admission form | Lakhimpur Markaz Academy

Personal Info

Student's Name:

Father's Name:

Mother's Name:

Nationality:

Religion:

Category:

Local Guardian(any):

Present Address: (Vill./ Ward/ Street , PO, PS , Dist, State, Pincode)

Permanent Address: (Vill./ Ward/ Street , PO, PS , Dist, State, Pincode)

Phone Number:

Date of Birth:

Academic Info

Admission Session:

Admission Seeking Class For:

Last Exam Passed Mark:

Last Exam Passed Percentage:

Identity Mark:

Student Adhaar Card Number:

Document Section

Student Photo:

TC Photo (if any):

Birth Certificate/HSLC Admit:

Student Adhaar Proof (Any):

I hereby solemnly declare that :-
i) The information furnished above are true to the best of my knowledge and belief.

ii) I shall submit to the disciplinary jurisdiction of the Principal of the Academy and other authorities who may be vested with powers to exercise disciplinary controls under rules and regulations of the Academy.

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