Number of younger brothers Please Select 1 2 3 4 5 * . Number of elder brothers Please Select 1 2 3 4 5 * .
Number of younger sisters Please Select 0 1 2 3 4 5 * . Number of elder sisters Please Select 0 1 2 3 4 5 .
Name of the School attended blanks . Periods of Stay Please Select 1 2 3 4 5
Weather the pupil has produced the School Leaving certificate from the last school Attended Please Select Yes No N/A . Number Date
I request that the above named pupil may be admitted to the school *Standard blank* Medium Please Select kannada English Hindi .