DELHI PUBLIC SCHOOL - BOPAL, Ahmedabad
ENROLMENT FORM
Academic Session 2022-2023
PROVISIONAL Class: I DISE
ADMISSION NO. Number:
(Provisional Admission No. to be filled by Official staff)
Full Name of the Student (In Capital): ARUSH PATTNAIK
Date of Birth (In words & figures): Aug 10, 2015
Nationality of the Student: Indian
Category: (General/SC/ST/OBC): General Student’s
Photograph
Adhaar No : Blood Group: A+
Last School Attended: Other
Residential Address: FLAT NO.-F-402 AARYAN GLORIA Ahmedabad,
Gujarat, India
Phone: 8888899620 (M) 8888899620 (R) 8888899620
Father’s Name (Block Letters): MANAS RANJAN PATTNAIK
Academic Qualification: Bachelor of Pharmacy-B.Pharma
Father’s Photograph
Office Address: ZYFINE UNIT, SARKHEJ BAVLA ROAD,SANAND
E-mail:
[email protected] Office Tel. No.
Adhaar No. – Father: 302539490146 Mother: 605784488672
Blood Group – Father: O+ Mother: A+
Mother’s Name (Block Letters): DEBASMITA DAS Mother’s
Photograph
Academic Qualification: Other Designation:
Office Address:
E-mail:
[email protected] Office Tel. No. 7000897955
Transfer Certificate (Submitted/ Not Submitted)
(For admission original Copy/Notarized Copy of Birth Certificate issued by relevant Govt. authority and a valid address proof must
be submitted. Admission in class II onwards, will be considered PROVISIONAL unless Original LC/TC from the last school attended
is submitted.)
I solemnly affirm that the above information is true to the best of my knowledge.
Date:
Name of Parent/Guardian: Signature of the Parent:
Dec 17, 2021 8:58 AM
