GOVERNMENT SERVICE HOME Application form for New 10th std pattern 1. Name .. 2. Age & Date of Birth .. 3. Guardian name .. 4. Permanent address .. 5. Certificate should be enclosed for .. the following 1. Education .. 2. Medical certificate .. (to be obtained from Registered MO) 3. Income certificate .. (Below Rs.12000/- P.A from Tahsildar) 6. Brief life details of the applicant .. 1. Married (OR) Unmarried .. 2. No.of children .. 3. Previous Educational Institution .. name 7. Name & address of the two well known.. persons who knows the applicant 8. Parent /Guardian's signature .. Note of the two enquiry officers:- 1. Interview date .. 2. Is the applicant eligible for admission. I declare that the above details are true to the best of my knowledge and there will not be any change in that. If I selected I will obey the rules and regulations of the Home. Candidate signature Guardian's signature: Date
