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Full Name of Student in English Parent's (Father/ Mother) / Guardian 'S Name
Full Name of Student in English Parent's (Father/ Mother) / Guardian 'S Name
No
Class X - Roll No
Parents
(Father/
Mother)/
Guardian
s Name
Date of birth
of
student(dd/
mm/yyyy)
Gender(M/F/T)
Mandal/T
aluk/Blo
ck
Address
(Enter
Code
only)
Pincode
Disabled (Y/N)
Disability
Percentage ( 1Below 40% , 2
-40%-80%,3- Above
80%)
Student Bank
Branch IFSC
Name of
Institution
(Enter
Institution
code only)
Admissio
n type
Day
(1Name of
Date of
Scholar/
Regular,2
Current
Instituio
the
Course
Hosteller
Year of
n Bank
Course(C
Commence
(1- Daypaid/man
Study
Branch
ourse
ment
Scholar,2
agement
(1/2/3/4/
IFSC
Code
(dd/mm/yyy
,35)
Code
only)
y)
Hosteller
distance
)
educatio
n)
Instituion
Bank
Account
Number
Amount Amount
Payable Payable
to
to
Institutio Institutio
n (from
n (from
central)
State)
Study
tours
Annual
allowanc Addition
Thesis
e(for
al
typing
correspo allowanc
and
ndence
es (for
printing
course Disability
charges
students
)
)
Book
Bank
allowanc
e