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St.

Mary's High School, Jalna


St. Mary's Education Society
(Minority Institution)
Devalgaon Raja Road, Tq - Jalna, Dist. - Jalna
Tel : +91 2482231144 Email : smsjalna@gmail.com
School Recognition No..HS.10/EDN/76/707, Dt.28/09/1976 Medium:English
UDISE No. 27180102684 Board:Maharashtra State Board Index No.6101016

Registration Form Student


Photo

Form No : 400125 Admission No:


Class in which admission is sought VI
Full Name of the Student Tanushree Dinesh Purohit
Date Of Birth (With Birth Certificate) Age as on 27/02/2008 (11 Years 4 Months)
01/06/2019

Birth Place,Village,Taluka,District , JALNA, ,


Sex Female
Father's Full Name Dinesh B Purohit
Father's Qualification & Occupation B.COM, Private Service
Father Mobile Number 9423845183
If Father is Alumni, specify the details
Mother's Full Name Shithil D Purohit
Mother's Qualification & Occupation , Housewife
Mother Mobile Number 9552720034
If Mother is Alumni, specify the details
Mother Tongue
Category, Caste, Religion , ,
Full Address Arunima Gokuldham
Family Annual Income 0
Sibling In St. Mary's / Ex. St. Marians
Distance From School
Last School, Class and Board , I,

Hereby I Dinesh B Purohit agree to abide by the rules and regulations,(School Time,Fees,Uniform and Discipline) of
St Mary's High School and work for the welfare of our children. The information I have given regarding my child is
correct and true.I Promise that I will not bring any change (Name,Date of Birth,Cast ,Surname and Spelling etc) in
what I have filled

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Date:1/25/2019 H.M/Principal Parent's Signature