any time during the course of stay of my ward in this institution.
I agree to the removal of the name of my child from the rolls of the school at any thime in the school year if his/her presence in the
school becomes detrimental to the school or to other students and I will abide by the decision of the Principal regading such
matters. I also agree that date of birth once submitted, will not be changed hereafter.

Signature of Parent/Guardian

For Office Use

Approved by
Registratio No. 3964/2014

Date of Admission 25/06/2014

Chairman Principal
List of document submitted:
-
Sign . of accountant
 KERALA SAMAJAM MODEL SCHOOL
GOLMURI, JAMSHEDPUR - 831009

Class & Section VI C

Admissio No. 3749/2014

Photograph

Name of the Candidate HARSHIT TIWARI

Date of Birth 7/27/2010

Gender Male

Religion HINDUISM

Category GENERAL

Father's Name RABINDRA TIWARI

Fahter's Mobile Number 9931129380

Father's Qualification
Father's Occupation
Father's Annual Income 0

Father's Office/Business Address

Mother's Name SUNITA TIWARI
Mother's Mobile Number 7903343357

Mother's Qualification
Mother's Occupation
Mother's Annual Income 0
Mother's Office/Business Address
Residential Address 49, GURUDWARA BASTI, MANGO

Admission No. of Brother/Sister

Declaration: I solemnly declare that the particulars given above are true and correct to the best of my knowledge. I am
fully acquainted with the rules and requlations of the school and promise to abide by them. I have gone through the
School Prospectus thoroughly. I shall accept terms and conditions. working hours, dress code. fees of the school if
changed. modified/altered at any time during the course of stay of my ward in this institution.
I agree to the removal of the name of my child from the rolls of the school at any thime in the school year if his/her presence in the
school becomes detrimental to the school or to other students and I will abide by the decision of the Principal regading such
matters. I also agree that date of birth once submitted, will not be changed hereafter.

Signature of Parent/Guardian

For Office Use

Approved by
Registratio No. 3749/2014

Date of Admission 21/01/2014

Chairman Principal
List of document submitted:
-
Sign . of accountant
 KERALA SAMAJAM MODEL SCHOOL
GOLMURI, JAMSHEDPUR - 831009

Class & Section VI C

Admissio No. 3863/2014

Photograph

Name of the Candidate HIBAH SYED

Date of Birth 10/19/2009

Gender Female

Religion ISLAM

Category GENERAL

Father's Name SYED MOHAMMAD IZHAR

Fahter's Mobile Number 9234569956

Father's Qualification Graduate
Father's Occupation SERVICE
Father's Annual Income 20

Father's Office/Business Address H. No - 87, Golmuri

Mother's Name SHABANA BEGUM

Mother's Mobile Number 7004817793

Mother's Qualification Plus Two / Intermediate

Mother's Occupation HOUSE WIFE

Mother's Annual Income 0
Mother's Office/Business Address Do
Residential Address [Link]-87, 2ND FLOOR, MUSLIM BASTI, GOLMURI

Admission No. of Brother/Sister

Declaration: I solemnly declare that the particulars given above are true and correct to the best of my knowledge. I am
fully acquainted with the rules and requlations of the school and promise to abide by them. I have gone through the
School Prospectus thoroughly. I shall accept terms and conditions. working hours, dress code. fees of the school if
changed. modified/altered at any time during the course of stay of my ward in this institution.
I agree to the removal of the name of my child from the rolls of the school at any thime in the school year if his/her presence in the
school becomes detrimental to the school or to other students and I will abide by the decision of the Principal regading such
matters. I also agree that date of birth once submitted, will not be changed hereafter.

Signature of Parent/Guardian

For Office Use

Approved by
Registratio No. 3863/2014

Date of Admission 17/02/2014

Chairman Principal
List of document submitted:
-
Sign . of accountant
 KERALA SAMAJAM MODEL SCHOOL
GOLMURI, JAMSHEDPUR - 831009

Class & Section VI C

Admissio No. 3771/2014

Photograph

Name of the Candidate ISHIKA SHARMA

Date of Birth 2/3/2010

Gender Female

Religion HINDUISM

Category
Father's Name NAVNEET SHARMA

Fahter's Mobile Number 9142048937

Father's Qualification
Father's Occupation
Father's Annual Income 0

Father's Office/Business Address

Mother's Name ANUPA SHARMA
Mother's Mobile Number 6203572984

Mother's Qualification
Mother's Occupation
Mother's Annual Income 0
Mother's Office/Business Address
Residential Address NEW SUBASH COLONU, ROAD NO-34, SANJAY PATH, DIMNA ROAD,

Admission No. of Brother/Sister

Declaration: I solemnly declare that the particulars given above are true and correct to the best of my knowledge. I am
fully acquainted with the rules and requlations of the school and promise to abide by them. I have gone through the
School Prospectus thoroughly. I shall accept terms and conditions. working hours, dress code. fees of the school if
changed. modified/altered at any time during the course of stay of my ward in this institution.
I agree to the removal of the name of my child from the rolls of the school at any thime in the school year if his/her presence in the
school becomes detrimental to the school or to other students and I will abide by the decision of the Principal regading such
matters. I also agree that date of birth once submitted, will not be changed hereafter.

Signature of Parent/Guardian

For Office Use

Approved by
Registratio No. 3771/2014

Date of Admission 21/01/2014

Chairman Principal
List of document submitted:
-
Sign . of accountant
 KERALA SAMAJAM MODEL SCHOOL
GOLMURI, JAMSHEDPUR - 831009

Class & Section VI C

Admissio No. 3891/2014

Photograph

Name of the Candidate MAYANK RAJ

Date of Birth 3/6/2010

Gender Male

Religion HINDUISM

Category GENERAL

Father's Name AMIT KUMAR

Fahter's Mobile Number 7654397234

Father's Qualification
Father's Occupation
Father's Annual Income 0

Father's Office/Business Address

Mother's Name SANGEETA MANDAL
Mother's Mobile Number 8092448579

Mother's Qualification
Mother's Occupation
Mother's Annual Income 0
Mother's Office/Business Address
Residential Address [Link]-1, SHIVAM COMPLEX, SUNDER GARDEN, SANJAY PATH,

Admission No. of Brother/Sister

Declaration: I solemnly declare that the particulars given above are true and correct to the best of my knowledge. I am
fully acquainted with the rules and requlations of the school and promise to abide by them. I have gone through the
School Prospectus thoroughly. I shall accept terms and conditions. working hours, dress code. fees of the school if
changed. modified/altered at any time during the course of stay of my ward in this institution.
I agree to the removal of the name of my child from the rolls of the school at any thime in the school year if his/her presence in the
school becomes detrimental to the school or to other students and I will abide by the decision of the Principal regading such
matters. I also agree that date of birth once submitted, will not be changed hereafter.

Signature of Parent/Guardian

For Office Use

Approved by
Registratio No. 3891/2014

Date of Admission 17/02/2014

Chairman Principal
List of document submitted:
-
Sign . of accountant
 KERALA SAMAJAM MODEL SCHOOL
GOLMURI, JAMSHEDPUR - 831009

Class & Section VI C

Admissio No. 3897/2014

Photograph

Name of the Candidate MAYANK RAJ MOONKA

Date of Birth 12/9/2009

Gender Male

Religion HINDUISM

Category GENERAL

Father's Name SHAMBHU MOONKA

Fahter's Mobile Number 9430184797

Father's Qualification
Father's Occupation
Father's Annual Income 0

Father's Office/Business Address

Mother's Name SUSHMA MOONKA
Mother's Mobile Number 7765930467

Mother's Qualification
Mother's Occupation
Mother's Annual Income 0
Mother's Office/Business Address
Residential Address A, SAKHCI MILL AND GODOWN AREA, SAKCHI

Admission No. of Brother/Sister

Declaration: I solemnly declare that the particulars given above are true and correct to the best of my knowledge. I am
fully acquainted with the rules and requlations of the school and promise to abide by them. I have gone through the
School Prospectus thoroughly. I shall accept terms and conditions. working hours, dress code. fees of the school if
changed. modified/altered at any time during the course of stay of my ward in this institution.
I agree to the removal of the name of my child from the rolls of the school at any thime in the school year if his/her presence in the
school becomes detrimental to the school or to other students and I will abide by the decision of the Principal regading such
matters. I also agree that date of birth once submitted, will not be changed hereafter.

Signature of Parent/Guardian

For Office Use

Approved by
Registratio No. 3897/2014

Date of Admission 17/02/2014

Chairman Principal
List of document submitted:
-
Sign . of accountant
 KERALA SAMAJAM MODEL SCHOOL
GOLMURI, JAMSHEDPUR - 831009

Class & Section VI C

Admissio No. 3718/2014

Photograph

Name of the Candidate MOHAMMAD AAMISH JAMAL

Date of Birth 6/15/2010

Gender Male

Religion ISLAM

Category GENERAL

Father's Name MOHAMMAD SHAHID JAMAL

Fahter's Mobile Number 9835550967

Father's Qualification
Father's Occupation
Father's Annual Income 0

Father's Office/Business Address

Mother's Name SAFIHA NIKHAT
Mother's Mobile Number 9973523144

Mother's Qualification
Mother's Occupation
Mother's Annual Income 0
Mother's Office/Business Address
Residential Address ROAD NO-11, [Link]-11A, ZAKIRNAGAR, MANGO

Admission No. of Brother/Sister

Declaration: I solemnly declare that the particulars given above are true and correct to the best of my knowledge. I am
fully acquainted with the rules and requlations of the school and promise to abide by them. I have gone through the
School Prospectus thoroughly. I shall accept terms and conditions. working hours, dress code. fees of the school if
changed. modified/altered at any time during the course of stay of my ward in this institution.
I agree to the removal of the name of my child from the rolls of the school at any thime in the school year if his/her presence in the
school becomes detrimental to the school or to other students and I will abide by the decision of the Principal regading such
matters. I also agree that date of birth once submitted, will not be changed hereafter.

Signature of Parent/Guardian

For Office Use

Approved by
Registratio No. 3718/2014

Date of Admission 21/01/2014

Chairman Principal
List of document submitted:
-
Sign . of accountant
 KERALA SAMAJAM MODEL SCHOOL
GOLMURI, JAMSHEDPUR - 831009

Class & Section VI C

Admissio No. 3743/2014

Photograph

Name of the Candidate MOHAMMAD AREEB NUMAAN

Date of Birth 9/17/2010

Gender Male

Religion ISLAM

Category GENERAL

Father's Name MOHAMMAD SAYEED

Fahter's Mobile Number 9835342784

Father's Qualification
Father's Occupation
Father's Annual Income 0

Father's Office/Business Address

Mother's Name TARANNUM NIZAM
Mother's Mobile Number 8102294842

Mother's Qualification
Mother's Occupation
Mother's Annual Income 0
Mother's Office/Business Address
Residential Address 126, SANJAY ROAD, SAKCHI

Admission No. of Brother/Sister

Declaration: I solemnly declare that the particulars given above are true and correct to the best of my knowledge. I am
fully acquainted with the rules and requlations of the school and promise to abide by them. I have gone through the
School Prospectus thoroughly. I shall accept terms and conditions. working hours, dress code. fees of the school if
changed. modified/altered at any time during the course of stay of my ward in this institution.
I agree to the removal of the name of my child from the rolls of the school at any thime in the school year if his/her presence in the
school becomes detrimental to the school or to other students and I will abide by the decision of the Principal regading such
matters. I also agree that date of birth once submitted, will not be changed hereafter.

Signature of Parent/Guardian

For Office Use

Approved by
Registratio No. 3743/2014

Date of Admission 21/01/2014

Chairman Principal
List of document submitted:
-
Sign . of accountant
 KERALA SAMAJAM MODEL SCHOOL
GOLMURI, JAMSHEDPUR - 831009

Class & Section VI C

Admissio No. 3696/2014

Photograph

Name of the Candidate NEET MEHANDIRATTA

Date of Birth 7/14/2010

Gender Female

Religion HINDUISM

Category GENERAL

Father's Name ANISH KUMAR

Fahter's Mobile Number 9334611487

Father's Qualification
Father's Occupation
Father's Annual Income 0

Father's Office/Business Address

Mother's Name REENA MEHANDIRATTA
Mother's Mobile Number 6205107602

Mother's Qualification
Mother's Occupation
Mother's Annual Income 0
Mother's Office/Business Address
Residential Address 41, PUNJABI REFUJEE COLONY, AGRICO

Admission No. of Brother/Sister

Declaration: I solemnly declare that the particulars given above are true and correct to the best of my knowledge. I am
fully acquainted with the rules and requlations of the school and promise to abide by them. I have gone through the
School Prospectus thoroughly. I shall accept terms and conditions. working hours, dress code. fees of the school if
changed. modified/altered at any time during the course of stay of my ward in this institution.
I agree to the removal of the name of my child from the rolls of the school at any thime in the school year if his/her presence in the
school becomes detrimental to the school or to other students and I will abide by the decision of the Principal regading such
matters. I also agree that date of birth once submitted, will not be changed hereafter.

Signature of Parent/Guardian

For Office Use

Approved by
Registratio No. 3696/2014

Date of Admission 21/01/2014

Chairman Principal
List of document submitted:
-
Sign . of accountant
 KERALA SAMAJAM MODEL SCHOOL
GOLMURI, JAMSHEDPUR - 831009

Class & Section VI C

Admissio No. 3860/2014

Photograph

Name of the Candidate NISHU PRIYA

Date of Birth 11/28/2009

Gender Female

Religion HINDUISM

Category SC

Father's Name BHAVESH KUMAR

Fahter's Mobile Number 6200591587

Father's Qualification Matriculation
Father's Occupation ARMY
Father's Annual Income 800000

Father's Office/Business Address Q/NO:-150,NEW D/S FLAT GOLMURI

Mother's Name ASHA KUMARI

Mother's Mobile Number 7762824580

Mother's Qualification Plus Two / Intermediate

Mother's Occupation HOUSE WIFE

Mother's Annual Income 0
Mother's Office/Business Address Q/NO:-150,NEW D/S FLAT,GOLMURI
Residential Address Q/NO:-150 ,NEW D/S FLAT, GOLMURI

Admission No. of Brother/Sister

Declaration: I solemnly declare that the particulars given above are true and correct to the best of my knowledge. I am
fully acquainted with the rules and requlations of the school and promise to abide by them. I have gone through the
School Prospectus thoroughly. I shall accept terms and conditions. working hours, dress code. fees of the school if
changed. modified/altered at any time during the course of stay of my ward in this institution.
I agree to the removal of the name of my child from the rolls of the school at any thime in the school year if his/her presence in the
school becomes detrimental to the school or to other students and I will abide by the decision of the Principal regading such
matters. I also agree that date of birth once submitted, will not be changed hereafter.

Signature of Parent/Guardian

For Office Use

Approved by
Registratio No. 3860/2014

Date of Admission 12/02/2014

Chairman Principal
List of document submitted:
-
Sign . of accountant
 KERALA SAMAJAM MODEL SCHOOL
GOLMURI, JAMSHEDPUR - 831009

Class & Section VI C

Admissio No. 3884/2014

Photograph

Name of the Candidate PALAK CHOUDHARY

Date of Birth 1/24/2010

Gender Female

Religion HINDUISM

Category GENERAL

Father's Name RUPESH CHOUDHARY

Fahter's Mobile Number 7209314474

Father's Qualification
Father's Occupation
Father's Annual Income 0

Father's Office/Business Address

Mother's Name TANNU CHOUDHARY
Mother's Mobile Number 7677644204

Mother's Qualification
Mother's Occupation
Mother's Annual Income 0
Mother's Office/Business Address
Residential Address 240, B BLOCK, TUILADUNGARI, GOLMURI

Admission No. of Brother/Sister

Declaration: I solemnly declare that the particulars given above are true and correct to the best of my knowledge. I am
fully acquainted with the rules and requlations of the school and promise to abide by them. I have gone through the
School Prospectus thoroughly. I shall accept terms and conditions. working hours, dress code. fees of the school if
changed. modified/altered at any time during the course of stay of my ward in this institution.
I agree to the removal of the name of my child from the rolls of the school at any thime in the school year if his/her presence in the
school becomes detrimental to the school or to other students and I will abide by the decision of the Principal regading such
matters. I also agree that date of birth once submitted, will not be changed hereafter.

Signature of Parent/Guardian

For Office Use

Approved by
Registratio No. 3884/2014

Date of Admission 17/02/2014

Chairman Principal
List of document submitted:
-
Sign . of accountant
 KERALA SAMAJAM MODEL SCHOOL
GOLMURI, JAMSHEDPUR - 831009

Class & Section VI C

Admissio No. 3841/2014

Photograph

Name of the Candidate PANKURI TIWARY

Date of Birth 5/19/2010

Gender Female

Religion HINDUISM

Category GENERAL

Father's Name SHIV SHANKAR TIWARY

Fahter's Mobile Number 9939184788

Father's Qualification
Father's Occupation
Father's Annual Income 0

Father's Office/Business Address

Mother's Name VANDANA TIWARY
Mother's Mobile Number 8825343557

Mother's Qualification
Mother's Occupation
Mother's Annual Income 0
Mother's Office/Business Address
Residential Address TUILA DUNGARI, LINE NO-5, [Link]-64A, BLOCK, EAST SINGHBHUM

Admission No. of Brother/Sister

Declaration: I solemnly declare that the particulars given above are true and correct to the best of my knowledge. I am
fully acquainted with the rules and requlations of the school and promise to abide by them. I have gone through the
School Prospectus thoroughly. I shall accept terms and conditions. working hours, dress code. fees of the school if
changed. modified/altered at any time during the course of stay of my ward in this institution.
I agree to the removal of the name of my child from the rolls of the school at any thime in the school year if his/her presence in the
school becomes detrimental to the school or to other students and I will abide by the decision of the Principal regading such
matters. I also agree that date of birth once submitted, will not be changed hereafter.

Signature of Parent/Guardian

For Office Use

Approved by
Registratio No. 3841/2014

Date of Admission 23/01/2014

Chairman Principal
List of document submitted:
-
Sign . of accountant
 KERALA SAMAJAM MODEL SCHOOL
GOLMURI, JAMSHEDPUR - 831009

Class & Section VI C

Admissio No. 3843/2014

Photograph

Name of the Candidate PARLEEN KAUR

Date of Birth 2/21/2010

Gender Female

Religion SIKHISM

Category GENERAL

Father's Name SURENDERPAL SINGH

Fahter's Mobile Number 9334554066

Father's Qualification
Father's Occupation
Father's Annual Income 0

Father's Office/Business Address

Mother's Name MANJEET KOUR
Mother's Mobile Number 7004597223

Mother's Qualification
Mother's Occupation
Mother's Annual Income 0
Mother's Office/Business Address
Residential Address B/56B, MANDIR ROAD, BAGUNNAGAR, BARIDIH

Admission No. of Brother/Sister

Declaration: I solemnly declare that the particulars given above are true and correct to the best of my knowledge. I am
fully acquainted with the rules and requlations of the school and promise to abide by them. I have gone through the
School Prospectus thoroughly. I shall accept terms and conditions. working hours, dress code. fees of the school if
changed. modified/altered at any time during the course of stay of my ward in this institution.
I agree to the removal of the name of my child from the rolls of the school at any thime in the school year if his/her presence in the
school becomes detrimental to the school or to other students and I will abide by the decision of the Principal regading such
matters. I also agree that date of birth once submitted, will not be changed hereafter.

Signature of Parent/Guardian

For Office Use

Approved by
Registratio No. 3843/2014

Date of Admission 23/01/2014

Chairman Principal
List of document submitted:
-
Sign . of accountant
 KERALA SAMAJAM MODEL SCHOOL
GOLMURI, JAMSHEDPUR - 831009

Class & Section VI C

Admissio No. 3929/2014

Photograph

Name of the Candidate PRASHANT TRIVEDI

Date of Birth 5/17/2010

Gender Male

Religion HINDUISM

Category GENERAL

Father's Name SHASHI BHUSHAN TRIVEDI

Fahter's Mobile Number 9835112391

Father's Qualification
Father's Occupation
Father's Annual Income 0

Father's Office/Business Address

Mother's Name ALKA TRIVEDI
Mother's Mobile Number 9470995680

Mother's Qualification
Mother's Occupation
Mother's Annual Income 0
Mother's Office/Business Address
Residential Address 84, NLO SITARAMDERA, AGRICO

Admission No. of Brother/Sister

Declaration: I solemnly declare that the particulars given above are true and correct to the best of my knowledge. I am
fully acquainted with the rules and requlations of the school and promise to abide by them. I have gone through the
School Prospectus thoroughly. I shall accept terms and conditions. working hours, dress code. fees of the school if
changed. modified/altered at any time during the course of stay of my ward in this institution.
I agree to the removal of the name of my child from the rolls of the school at any thime in the school year if his/her presence in the
school becomes detrimental to the school or to other students and I will abide by the decision of the Principal regading such
matters. I also agree that date of birth once submitted, will not be changed hereafter.

Signature of Parent/Guardian

For Office Use

Approved by
Registratio No. 3929/2014

Date of Admission 20/02/2014

Chairman Principal
List of document submitted:
-
Sign . of accountant
 KERALA SAMAJAM MODEL SCHOOL
GOLMURI, JAMSHEDPUR - 831009

Class & Section VI C

Admissio No. 3909/2014

Photograph

Name of the Candidate PRIYADARSHINI KUMARI

Date of Birth 12/30/2009

Gender Female

Religion HINDUISM

Category GENERAL

Father's Name SUJIT KUMAR

Fahter's Mobile Number 8210386052

Father's Qualification
Father's Occupation
Father's Annual Income 0

Father's Office/Business Address

Mother's Name RASHMI KUMARI
Mother's Mobile Number 7050163806

Mother's Qualification
Mother's Occupation
Mother's Annual Income 0
Mother's Office/Business Address
Residential Address [Link]-240, ROAD NO-26, KS ROAD, ULIDIH, MANGO

Admission No. of Brother/Sister

Declaration: I solemnly declare that the particulars given above are true and correct to the best of my knowledge. I am
fully acquainted with the rules and requlations of the school and promise to abide by them. I have gone through the
School Prospectus thoroughly. I shall accept terms and conditions. working hours, dress code. fees of the school if
changed. modified/altered at any time during the course of stay of my ward in this institution.
I agree to the removal of the name of my child from the rolls of the school at any thime in the school year if his/her presence in the
school becomes detrimental to the school or to other students and I will abide by the decision of the Principal regading such
matters. I also agree that date of birth once submitted, will not be changed hereafter.

Signature of Parent/Guardian

For Office Use

Approved by
Registratio No. 3909/2014

Date of Admission 18/02/2014

Chairman Principal
List of document submitted:
-
Sign . of accountant
 KERALA SAMAJAM MODEL SCHOOL
GOLMURI, JAMSHEDPUR - 831009

Class & Section VI C

Admissio No. 3820/2014

Photograph

Name of the Candidate RAMANDEEP KAUR

Date of Birth 12/23/2009

Gender Female

Religion SIKHISM

Category GENERAL

Father's Name JIGAR SINGH

Fahter's Mobile Number 9608162704

Father's Qualification
Father's Occupation
Father's Annual Income 0

Father's Office/Business Address

Mother's Name KARAMJEET KOUR
Mother's Mobile Number 6207109645

Mother's Qualification
Mother's Occupation
Mother's Annual Income 0
Mother's Office/Business Address
Residential Address GURUNANAK BASTI, DIMNA ROAD, MANGO

Admission No. of Brother/Sister

Declaration: I solemnly declare that the particulars given above are true and correct to the best of my knowledge. I am
fully acquainted with the rules and requlations of the school and promise to abide by them. I have gone through the
School Prospectus thoroughly. I shall accept terms and conditions. working hours, dress code. fees of the school if
changed. modified/altered at any time during the course of stay of my ward in this institution.
I agree to the removal of the name of my child from the rolls of the school at any thime in the school year if his/her presence in the
school becomes detrimental to the school or to other students and I will abide by the decision of the Principal regading such
matters. I also agree that date of birth once submitted, will not be changed hereafter.

Signature of Parent/Guardian

For Office Use

Approved by
Registratio No. 3820/2014

Date of Admission 22/01/2014

Chairman Principal
List of document submitted:
-
Sign . of accountant
 KERALA SAMAJAM MODEL SCHOOL
GOLMURI, JAMSHEDPUR - 831009

Class & Section VI C

Admissio No. 3947/2014

Photograph

Name of the Candidate RANVEER PODDAR

Date of Birth 5/10/2009

Gender Male

Religion HINDUISM

Category OBC

Father's Name SUKHDEV PODDAR

Fahter's Mobile Number 9204529214

Father's Qualification
Father's Occupation
Father's Annual Income 0

Father's Office/Business Address

Mother's Name SHEELA PODDAR
Mother's Mobile Number 7004992122

Mother's Qualification
Mother's Occupation
Mother's Annual Income 0
Mother's Office/Business Address
Residential Address [Link]-119, PRATHRAKWN, KASHIDIH, SARAIKELA-KHARSAWAN

Admission No. of Brother/Sister

Declaration: I solemnly declare that the particulars given above are true and correct to the best of my knowledge. I am
fully acquainted with the rules and requlations of the school and promise to abide by them. I have gone through the
School Prospectus thoroughly. I shall accept terms and conditions. working hours, dress code. fees of the school if
changed. modified/altered at any time during the course of stay of my ward in this institution.
I agree to the removal of the name of my child from the rolls of the school at any thime in the school year if his/her presence in the
school becomes detrimental to the school or to other students and I will abide by the decision of the Principal regading such
matters. I also agree that date of birth once submitted, will not be changed hereafter.

Signature of Parent/Guardian

For Office Use

Approved by
Registratio No. 3947/2014

Date of Admission 16/04/2014

Chairman Principal
List of document submitted:
-
Sign . of accountant
 KERALA SAMAJAM MODEL SCHOOL
GOLMURI, JAMSHEDPUR - 831009

Class & Section VI C

Admissio No. 3872/2014

Photograph

Name of the Candidate RIDHI SHARMA

Date of Birth 9/12/2010

Gender Female

Religion SIKHISM

Category GENERAL

Father's Name VIKASH KUMAR SHARMA

Fahter's Mobile Number 9334571812

Father's Qualification
Father's Occupation
Father's Annual Income 0

Father's Office/Business Address

Mother's Name SALONI SHARMA
Mother's Mobile Number 9955015783

Mother's Qualification
Mother's Occupation
Mother's Annual Income 0
Mother's Office/Business Address
Residential Address 13/A, PUNJABI REFUJEE COLONY

Admission No. of Brother/Sister

Declaration: I solemnly declare that the particulars given above are true and correct to the best of my knowledge. I am
fully acquainted with the rules and requlations of the school and promise to abide by them. I have gone through the
School Prospectus thoroughly. I shall accept terms and conditions. working hours, dress code. fees of the school if
changed. modified/altered at any time during the course of stay of my ward in this institution.
I agree to the removal of the name of my child from the rolls of the school at any thime in the school year if his/her presence in the
school becomes detrimental to the school or to other students and I will abide by the decision of the Principal regading such
matters. I also agree that date of birth once submitted, will not be changed hereafter.

Signature of Parent/Guardian

For Office Use

Approved by
Registratio No. 3872/2014

Date of Admission 17/02/2014

Chairman Principal
List of document submitted:
-
Sign . of accountant
 KERALA SAMAJAM MODEL SCHOOL
GOLMURI, JAMSHEDPUR - 831009

Class & Section VI C

Admissio No. 3726/2014

Photograph

Name of the Candidate RISHIKA THAKUR

Date of Birth 5/25/2010

Gender Female

Religion HINDUISM

Category GENERAL

Father's Name RAKESH KUMAR THAKUR

Fahter's Mobile Number 7488139060

Father's Qualification
Father's Occupation
Father's Annual Income 0

Father's Office/Business Address

Mother's Name REENA RANJAN THAKUR
Mother's Mobile Number 9334650812

Mother's Qualification
Mother's Occupation
Mother's Annual Income 0
Mother's Office/Business Address
Residential Address C/0-SHEOJEE PRASAD, [Link]-B/B-1283_1284, GOUND FLOOR, NEW LINE,

Admission No. of Brother/Sister

Declaration: I solemnly declare that the particulars given above are true and correct to the best of my knowledge. I am
fully acquainted with the rules and requlations of the school and promise to abide by them. I have gone through the
School Prospectus thoroughly. I shall accept terms and conditions. working hours, dress code. fees of the school if
changed. modified/altered at any time during the course of stay of my ward in this institution.
I agree to the removal of the name of my child from the rolls of the school at any thime in the school year if his/her presence in the
school becomes detrimental to the school or to other students and I will abide by the decision of the Principal regading such
matters. I also agree that date of birth once submitted, will not be changed hereafter.

Signature of Parent/Guardian

For Office Use

Approved by
Registratio No. 3726/2014

Date of Admission 21/01/2014

Chairman Principal
List of document submitted:
-
Sign . of accountant
 KERALA SAMAJAM MODEL SCHOOL
GOLMURI, JAMSHEDPUR - 831009

Class & Section VI C

Admissio No. 3687/2014

Photograph

Name of the Candidate ROOPJOT SINGH

Date of Birth 11/8/2009

Gender Male

Religion SIKHISM

Category GENERAL

Father's Name HARKAMAL SINGH

Fahter's Mobile Number 9883171351

Father's Qualification
Father's Occupation
Father's Annual Income 0

Father's Office/Business Address

Mother's Name MANDEEP KAUR
Mother's Mobile Number 9835322483

Mother's Qualification
Mother's Occupation
Mother's Annual Income 0
Mother's Office/Business Address
Residential Address [Link]-37, SOHAL NIWAS, ZONE NO-1B, LOYOLA [Link] COLLEGE ROAD,

Admission No. of Brother/Sister

Declaration: I solemnly declare that the particulars given above are true and correct to the best of my knowledge. I am
fully acquainted with the rules and requlations of the school and promise to abide by them. I have gone through the
School Prospectus thoroughly. I shall accept terms and conditions. working hours, dress code. fees of the school if
changed. modified/altered at any time during the course of stay of my ward in this institution.
I agree to the removal of the name of my child from the rolls of the school at any thime in the school year if his/her presence in the
school becomes detrimental to the school or to other students and I will abide by the decision of the Principal regading such
matters. I also agree that date of birth once submitted, will not be changed hereafter.

Signature of Parent/Guardian

For Office Use

Approved by
Registratio No. 3687/2014

Date of Admission 21/01/2014

Chairman Principal
List of document submitted:
-
Sign . of accountant
 KERALA SAMAJAM MODEL SCHOOL
GOLMURI, JAMSHEDPUR - 831009

Class & Section VI C

Admissio No. 3899/2014

Photograph

Name of the Candidate SAMARTH AGARWAL

Date of Birth 9/24/2010

Gender Male

Religion HINDUISM

Category GENERAL

Father's Name MUKESH AGARWAL

Fahter's Mobile Number 8210988090

Father's Qualification
Father's Occupation
Father's Annual Income 0

Father's Office/Business Address

Mother's Name SWEETY AGARWAL
Mother's Mobile Number 9204395446

Mother's Qualification
Mother's Occupation
Mother's Annual Income 0
Mother's Office/Business Address
Residential Address KRISHNA SALES, AGENCY, 20, TEMPLE ROAD, GAYATRI NAGAR,

Admission No. of Brother/Sister

Declaration: I solemnly declare that the particulars given above are true and correct to the best of my knowledge. I am
fully acquainted with the rules and requlations of the school and promise to abide by them. I have gone through the
School Prospectus thoroughly. I shall accept terms and conditions. working hours, dress code. fees of the school if
changed. modified/altered at any time during the course of stay of my ward in this institution.
I agree to the removal of the name of my child from the rolls of the school at any thime in the school year if his/her presence in the
school becomes detrimental to the school or to other students and I will abide by the decision of the Principal regading such
matters. I also agree that date of birth once submitted, will not be changed hereafter.

Signature of Parent/Guardian

For Office Use

Approved by
Registratio No. 3899/2014

Date of Admission 18/02/2014

Chairman Principal
List of document submitted:
-
Sign . of accountant
 KERALA SAMAJAM MODEL SCHOOL
GOLMURI, JAMSHEDPUR - 831009

Class & Section VI C

Admissio No. 3776/2014

Photograph

Name of the Candidate SATYAM RAJ

Date of Birth 2/25/2010

Gender Male

Religion HINDUISM

Category GENERAL

Father's Name MANOJ KUMAR

Fahter's Mobile Number 8789779482

Father's Qualification
Father's Occupation
Father's Annual Income 0

Father's Office/Business Address

Mother's Name PUSPA RAJ
Mother's Mobile Number 9060077581

Mother's Qualification
Mother's Occupation
Mother's Annual Income 0
Mother's Office/Business Address
Residential Address SAKCHI, JAIL CHOWK PEON COLONY, SAKCHI

Admission No. of Brother/Sister

Declaration: I solemnly declare that the particulars given above are true and correct to the best of my knowledge. I am
fully acquainted with the rules and requlations of the school and promise to abide by them. I have gone through the
School Prospectus thoroughly. I shall accept terms and conditions. working hours, dress code. fees of the school if
changed. modified/altered at any time during the course of stay of my ward in this institution.
I agree to the removal of the name of my child from the rolls of the school at any thime in the school year if his/her presence in the
school becomes detrimental to the school or to other students and I will abide by the decision of the Principal regading such
matters. I also agree that date of birth once submitted, will not be changed hereafter.

Signature of Parent/Guardian

For Office Use

Approved by
Registratio No. 3776/2014

Date of Admission 21/01/2014

Chairman Principal
List of document submitted:
-
Sign . of accountant
 KERALA SAMAJAM MODEL SCHOOL
GOLMURI, JAMSHEDPUR - 831009

Class & Section VI C

Admissio No. 3938/2014

Photograph

Name of the Candidate SHAHIRAH KHAN

Date of Birth 8/12/2009

Gender Female

Religion ISLAM

Category GENERAL

Father's Name JAWED KHAN

Fahter's Mobile Number 7004512425

Father's Qualification
Father's Occupation
Father's Annual Income 0

Father's Office/Business Address

Mother's Name NADIA KHATOON
Mother's Mobile Number 7004512425

Mother's Qualification
Mother's Occupation
Mother's Annual Income 0
Mother's Office/Business Address
Residential Address [Link]-403, LINE NO-28, TOILA DUNGARI, GOLMURI

Admission No. of Brother/Sister

Declaration: I solemnly declare that the particulars given above are true and correct to the best of my knowledge. I am
fully acquainted with the rules and requlations of the school and promise to abide by them. I have gone through the
School Prospectus thoroughly. I shall accept terms and conditions. working hours, dress code. fees of the school if
changed. modified/altered at any time during the course of stay of my ward in this institution.
I agree to the removal of the name of my child from the rolls of the school at any thime in the school year if his/her presence in the
school becomes detrimental to the school or to other students and I will abide by the decision of the Principal regading such
matters. I also agree that date of birth once submitted, will not be changed hereafter.

Signature of Parent/Guardian

For Office Use

Approved by
Registratio No. 3938/2014

Date of Admission 25/02/2014

Chairman Principal
List of document submitted:
-
Sign . of accountant
 KERALA SAMAJAM MODEL SCHOOL
GOLMURI, JAMSHEDPUR - 831009

Class & Section VI C

Admissio No. 3921/2014

Photograph

Name of the Candidate SHREYASH SINHA

Date of Birth 3/9/2010

Gender Male

Religion HINDUISM

Category GENERAL

Father's Name ASHUTOSH KUMAR

Fahter's Mobile Number 9470164168

Father's Qualification
Father's Occupation
Father's Annual Income 0

Father's Office/Business Address

Mother's Name VANDANA SINHA
Mother's Mobile Number 9110933816

Mother's Qualification
Mother's Occupation
Mother's Annual Income 0
Mother's Office/Business Address
Residential Address 129, DEV KUNJ APPARTMENT, NEAR PARDIH CHOWK, MANGO

Admission No. of Brother/Sister

Declaration: I solemnly declare that the particulars given above are true and correct to the best of my knowledge. I am
fully acquainted with the rules and requlations of the school and promise to abide by them. I have gone through the
School Prospectus thoroughly. I shall accept terms and conditions. working hours, dress code. fees of the school if
changed. modified/altered at any time during the course of stay of my ward in this institution.
I agree to the removal of the name of my child from the rolls of the school at any thime in the school year if his/her presence in the
school becomes detrimental to the school or to other students and I will abide by the decision of the Principal regading such
matters. I also agree that date of birth once submitted, will not be changed hereafter.

Signature of Parent/Guardian

For Office Use

Approved by
Registratio No. 3921/2014

Date of Admission 19/02/2014

Chairman Principal
List of document submitted:
-
Sign . of accountant
 KERALA SAMAJAM MODEL SCHOOL
GOLMURI, JAMSHEDPUR - 831009

Class & Section VI C

Admissio No. 3733/2014

Photograph

Name of the Candidate SHRISTY KUMARI PRADHAN

Date of Birth 9/18/2010

Gender Female

Religion HINDUISM

Category GENERAL

Father's Name BARUN KUMAR PRADHAN

Fahter's Mobile Number 9431333108

Father's Qualification
Father's Occupation
Father's Annual Income 0

Father's Office/Business Address

Mother's Name ARCHANA PRADHAN
Mother's Mobile Number 8002819775

Mother's Qualification
Mother's Occupation
Mother's Annual Income 0
Mother's Office/Business Address
Residential Address MURAKATI BASTI, PO-LOHABASA, BIRSNAGAR

Admission No. of Brother/Sister

Declaration: I solemnly declare that the particulars given above are true and correct to the best of my knowledge. I am
fully acquainted with the rules and requlations of the school and promise to abide by them. I have gone through the
School Prospectus thoroughly. I shall accept terms and conditions. working hours, dress code. fees of the school if
changed. modified/altered at any time during the course of stay of my ward in this institution.
I agree to the removal of the name of my child from the rolls of the school at any thime in the school year if his/her presence in the
school becomes detrimental to the school or to other students and I will abide by the decision of the Principal regading such
matters. I also agree that date of birth once submitted, will not be changed hereafter.

Signature of Parent/Guardian

For Office Use

Approved by
Registratio No. 3733/2014

Date of Admission 21/01/2014

Chairman Principal
List of document submitted:
-
Sign . of accountant
 KERALA SAMAJAM MODEL SCHOOL
GOLMURI, JAMSHEDPUR - 831009

Class & Section VI C

Admissio No. 3934/2014

Photograph

Name of the Candidate SHUBH AGRAHARI

Date of Birth 6/11/2010

Gender Male

Religion HINDUISM

Category GENERAL

Father's Name DEEPAK KUMAR AGRAHARI

Fahter's Mobile Number 9525194135

Father's Qualification
Father's Occupation
Father's Annual Income 0

Father's Office/Business Address

Mother's Name BABITA AGRAHARI
Mother's Mobile Number 7091120784

Mother's Qualification
Mother's Occupation
Mother's Annual Income 0
Mother's Office/Business Address
Residential Address GTBN-4/13, SHIV SINGH BAGAN AGRICO

Admission No. of Brother/Sister

Declaration: I solemnly declare that the particulars given above are true and correct to the best of my knowledge. I am
fully acquainted with the rules and requlations of the school and promise to abide by them. I have gone through the
School Prospectus thoroughly. I shall accept terms and conditions. working hours, dress code. fees of the school if
changed. modified/altered at any time during the course of stay of my ward in this institution.
I agree to the removal of the name of my child from the rolls of the school at any thime in the school year if his/her presence in the
school becomes detrimental to the school or to other students and I will abide by the decision of the Principal regading such
matters. I also agree that date of birth once submitted, will not be changed hereafter.

Signature of Parent/Guardian

For Office Use

Approved by
Registratio No. 3934/2014

Date of Admission 21/02/2014

Chairman Principal
List of document submitted:
-
Sign . of accountant
 KERALA SAMAJAM MODEL SCHOOL
GOLMURI, JAMSHEDPUR - 831009

Class & Section VI C

Admissio No. 3873/2014

Photograph

Name of the Candidate TEJAS JAISWAL

Date of Birth 7/30/2010

Gender Male

Religion HINDUISM

Category GENERAL

Father's Name SANJIT JAISWAL

Fahter's Mobile Number 7004651060

Father's Qualification
Father's Occupation
Father's Annual Income 0

Father's Office/Business Address

Mother's Name NITU JAISWAL
Mother's Mobile Number 7004455492

Mother's Qualification
Mother's Occupation
Mother's Annual Income 0
Mother's Office/Business Address
Residential Address FLAT NO-55/4, AMITA APPARTMENT, [Link]-118, NEW BARADWARI

Admission No. of Brother/Sister

Declaration: I solemnly declare that the particulars given above are true and correct to the best of my knowledge. I am
fully acquainted with the rules and requlations of the school and promise to abide by them. I have gone through the
School Prospectus thoroughly. I shall accept terms and conditions. working hours, dress code. fees of the school if
changed. modified/altered at any time during the course of stay of my ward in this institution.
I agree to the removal of the name of my child from the rolls of the school at any thime in the school year if his/her presence in the
school becomes detrimental to the school or to other students and I will abide by the decision of the Principal regading such
matters. I also agree that date of birth once submitted, will not be changed hereafter.

Signature of Parent/Guardian

For Office Use

Approved by
Registratio No. 3873/2014

Date of Admission 17/02/2014

Chairman Principal
List of document submitted:
-
Sign . of accountant
 KERALA SAMAJAM MODEL SCHOOL
GOLMURI, JAMSHEDPUR - 831009

Class & Section VI C

Admissio No. 3833/2014

Photograph

Name of the Candidate TIYASHA DUTTA

Date of Birth 2/24/2010

Gender Female

Religion HINDUISM

Category GENERAL

Father's Name SHYAMAL KUMAR DUTTA

Fahter's Mobile Number 9431180240

Father's Qualification
Father's Occupation
Father's Annual Income 0

Father's Office/Business Address

Mother's Name BARNALI DUTTA
Mother's Mobile Number 9304966910

Mother's Qualification
Mother's Occupation
Mother's Annual Income 0
Mother's Office/Business Address
Residential Address HOME NO-10, PARASNAGAR, PO MANGO

Admission No. of Brother/Sister

Declaration: I solemnly declare that the particulars given above are true and correct to the best of my knowledge. I am
fully acquainted with the rules and requlations of the school and promise to abide by them. I have gone through the
School Prospectus thoroughly. I shall accept terms and conditions. working hours, dress code. fees of the school if
changed. modified/altered at any time during the course of stay of my ward in this institution.
I agree to the removal of the name of my child from the rolls of the school at any thime in the school year if his/her presence in the
school becomes detrimental to the school or to other students and I will abide by the decision of the Principal regading such
matters. I also agree that date of birth once submitted, will not be changed hereafter.

Signature of Parent/Guardian

For Office Use

Approved by
Registratio No. 3833/2014

Date of Admission 22/01/2014

Chairman Principal
List of document submitted:
-
Sign . of accountant
 KERALA SAMAJAM MODEL SCHOOL
GOLMURI, JAMSHEDPUR - 831009

Class & Section VI C

Admissio No. 3918/2014

Photograph

Name of the Candidate VEDANT SINGHAL

Date of Birth 6/11/2010

Gender Male

Religion HINDUISM

Category GENERAL

Father's Name PRAMOD AGARWAL

Fahter's Mobile Number 8709825020

Father's Qualification
Father's Occupation
Father's Annual Income 0

Father's Office/Business Address

Mother's Name PRITY AGARWAL
Mother's Mobile Number 8578024597

Mother's Qualification
Mother's Occupation
Mother's Annual Income 0
Mother's Office/Business Address
Residential Address 605, DREAM PALACE, NEW BARADWARI, SAKCHI

Admission No. of Brother/Sister

Declaration: I solemnly declare that the particulars given above are true and correct to the best of my knowledge. I am
fully acquainted with the rules and requlations of the school and promise to abide by them. I have gone through the
School Prospectus thoroughly. I shall accept terms and conditions. working hours, dress code. fees of the school if
changed. modified/altered at any time during the course of stay of my ward in this institution.
I agree to the removal of the name of my child from the rolls of the school at any thime in the school year if his/her presence in the
school becomes detrimental to the school or to other students and I will abide by the decision of the Principal regading such
matters. I also agree that date of birth once submitted, will not be changed hereafter.

Signature of Parent/Guardian

For Office Use

Approved by
Registratio No. 3918/2014

Date of Admission 18/02/2014

Chairman Principal
List of document submitted:
-
Sign . of accountant
 KERALA SAMAJAM MODEL SCHOOL
GOLMURI, JAMSHEDPUR - 831009

Class & Section VI C

Admissio No. 3751/2014

Photograph

Name of the Candidate YASH GOHIL

Date of Birth 12/15/2009

Gender Male

Religion HINDUISM

Category GENERAL

Father's Name BRIJESH GOSHIL

Fahter's Mobile Number 9835163420

Father's Qualification
Father's Occupation
Father's Annual Income 0

Father's Office/Business Address

Mother's Name VAISHALI GOHIL
Mother's Mobile Number 9801577676

Mother's Qualification
Mother's Occupation
Mother's Annual Income 0
Mother's Office/Business Address
Residential Address LINE NO-2, [Link]-11,12, TUILADUNGARI, A BLOCK,

Admission No. of Brother/Sister

Declaration: I solemnly declare that the particulars given above are true and correct to the best of my knowledge. I am
fully acquainted with the rules and requlations of the school and promise to abide by them. I have gone through the
School Prospectus thoroughly. I shall accept terms and conditions. working hours, dress code. fees of the school if
changed. modified/altered at any time during the course of stay of my ward in this institution.
I agree to the removal of the name of my child from the rolls of the school at any thime in the school year if his/her presence in the
school becomes detrimental to the school or to other students and I will abide by the decision of the Principal regading such
matters. I also agree that date of birth once submitted, will not be changed hereafter.

Signature of Parent/Guardian

For Office Use

Approved by
Registratio No. 3751/2014

Date of Admission 21/01/2014

Chairman Principal
List of document submitted:
-
Sign . of accountant
 KERALA SAMAJAM MODEL SCHOOL
GOLMURI, JAMSHEDPUR - 831009

Class & Section VI C

Admissio No. 3894/2014

Photograph

Name of the Candidate YASHVI NAYYAR

Date of Birth 4/5/2010

Gender Female

Religion HINDUISM

Category GENERAL

Father's Name JOGESH NAYYAR

Fahter's Mobile Number 9263943515

Father's Qualification
Father's Occupation
Father's Annual Income 0

Father's Office/Business Address

Mother's Name NAMITA NAYYAR
Mother's Mobile Number 7209666562

Mother's Qualification
Mother's Occupation
Mother's Annual Income 0
Mother's Office/Business Address
Residential Address J4, C/5, ASTHA SPACE TOWN, DIMNA ROAD, MANGO

Admission No. of Brother/Sister

Declaration: I solemnly declare that the particulars given above are true and correct to the best of my knowledge. I am
fully acquainted with the rules and requlations of the school and promise to abide by them. I have gone through the
School Prospectus thoroughly. I shall accept terms and conditions. working hours, dress code. fees of the school if
changed. modified/altered at any time during the course of stay of my ward in this institution.
I agree to the removal of the name of my child from the rolls of the school at any thime in the school year if his/her presence in the
school becomes detrimental to the school or to other students and I will abide by the decision of the Principal regading such
matters. I also agree that date of birth once submitted, will not be changed hereafter.

Signature of Parent/Guardian

For Office Use

Approved by
Registratio No. 3894/2014

Date of Admission 17/02/2014

Chairman Principal
List of document submitted:
-
Sign . of accountant