FHªijfS¡fhd Ïytr k‰W« f£lha¡ fšé cçik¢r£l« - 2009 ÃçÎ 12(1) ( C ) Ï‹go mid¤J¢

ÁWgh‹ika‰w jåah® Raã gŸëfëš thŒ¥ò kW¡f¥g£l k‰W« eètilªj Ãçédç‹

FHªijfS¡F EiHÎãiy tF¥Ãš 25% Ïl xJ¡Ñ£o‹ Ñœ nr®¡if nfhU« é©z¥g¥ got«
Application Form for Admission of children of Weaker Sections and Disadvantaged Groups in
Private Non - minority and Un - Aided Schools Under RTE Act, 2009 - 25% Reservation

District / kht£l« :
Photo /
Application Category / é©z¥g tif ஒளளபபடம

Weaker Section / நலலவடடநத பபரவபனர

Disadvantage Group (Special Category) / வவயபப மறககபபடட பபரவபனர (சலறபப பபரவ)

Disadvantage Group / வவயபப மறககபபடட பபரவபனர

A Weaker Section / நலலவடடநத பபரவபனர :

Total Annual Income of Parents / Guardian from all sources

for claim under Weaker Section category /
bg‰nwhç‹ / fh¥ghsç‹ M©L tUkhd« :

B Disadvantage Group (Special Category) / வவயபப மறககபபடட பபரவபனர (சலறபப பபரவ) :

Orphan / ஆதரவறறறவர HIV affected / எச.ஐ.வப-யபனவல

பவதலககபபடடவர
Differently abled / மவறற தலறனவளள
Child of Scavenger / தபபரவத
Transgender / மனறவம பவலலனம
ததவழலலவளளயபன கழநடத

C Disadvantage Group / வவயபப மறககபபடட பபரவபனர :

Religion / kj« : Community / rh :

Hindu / இநத Backward Community / பபறபடததபபடறடவர

Muslim / Most Backward Class(MBC) / மலகவம பபறபடததபபடறடவர

இஸலவமலயர
Denotified Community (DNC) / சசரமரபபனர சமகம

Christian / Scheduled Caste (SC) / தவழததபபடறடவர

கலரஸதவர

Scheduled Caste Arunthathiyar (SCA) / தவழததபபடறடவர (அரநததலயர)

Others /
மறறடவ
Scheduled Tribe (ST) / பழஙகடயபனர

1. Name of the Child / FHªijæ‹ bga® :

2. Name of Parents / Guardian
Father / jªijah® bga® :
Mother / jhah® bga® :
Guardian(if Parents are not alive ) /
:
fh¥ghs® bga®
3. Date of Birth / Ãwªj nj :
4. Age as on 31st July 2017 /
31.07.2017-š cŸsgo taJ : Year / tUl« : Month / khj« :
5. Gender / ghèd« :
6. Occupation of Parents/Guardian :
Father / jªijah® bjhêš :
Mother / jhah® bjhêš :

Guardian / fh¥ghs® bjhêš :

7. Aadhar No of Parents / Guardian :

Father / jªijah® Mjh® v© :

Mother / jhah® Mjh® v© :

Guardian / fh¥ghs® Mjh® v© :

8. Residential Address / bjhl®ò Kftç :

9. PIN Code / mŠrš F¿pL v©

:
10. Mobile No / if¥ngÁ v©
:
11. E-Mail Address / ä‹dŠrš Kftç
:

S.No SCHOOL NAME / gŸëæ‹ bga®

1.

2.

3.

4.

5.

வபணணபபதடன இடணகக றவணடய சவனறலதழகள :

1. Photograph of Child / கழநடதயபன ஒளளபபடம

2. Photograph of Birth Certificate / பபறபப சவனறலதழ

3. Address Proof / மகவர சவனற

4. Community Certificate Proof / சவதலச சவனறலதழ

(for Disadvantage Group / வவயபப மறககபபடட பபரவபனர)

5. Income Certificate Proof / வரமவனச சவனறலதழ

(for Weaker Section / நலலவடடநத பபரவபனர)

6. Priority Category Certificate Proof / மரததவச சவனறலதழ

(for Disadvantage Group (Special Category) / வவயபப மறககபபடட பபரவபனர (சலறபப பபரவ))

Date / ehŸ : Signature of the Mother/Father/Guardian

Place / Ïl« : jªij / jhŒ / ghJfhty® x¥g«