JHARKHAND ACADEMIC COUNCIL, RANCHI

Registration Form for Secondary Examination, Year 2015.

( All corrections to be made in English Capital letters only )


School Code 51049

Serial No. 0084

Unique Identification Details (UID) No. 511152206302
Name of the School JUGSALAI GIRL'S HIGH SCHOOL JAMSHEDPUR
1. Class Roll No.

0087
2. Area / Locality
U

R - Rural
U - Urban
3. Sex
F

M - Male
F - Female
4. Category
R

R - Regular
P - Private
5. Caste
B

C - Schedule Caste
T - Schedule Tribe
B - Backward Caste - 1
M - Backward Caste - 2
O - Others
6. Handicapped
N

B - Blind
D - Deaf
U - Dumb
O - Orthopedically Challenged
S - Spastic
N - None
7. Religion
H

H - Hinduism
I - Islam
S - Sikhism
C - Christianity
O - Others
8. Nationality
I

I - Indian
O - Others
9. Medium of Examination
H

H - Hindi
U - Urdu
E - English
B - Bengali
O - Oriya

10. Date of Birth

Date
04

Month
01
Year
2000

11. Candidate's Name
ASHA KUMARI



12. Mother's Name
SHIRATI DEVI



13. Father's Name
BHUAR SINGH



14. Subjects Offered ( To be filled as per subject list only )
Subject Code
Language I H N A
2 E N G
Compulsory I M T H
2 S C T
3 S O C
Additional S N K

15. Photograph &
Signature
as it would appear



16. Declaration :
I hereby declare that the changes/
corrections mentioned above are correct to
the best of my knowledge & belief. If any
of the information provided is false, I shall
abide by the actions & decisions taken by
the Jharkhand Academic Council.

Signature of Candidate
Signature of Father / Guardian

( To be filled in by the School )
Certified that the photograph pasted above is of the candidate whose details are printed in this form. The same has been verified & found correct by me. Corrections may please be
allowed.
Signature of Head of the Institution with Seal

Instructions to Candidates
1 Please ensure that your details mentioned above are correct as since the same will be used in printing your Registration Slip, Admit Card, Mark Sheet, Provisional Certificate & Final Certificate. No change of details will be
allowed later on.
2 All necessary corrections should be made in a single form using blue ball point pen only. In no circumstances a candidate can submit more than one form.
3 For marking changes in your data you are required to do the same in the box area provided below the column in the form.
4 Change of photograph will be done by Jhakhand Academic Council, hence the same will get reflected in the Registration Slip. For change of photograph you are required to put your signature in the box area below the
photograph, request for change of photograph without signature is liable to rejection.
5 Declaration (Column 16) is compulsory for making changes in data/photo, you are required to fill the same before submission of the form.
Not Applied for any Correction.