GD GOENKA PUBLIC SCHOOL PURNEA

Matia Chowk, Ranipatra NH - 131 A, Dist-Purnea, Bihar- 854337

Online Registraion Form

Fill Online Registration Form -> Registration Number Generated -> Pay Online Application fee for Generated Registration number -> Payment Transaction number generated (keep this for payment tracking)

Name of the Student:

Seeking Admission to Class:

--Select--

DOB

Blood Group

--Select Blood Group-- O + O - A + A - B + B - AB + AB -

Nationality

--Select Nationality-- Indian Other than Indian

Religion

--Select --

Caste

--Select Caste Category--

Gender

--Select-- Male Female

Handicap

--Select-- NA Blind Deaf Handicapped Dyslexic Spastic

Minority

--Select-- NO YES

Place of birth

Mother Tongue

Name of School Last Studied

Class Last Studied

Date of leaving School

Photograph

Scan copy of DOB

Parent Details

Name of the Mother

Mother Adhar No

Residence Tel

Mobile No

Email Id

Mother Qualification

Name of the Father

Father Adhar No

Profession

Residential Address

WhatsApp Number

Email Id

Father Qualification

Place of Work

City

State

--Select-- Andhra Pradesh Arunachal Pradesh Assam Bihar Chhattisgarh Goa Gujarat Haryana Himachal Pradesh Jharkhand Karnataka Kerala Madhya Pradesh Maharashtra Manipur Meghalaya Mizoram Nagaland Odisha Punjab Rajasthan Sikkim Tamil Nadu Telangana Tripura Uttar Pradesh Uttarakhand West Bengal Andaman and Nicobar Islands Chandigarh Dadra & Nagar Haveli Delhi Jammu and Kashmir Lakshadweep Puducherry Ladakh

Contact No(INDIA)

Remark if any

School Transport Needed

--Select-- No Yes

Whether the candidate is

Single Girl Child

Specially abled (Divyangjan)

Belonging to the EWS

Specially abled (Divyangjan)

Belonging to the EWS

Adhar No

Scan copy of Adhar

Last School affiliated is

--Select--

Result of last class/Pre Board

Subject	Maximum Marks	Marks obtained	% of Marks
--Select--
--Select--
--Select--
--Select--
--Select--
--Select--
--Select--

Total

Year of passing

--Select-- 2014 2015 2016 2017 2018 2019 2020 2021 2022 2023 2024

Remark on Passing

Transfer Certificate No

Date of Issue Certificate

Course opt for class XI

PCM

PCB

COMM

HUMANITIES (ARTS)

Subject Opted

Compulsory Subject					Additional Subject Optional
Subject1	Subject2	Subject3	Subject4	Subject5	Subject6

Details of siblings(if any)

Admission No

1.

2.

3.

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