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1 DELHI PUBLIC SCHOOL Navi Mumbai CBSE Affiliation No. : Registration Form Reg.no. Academic Session (To be filled by the office) Photograph Fill the details in block letters 1. Pupil s Name: (as per Birth Certificate / Transfer Certificate) 2. Date of Birth: DD MM YYYY Gender: M F 3. Age as on Yrs Months Days Class : 4. Academic Record (Previous year): if applicable Class Year School Board Overall grade/ Percentage 5. Particulars of the Parent: Parents Details Father Mother Name Academic Qualifications Occupation / Profession Full Designation Office Address Tel (O) Mobile Monthly Income (Rs.) Current Residential Address. Permanent Residential Address Tel (R ) / Mobile DPS Alumni : (Father) Year of passing Branch (Mother) Year of passing Branch Sibling (Studying in DPS, Navi Mumbai): Name: Class/ Section: Name of the Child Acknowledgment Slip Admission to Class Registration No Date Signature (for Office Use):

2 Declaration: 1. I understand that the REGISTRATION FEE is non-refundable. I also fully understand that REGISTRATION is not a guarantee for admission. Admission is granted as per the school norms. 2. I hereby certify that the date of birth and spelling of the name of my child /ward given in this form are correct to the best of my knowledge. And I shall not make any request for any CHANGE. 3. I understand that rendering false or misleading information or withholding correct information shall lead to cancellation of child s admission at the school. 4. I hereby certify that my child / ward and myself shall follow all the rules, regulations and procedures given in the school almanac and any other rules etc. as laid down by the school from time to time. UTR No. Date Date: Place: Signature of parent / guardian DELHI PUBLIC SCHOOL NAVI MUMBAI Palm Beach Marg, Nerul, Navi Mumbai Tel: , Tele fax: Website: dpsnavimumbai.org

3 DELHI PUBLIC SCHOOL Nerul Navi Mumbai Name of the Child : Reg.No. Sr. No. Specification For Parents For the School 1 Area Code (Neighbourhood) 2 Siblings (Real brother/sister) Studying in DPS, Navi Mumbai Class/Sec Name of the student 3 Alumni : (DPS) Father Mother Yes /No Yes/No 4. Child with Minimum Special Needs (only orthopaedically challenged (with up to 25% disability) who can be mainstreamed within the existing facilities.) Yes/No

4 DISTANCE CHART Pre Nursery Admission ( ) Area Code Nerul CBD-Belapur M N O P A B C D X Y S T U Sec 52, Sec 54, Sec 56, Sec 58A Sec 50 (New/Old) Nerul Sec 46, Sec 46A, Sec 44, Sec 44A Nerul Sec 48, Sec 48A Sec 38, Sec 42A, Sec 42 Sec 34, Sec 36, Sec 32, Sec 30, Sec 40 Karave Gaon, Nerul (E) Sec 25, Sec27 Sec 26, Sec 28 Nerul (E) Sec 19A, Sec 21, Sec 23 Sec 18, Nerul (E) Sec 19, Nerul Stn. Sec-14, Sec 16, Sec 18A, Sec 6, Sec 8, Sec 24, Sec 12, Sec 10 Sarsole Village, Sec 20, Sec 22 Nerul (E) Sec 13, Sec 15, Sec 17 Sec 2, Sec 4,Shiravane village Nerul (E) Sec1, Sec 3, Sec 5, Sec 7, Sec 9, Sec 11 Sanpada and Juinagar Sec 22, Sec 23, Sec 20, Sec 19, Sec 18, Sec 16A, Sec 16, Sec 14, Sec 13, Sec 1, Sec 2, Sec 3, Sec 7, Sec 6, Sec 10, Sec 11, Sec 15, Sec 4, Sec 9, Sec 17 Vashi - Sec 1, Sec 2, Sec 3, Sec 4, Sec 6, Sec 7, Sec 8, Sec 9, Sec 10, Sec 10A, Sec 11, Sec 12, Sec 14, Sec 15, Sec 16, Sec 29, Sec 30, Sec 17 Vashi Sec 19 to Sec 27, Sec 28 Koperkharine Sec 11, Sec 14, Sec 18, Sec 8, Sec 13, Sec 9, Sec 15 - CBD Sec-32 - CBD Sec 15A CBD Sec 20, Sec 15 CBD Sec 19, Sec 21, Sec 22 Ulwe Rati Bunder CBD Sec 24, Sec 25, Sec 23, Sec 26, Sec 27, Sec 28, Sec 29, Sec 11, Sec 14 Diwale Village CBD Sec 30, Sec 31, Sec 10 RBI CGO CBD Sec 9, Sec 9N, Sec 1, Sec 1A, Sec 2, Sec 3, Sec 4, Sec 5, Sec 6, Sec 12, Sec 13, Ulwe, Kombad Bhuje, MOHA, Ambuja Cement CBD Sec 8A, Sec 8B, Artist Village, Ulwe Sec 2, Sec 3, Gaonthan Sonkhar CBD RBI, Bharti Vidyapeeth, Ulwe Sec 23, Sec 20, Sec 5, Sec 3, Sec 19A, Sec 19 Kharghar Sec 1, Sec 2, Sec 4, Sec 5, Sec 6, Sec 7, Sec 8, Sec 9, Sec 10,Ulwe, Wahal Village Sec 19B, Sec 18 Kharghar (Before Central Park) Ulwe Sec 9, Sec 8, Sec 17, Sec 16 V Koperkhairne Sec 1 Rest of Navi Mumbai Kharghar (Sectors after central park)

5 SCHOOL BANK ACCOUNT DETAILS FOR REGISTRATION (PRE-NUR ) SCHOOL ACCOUNT NAME DELHI PUBLIC SCHOOL - CURRENT A/C BANK ACCOUNT NAME ORIENTAL BANK OF COMMERCE NERUL STATION COMPLEX BANK IFSC CODE ORBC BANK ACCOUNT NO REGISTRATION AMOUNT Rs.900/- Duly filled in downloaded form along with payment confirmation (UTR acknowledgement) print out shall be submitted from 13/12/2017 to 22/12/2017 from 10:00am pm (on working days only)

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