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APPLICATION FOR ADMISSION TO NURSERY

Child Photo Mother Photo Father Photo Guardian Photo

Form No. Registraion Date: 02-02-2017
Class
Student's Name Student's Details
Gender
Date of Birth : 10212 Permanant Address : C47, KISMAT NAGAR,
Place of Birth : NURSERY Temporary Address C.S.T. ROAD, KURLA
: MUSTAFA RAZA WEST,MUMBAI,
Nationality :M 400070,MAHARASHTRA
Religion : 22-01-2014 : 401, A WING, BLDG.
Community : MUMBAI, NO. 20, KAPADIA
Mother tongue MAHARASHTRA NAGAR, C.S.T. ROAD,
: INDIAN KURLA
: ISLAM WEST,MUMBAI,
: MUSLIUM 400070,MAHARASHTRA
: URDU

Student's Family Particulars

Father's Name : ABDUL Family Office Address : C47, KISMAT NAGAR,
MAJEED ABDUL
Father's Age RASHID QURESHI C.S.T. ROAD KURLA
Qualification : 45
Father's Occupation : 11 WEST,MUMBAI,
Designation : BUSINESS MEN
Mother Name : 400070,MAHARSHTRA
Mother Occupation : MEHRUNNISHA
Mother Qualification : HOUSEWIFE Family Phone : 9820424696
Family Residential :5
Address : 401, A WING BLDG. NO. Family Mobile : 9820424696
20, KAPADIA NAGAR,
C.S.T. ROAD, KURLA Family Fax : 9820424696
WEST,MUMBAI,
400070,MAHARASHTRA Family Email :

[email protected]

m

Family Monthly Income : 30000

Family Mother Tongue : URDU

Student's Guardian Particulars

Guardian's Name : FARIDA ABDUL Guardian's Phone : 9820424696
RASHEED QURESHI Guardian's Mobile : 9820424696
Relation With Student : AUNTY Guardian's Fax : 9820424696
Guardian's Age : 30 Guardian's Email :
Guardian's Occupation : TEACHER [email protected]
Designation : TEACHER Guardian's Monthly m
Guardian's Residential : 401, A WING BLDG. NO. Income : 15000
Address 20, KAPADIA NAGAR, Guardian's Mother
C.S.T. ROAD, KURLA Tongue : URDU
Guardian's Office WEST,MUMBAI,
Address 400070,MAHARASHTRA
: ANJUMAN INAYATUL
ISLAM,
GOVANDI,
MUMBAI,
MAHAR
ASHTRA,
MAHARASHTRA

Student's Details

Languages Known : ,, Last School Details
Languages Spoken At :,
Home Admission Date : 30-11--0001
Last School Name :
Last School Address : Leaving Date : 30-11--0001

Reason For Leaving :

School

Student's Any Illness Or :

Disabilities

UNDER TAKING CUM DECLARATION

A. Respected Sir / Madam,

I, the undersigned Parents / Guardian do hereby confirm that I have applied for the
admission of

Master/ Miss QURESHI MUSTAFA RAZA ABDUL MAJEED MEHRUNNISHA in your
instutation,

I have read about the procedures and policies of your Institutions and I am also fully
aware that your Institution is PERMANTLY UN-AIDED and I wish to admit him / her at
my own will, and hereby agree and confirm that the institution is running the school, on
UN-AIDED basis. I also hereby agree and undertake not to raise any dispute in respect
of monthly fees being charged from time, and also shall have NO-OBJECTION for the
revision of the fees from time to time. At present the rate of Admission / Tuition / Term
Fees is Rs.__________ per month for the academic year 20___ to 20___ w.e.f. June year
20___ to _____

I also agree and undertake to abide by the necessary rules and regulations of

your Institution and shall not do anything contradictory to the rules and regulation of
the Institution.

I declare that the information submitted by me is true and accurate and I agree
that, if it is found to be suppressed or incorrect, this application may be rejected and
could lead to exclusion of my ward from the school.

I fully agree to the fact that acceptance of this application does not in any
guarantee admission. If is only at the discretion of school authorities.

I hereby state that signing this application form implies unconditional acceptance
of all school’s Admission procedures and rules, regulation & fees enforced and man
be changed from time to time.

I am conscious of the Constitutional rights of the Management to administer this
minority Educational Institution according to their choice, and accept their decision on
admissions, favorable or otherwise, as final and binding.

I am executing this undertaking to be produced before concerned and relevant
authorities for necessary purposes, to show that I have no dispute, and / or objection
for fees, rules and regulations of the Institution, and I have put my signature in full
sense, without any bad influence, and / or coercion of whatsoever nature, and the
contents are fully explained and understood by me.

B. The information above on behalf of Master / Miss QURESHI MUSTAFA RAZA ABDUL
MAJEED MEHRUNNISHA is true to the best of my knowledge. I have read the RULES
and REGULATIONS of the school and undertake to submit to the normal enforcement of
the same to the satisfaction of the PRINCIPAL / MANAGER whose decision shall be
final.

C. Fees once paid will not be refunded.
D. PARENTS ARE REQUESTED NOT TO USE UNPARLIAMENTARY LANGUAGE WITH THE

MEMBERS OF MANAGEMENT & SCHOOL AUTHORITIES
E. All the parents are requested to maintain punctuality of their wards. Especially who

avails Auto / Taxi / Bus facility.
F. School will not be liable for any mishap caused by the transportation facility as it is the

responsibility of parents.
G. All the parents are requested to clear their dues before test and examinations failing

which their ward will not be allowed to appear in Test / Exam.
H. Parents are requested to submit their ward’s previous Leaving Certificate while taking

admission, School will not be responsible for confirmation of admission and refund of
fees if admission is taken without submission of Leaving Certificate.
I. Parents are requested not to claim any short of concession in fees as reasonable fees
is collected in this Institution.

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