Last Date of Submission:
Without Late Fee: .................
With Late Fee: .................
For Office Use Only:
App. No. .......... Reg. No. ............
Date ..............
Residential Senior Secondary Boys' School; Affiliated to CBSE, N. Delhi (A. No. 03430100)
At & Post Jasidih - 814 142, Dist. - Deoghar (Jharkhand)
Office Contact No.: +91 7070194790 - 92; 7485093119 - 20
Web:, email:
1.   Candidate's Image * :
  Candidate's Name * :
A. Date Of Birth *:
B. Name & address of the school in which now reading:
Board: Year * : Medium:
(Please attach the photocopy of the mark sheet of the pre board examination)
C. Admission sought in Class *: Height: Weight: Gender *:
  Nationality: Religion : Blood Group:
  Aadhaar No.: (Please attach the photocopy of Aadhaar Card)
  Caste : In case OBC specify tribe: Mother Tongue:
D. Special aptitude and interest:
E. Does he suffer from bed-wetting, insomnia, asthma, stammering or any disease/disorder or is under any medication? (Give full information)
F. Allergic to (If any):
(Medical fitness certificate by any qualified medical practitioner not less than MBBS to be provided)
2.   Father's Name:
    Qualification: Occupation: Contact No.:
3.   Mother's Name:
    Qualification: Occupation: Contact No.:
4.   Guardian's Name: (only if father is not the guardian)
    Relation with the candidate
    Qualification: Occupation: Contact No.:
5.   Combined Annual Income
6.   Address : (i) Present (Mailing):
    PO Dist. State PIN
    Contact No. Email *.
    (ii) Permanent:
    PO Dist. State PIN
    Phone no. with STD code Mobile No. *
7.   Local Guardian's Name: (If any)
    Relation with the candidate Address
    Qualification: Occupation: Contact No.:
8.   Sibling studying in the institution (Name and Adm. No.):
9.   Subject Offered: *

  • Choice A : English (Core), Physics, Chemistry, Mathematics
  • Choice B : English (Core), Physics, Chemistry, Biology

    Mention the chosen subjects combination: (Choice A/Choice B)
    Fifth and Additional Subjects Choices * : Biology (In case of Choice A only), Mathematics (In case of Choice B only), Computer Science, Physical Education, Economics, Painting
Mention the opted subjects name (the same subject should not be repeated):
Fifth Subject: Additional Subject:
*The opted subject(s) may be withdrawn due to shortage in minimum strength or any other inevitable reasons. In such a case the candidate shall reconsider the subjects' selection from the remaining options.
10. Attachments  
  1. Board Examination Admit Card :
  2. Medical Fitnes Certificate :
  3. Pre Board Examination Mark Sheet :
  4. Aadhaar Card :
I, , hereby undertake
  • that I shall abide by all the Rules and Regulations of the Institution
  • that I shall uphold the good name, prestige, dignity and tradition of this reputed Institution by my gesture, posture, behavior, action and expression in all circumstances
  • that under no circumstance shall I leave the campus of the Institution without the express permission from appropriate authority
  • that I shall refrain from any such activities which may be termed as detrimental or injurious to the moral tone of the Institution
  • that in case of any problem/difficulty/constraint or grievance, I shall instantaneously quit the Institution as and when asked and desired by the Director/Principal

I, hereby declare that the statement made herein are true to the best of my knowledge. I am aware of the rules and regulations of the institution furnished in the school prospectus and I accept that these may be changed from time to time. I am aware that those are proper and necessary for the better education of my ward. I shall co-operate with the school management in every respect to enable them to educate my ward according to the rules and regulations as they frame from time to time.

In case of breach of discipline or neglect of studies or in the interest of the institution my ward's name may be removed from the institution at the discretion of the Director.

If my ward is withdrawn or removed from the institution before the end of a session I shall pay compensation for the remaining month of the academic years i.e. up to 31st of March at the rate of Rs. 1500/- per month before vacating the seat or applying for the Transfer Certificate.

I further declare that my ward is not suffering from any disease or infirmity and does not suffer from insomnia, asthma and is not allergic to any food item or medicine.

In all matters of dispute or differences, the decision of the Director of the institution will be final and binding on me.

I shall abide by the rules of Admission, Selection and Removal, as well as other rules and regulations of the institution, and in accordance with the same. I hereby apply for my ward's admission.

  1. An incomplete form will be summarily rejected.
  2. Candidate will have to produce Transfer Certificate (Original) at the time of admission.
  3. Please attach the following documents along with the application form (optional):
    1. Admit Card of the candidate,
    2. Medical Fitness Certificate from a Medical Practitioner not less than MBBS (in original),
    3. Photocopy of marksheet of the last examination attended and annual result of the previous class duly attested by the head of the institution or a gazetted officer, and
    4. Aadhar Card (Photocopy)
  4. Photographs requirements:
    1. Three passport sized photographs of the candidate with name and date of photography mentioned on it,
    2. One postcard size (4" x 6") group photograph of the candidate along with family members residing in it;
    3. Passport sized photograph of the local guardian if applicable