Sindhudurg District Ex – Servicemen Association’s
SINDHUDURG SAINIK SCHOOL
& JUNIOR COLLEGE, AMBOLI
At & Post – Amboli, Tal – Sawantwadi, Dist – Sindhudurg
No. ADMISSION FORM
JUNIOR COLLEGE
Respected Principal,
I wish to take admission in F.Y.J.C. / S. Y. J. C. Science during the year 2012 - 2013
My Particulars are as under :
1)Full Name :
In English (Capital) ______
In Devnagari------
Surname First name Father’s/Husband’s name Mother’s name
2)Date of Birth :In figures - ______
In words - ______
3)Age on 1 st June 2012______
4) Backward caste : SC/ST/DT/NT/OBC/ AdvancedSub-caste
Strike out which is not applicable (Xerox copy of caste certificate should be attached)
5)Weight : ______Height : ______
6)Father’s / Guardian’s Full name : ______
7)Designation of father/ Guardian, if serving : ______Annual Income ______
8)Permanent Address : ______
______Pin Code No. ______Blood Group :______
9)Local Address : ______
______Phone No. :______
10) Educational Information :
Std. / Name of the Jr. College / Name of Board/University / Year of
Passing / Seat No. / Total marks / %
S.S. C.
XIth Std.
Subjects Offered
SCIENCE FACULTY (Compulsory)
1 English2 Physics3 Chemistry
4 Biology5 Mathematic6 General Knowledge
If ward of Ex-Servicemen
Ex-Servicemen’s No.:-Post held :- ______
Name of Unit / Record office : ______
Total Service :
Note - Document to be attached whenever necessary.
1)Proof certificate showing a ward of Ex – servicemen signed and issued by District Sainik Welfare Board Officer.
2)Income certificate issued by Tahasildar in case of economically backward class cadets.
3)Statement of marks of standard X th
4)Medical Certificate about the physical fitness of the cadet.
Declaration :
I hereby declare that the above information is correct. I will be responsible & liable to any punishment if the information is incorrect. I have read the prospectus carefully. I assure you that I will abide by the rules & instructions mentioned in the prospectus. It is my entire responsibility to follow all the instructions displayed on the Notice- Board from time to time.
Father’s / Guardian’s SignatureStudent’s Signature
Bonafied certificate (Issued by headmaster of current school)
Kumar ______At/post ______Tahasil ______District ______is studying in ______(School name) for the academic year 201 - 201 in ______standard and his Birthdate according to general register’s record is ______in words ______and his caste with sub caste is ______His conduct in the school is good.
Place :-
Date :-
(Seal)Headmaster
(School’s Stamp)
Medical Certificate
I ______(Name of medical Officer) Address ______Regi. No.______have done the medical checkup of Kumar ______age ______At/post ______Tahasil ______and found him physically fit. He is not having any physical defect and skin disease.
The above cadet is medically fit for physical training given in Sainik School / Junior College.
Place :-
Date :-
Signature, Post.Regi. No. of
Medical Officer
Guarantee Letter
I ______assures that my son /ward Kumar ______
has been taken admission in SindhudurgSainik School & Junior College, Amboli in XI the std. I am aware that is necessary for him to appear for NDA examination after being passed 12 th examination. I have gone through the rules and regulations of the school and I agree the same.
Cadet’s SignatureFather / Guardian’s Signature
Place :-
Date :-