DAV PUBLIC SCHOOL , MCL, ANANTA VIHAR, ODISHA-759103 Directly Managed by DAV College Managing Committee, New Delhi

PROVISIONAL ADMISSION APPLICATION FORM

1. Registration for Class 2. Form No
3. Stream 4. Subject
5. TransactionID 6. Payment Status

1. PERSONAL (CAPITAL LETTERS)
1. Name of the Student 2. Date of Birth
3. Age As on 01.09.2025 4. Mobile
5. Aadhar No. 6. Email
7. Nationality 8. Religion
9. Category 10. Language
11. Gender 12. Blood Group
13. Selection Category 14. Permanent Address
15. Present Address

2. Parent/Guardian Detail
1. Father's Name
2. Education Qualification
(Mention Highest)
3. Occupation
4. Name Of the organisation
5. Designation
6. Address
7. Mobile
8. Father Aadhar No:
9. Father Email ID
10. Annual Family Income
11. Single parent
1. Mother Name
2. Education Qualification
(Mention Highest)
3. Occupation
4. Name Of the organisation
5. Designation
6. Address
7. Mobile
8. Mother Aadhar No:
9. Mother Email ID:

3. Previous School
1. Name of the School Last Attended with Address
2. Name of the Board 3. Registration No.
4. Board Roll No. 5. Year of Passing/Appearing

UNDERTAKING
MOTHER FATHER LOCAL GUARDIAN (if father / Mother is not the guardian)
Signature ______________ Signature ______________ Signature ______________
Name ______________ Name ______________ Name ______________
Date ______________ Date ______________ Date ______________

                                                                           FOR MCL EMPLOYEES ONLY
Certified that the applicant's father/mother, Mr/Mrs..................................................................... is an employee of Mahanadi Coalfields


Limited in the department of ........................................... Card No. ................................ .







Office Seal                                                                                                                                        Signature of the Head of the Department