APEEJAY SCHOOL PITAMPURA

APPLICATION FORM

Session applying for : 2024-2025

Application No. : PP-15023 Class applying for : III
1. Name of the Student : Atharv Dubey
2. Gender : Male 6. First Born Child ? : Yes
3. Residential Address : 7(a). School last attended : other play school

Address Line 1 : Krishi Apartment School Name, Address & Darbari Lal DAV Model School
Duration of study of child :
Address Line 2 : Flat No 79 Rohini Sector 13 7(b). Progress report of last 3 years in chronological order :
Class Session Marks Obtained Total Marks %/CGPA
City : Delhi PIN : 110085
I 2022-2023 100 100
State : Delhi
Pre Primary
2021-2022 100 100
Nursery 2020-2021 100 100
4. Date of Birth : 26-03-2016
5. Nationality : Indian 8. Any other APEEJAY school applied to(or Applying to)?No
If yes, select the other APEEJAY School :

9(a). Does the child have a Sibling in the same School : No Sibling Details :
No. of Siblings :
Sibling Name :
Admission No. of Sibling :
Class & Section of Sibling :
9(b). Does the child have a Sibling in another APEEJAY Sibling Details :
school : No No. of Siblings :
Sibling Name :
Admission No. of Sibling :
Class & Section of Sibling :
10. Is Parent Alumni of the same School ? No Who was Alumni ?
Father's Admission No. : Mother's Admission No. :
Year of joining same school : Year of joining same school :
Year of passing class XII(from same school): Year of passing class XII(from same school):
11. Single Parent ? No Status of Single Parent :
12. Is the child physically challenged ? No Details of physical disability :
Since when : Nature of physical :
disability

13(a). Father's details : 13(b). Mother's details :

Father's Name : Chandan Dubey Mother's Name : Kamala Dubey
Father's Profession : Legal Consultant Mother's Profession : Housewife (Homemaker)
Company/Org. Name : DSK Legal Company/Org. Name :
Company/Org. Type : Large Business( > 200 cr turnover) Company/Org. Type :
Sector of Company/Org.: Consulting Sector of Company/Org.:
Other Sector : Other Sector :
Father's Designation : Senior Associate Mother's Designation :
Office Address : Level 5 – Max House, Office Address :
Okhla Industrial Estate, Phase III
New Delhi – 110020

Office Telephone : 01146616666 Office Telephone :

Res. Telephone : 8838591784 Res. Telephone : 7021509948

Mobile Number : 8838591784 Mobile Number : 7021509948

Email Address : chandandube@[Link] Email Address : chandandube@[Link]

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Any other highlights of achievement of father or Any other highlights of achievement of mother or
anything else you would like us to know(optional): anything else you would like us to know(optional):

14. Is the child a ward of Confirmed Teacher of the same school (Yes/No) ? No
15. (a) Will the child be availing the transport facilitated by the school? (Yes/No ) ? No
(b) Choose the [Link]. of the stop from where the child will be boarding & deboarding the transport facilitated by the school :
16. (a) Does the child reside in an area where the transport facilitated by the school is available (Yes/No) ? No
(b) Choose the [Link]. of the area where the child resides :
17. Is the child's parent / grandparent a qualified Medical Doctor /
Govt. Civil Servant / Armed Forces (CO) /Martyr / Diplomatic Corps. ? No
18. Is the child's parent/grandparent a recognised State/National/International Awardee ? No
(conferred by a Government/International Body)
If yes, specify the details of the Award and the Awardee :

19(a) Maternal Grandfather's details : 19(b) Maternal Grandmother's details :

Living (Yes/No) ? Living (Yes/No) ?
Grandfather's Name : Grandmother's Name :
Grandfather's details/achievement : Grandmother's details/achievement :

19(c) Paternal Grandfather's details : 19(d) Paternal Grandmother's details :

Living (Yes/No) ? Living (Yes/No) ?
Grandfather's Name : Grandmother's Name :
Grandfather's details/achievement : Grandmother's details/achievement :

Please register my son / daughter / ward named above in your school. I shall produce the requisite documents at
the time of admission.

Signature________________________

Undertaking
I/We father, mother of Atharv Dubey hereby declare that all the information given above by me/us is correct.
Admission of my/our child may be cancelled and treated as null and void (without giving any reasons), if I/we fail to
produce necessary documents at the time of verification of details provided by me/us in the application form, or if any
information provided by me/us in the application form is found to be incomplete/false/wrong at any time.

(Photograph of Father) (Photograph of Mother)

( Signature of father ) ( Signature of mother )

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