St. Clare's Sr. Sec.
School
118, Prithvi Raj Road, Agra Cantt., Agra - 282001 (U.P.)
Application Form For Registration to Nursery (2025-26)
Form No. : 2025/NUR/0117
(Latest Photograph of child with parents)
48mm X 36mm
*2025/NUR/0117*
Candidate's Details
Name of the Child : AHIL HUSSAIN
Gender : BOY Religion : MUSLIM
Category : GENERAL DOB : 30/12/2021
Communication : 74 NITI BAGH TAJGANJ AGRA 282001 UTTAR PRADESH
Address
City : AGRA State : UTTAR PRADESH
Mobile No. : 9711793110 Phone :
Aadhar No. : Location : NEETI BAGH COLONY
Institute / Play group Last Attended : INTERNATIONAL Futuristic SCHOOL
Parent's Details
Father Name : IRSHAD HUSSAIN Mother Name : TAVASSUM BANO
Mobile : 9711793110 Mobile : 9997866931
E-Mail : [Link]@[Link] E-Mail : hussaintabassum1234
@[Link]
Aadhar No : 396978960903 Aadhar No : 275227530953
Qualification : GRADUATE Qualification : GRADUATE
Occupation : TRAVEL&TOURISM Occupation : HOUSE WIFE
Designation : TOUR GUIDE Designation : HOUSE WIFE
Organization Name : EASTWIND HOLIDAYS PVT LTD Organization Name :
Organization Address : 1335 PALAM VIHAR ROAD SECTOR Organization Address :
110 GURUGRAM HARYANA
122017
Monthly Income : 80000 Monthly Income : 25000
Mother Tongue : HINDI Mother Tongue : HINDI
State of Domicile : UTTAR PRADESH State of Domicile : UTTAR PRADESH
Whether Parent's / Guardian's work involve into transfer : NO
Other Details
Is Alumni : No Is Siblings : No
Is Neighbourhood : Yes Is Defence Personnel : No
Sibling Name [Brothers/ Sisters (Not Cousin) Studying in St. Clare's Sr. Sec. School, Agra
Sibling 1 Name : Class & Sec :
Sibling 2 Name : Class & Sec :
Sibling Name [Brothers/ Sisters (Not Cousin) Studied in St. Clare's Sr. Sec. School, Agra
Sibling 1 Name : Class : Year :
Sibling 2 Name : Class : Year :
Details of ex-students applying for their child
Name : Class : Year :
Please Note :
1. This application form is not transferrable.
2. An incomplete, illegible or incorrectly filled application will be rejected.
3. Admission will be given / granted:
i. as per the space / Vacancy available.
ii. with a balanced view of giving quality education and equal opportunities for both girls and boys
alike.
4. No scholar can be admitted without the original birth certificate from concerned authority; transfer
certificate duly countersigned by the concerned authority/board.
5. Date of Birth once registered cannot be altered [as per U.P. G.O. No. 1101/-1 (5)]
Enclosure :
1- A photocopy of Birth Certificate from Municipality.
2- A photocopy of Birth Certificate / Document issued by Hospital (if any)
3- Baptism Certificate (for Christian)
4- Category Certificate (if applicable).
5- Sibling Proof (if applicable).
6- Online Registration Payment Receipt.
7- Residential Proof - (Latest Electricity Bill) and Rental Receipt - (For those who are staying on rent)
8- Proof of Ex-Student (Marksheet / ID Card)
Date : 01/11/2024 Signature: Signature:
(IRSHAD HUSSAIN) (TAVASSUM BANO)
UNDERTAKING BY THE PARENTS / GUARDIANS
We the parents/guardians of AHIL HUSSAIN hereby state that :
We are seeking admission for our ward AHIL HUSSAIN in class Nursery in St. Clare's Sr. Sec. School Agra
We will abide by all the rules and regulations of the institution as contained in the school diary and as
amended from time to time.
We will give three month͛s notice or pay three month fee in lieu of notice before withdrawing our
child/ward.
We accept all charges in the fee schedule.
We are willing to accept the decision of the Principal and Staff with regard to admission and promotion.
In all disputes the decision of Principal will be final and binding on us.
We will be responsible for the conduct of our child / ward. In case of any breach of discipline or neglect of
studies his/her name may be removed from the rolls of the school at the discretion of the Head of the
institution.
We undertake to intimate promptly any change of address or telephone number and will co-operate with
the School authorities in the observance all school rules.
We agree that no refund shall be made under any circumstance once admission is granted and fee is
deposited.
We hereby confirm that the date of birth given is correct and that no request for a change in this date
will be made at any time. I/We agree to all the terms and conditions of the school.
Date : 01/11/2024 Signature: Signature:
(IRSHAD HUSSAIN) (TAVASSUM BANO)
St. Clare's Sr. Sec. School
Agra
ONLINE REGISTRATION PAYMENT RECEIPT
(School Copy)
Form No. : 2025/NUR/0117
Mobile No. : 9711793110
Student's Name : AHIL HUSSAIN
Father's Name : IRSHAD HUSSAIN
Amount : ൟ )LYH+XQGHUHG5XSHHV2QO\
Transaction ID : SCSAGRREG318011124033835
Transaction Date : 01/11/2024
St. Clare's Sr. Sec. School
Agra
ONLINE REGISTRATION PAYMENT RECEIPT
(Candidate's Copy)
Form No. : 2025/NUR/0117
Mobile No. : 9711793110
Student's Name : AHIL HUSSAIN
Father's Name : IRSHAD HUSSAIN
Amount : ൟ )LYH+XQGHUHG5XSHHV2QO\
Transaction ID : SCSAGRREG318011124033835
Transaction Date : 01/11/2024
Kindly deposit the School's Copy of this receipt at the school office along with the Registration Form and other
documents as required.
Seal and Signature
(School Office)
October 2024 / 1 / 10 / 11 / 2840 / 00430
Meter No. T24745246
T No. 3002672287
Bill Date 25-10-24
11 KV FEEDER :HCGO -11KV Gobar Chowki -FDR
JABBAR HUSSAIN
SERVICE NO.
LT 670162173
[Link].74 lfoZl ua
NEETI BAGH BILLING MONTH
fcy ekg OCTOBER 2024
TAJGANJ, AGRA
DUE DATE
ns; frfFk 08-11-24
CONTRACT DEMAND RECORDED DEMAND BILL DEMAND EXCESS DEMAND
Lohd`r fMek.M vafdr fMek.M fcy fMek.M vfrfjDr fMek.M
AFTER DUE DATE
4.00(KW) 4.28(KW) 4.28(KW) 0.28(KW) # 4096
ns; frfFk ds ckn
METERING DETAIL / ehVfjax fooj.k
Pay by due date / ns; frfFk rd
Meter Serial No. / ehVj ua- T24745246
MDKW KWH 4057
Past Reading / fiNyh jhfMax ____ 31093.00 Category / la;kstu VSfjQ LMV 1C
Present Reading / orZeku jhfMax ____ 31650.00 Bill Type / fcy dk izdkj NORMAL
MF / [Link] 1.00 1.00 Bill Days / fcy dh vof/k 31
Total / dqy 4.28 557.00
Current Reading Date / orZeku jhfMax dh frfFk 21-10-24
BILL DETAILS / fcy fooj.k Previous Reading Date / fiNyh jhfMax dh frfFk 20-09-24
Fixed Charges / fQDl pktZ 479.83 Disconnection Date / foPNsnu dh frfFk 23-11-24
Excess Demand Charges / vfrfjDr fMek.M pktZ 31.39
Energy Charges / ÅtkZ pktZ 3391.00 Last Payment Date / fiNys Òqxrku dh frfFk 30-09-24
Electricity Duty / fo|qr dj 193.54
Last Payment Amount / fiNys Òqxrku dh jkf'k 4155.00
Regulatory Surcharge 1 / jsxqysVjh ljpktZ 1 @ 1.14% 0.00
Regulatory Surcharge 2 / jsxqysVjh ljpktZ 2 @ 4.28% 0.00 Last Payment Mode / fiNys Òqxrku dh eksM ONLINE
Security Deposit / tekur jkf'k 1600
Purpose / mn~ns'; Domestic
Total Current Dues / dqy orZeku ns; jkf'k 4095.76
vU; Vh-ih-,y vo'ks"k ns; 0.00
Additional DVVNL Arrears /vfrfjä Mhohoh,u,y vo'ks"k
Arrears / vo'ks"k 0.42
Principal Amount / ewy jkf'k 0.00
Interest / C;kt 0.00
Total Dues / dqy ns; 4096.18 Total / dqy 0.00
Debit / Credit Note / Any Notice
Credit Note - Prompt Payment Rebate : 39.95
vkidk vafdr fo|qr Hkkj fcfyax Hkkj ls vf/kd ik;k x;k gSA d`i;k viuk Lohd`r Hkkj fu;fer djk;saA
Service No 670162173 Bill Due Date 08-11-24 Amount Payable 4096 Amt. Payable before due date 4057
Additional DVVNL Arrears Payable 0
TPL Other Arrears Payable 0
