FREE HINDI TUITION FOR PRIMARY & SECONDARY STUDENTS NIRALI NAGRI SABHA/VISHWANATH MANDIR MAHATMA GANDHI ROAD, PETIT RAFFRAY STUDENT’S REGISTRATION FORM Notes: i. Parents are requested to fill form and to submit by latest 15th April 2018 ii. Filled form will be collected on Saturday 07th April & Saturday 14th April at 4.00 p.m at Vishwanath Mandir or maybe be submitted by emailing at saivickyp@gmail.com iii. Our class will be run on weekdays from 04.15 till 05.15 p.m (Starting date will be communicated to you after registration deadline) iv. Classes will be run depending on the number of applications received v. Our tuitions are free of charge and run under the Mauritius Hindi Pracharini Sabha vi. For any additional information please contact the Secretary on 57901749 or Asst Secretary on 57691052
PART I: STUDENT’S PARTICULARS PLEASE FILL UP THE FORM IN BLOCK LETTERS 1. STUDENT'S NAME (AS PER BIRTH CERTIFICATE): -------------------------------------------------------------------2. GENDER: (M /F): --------------------------------------------3. STUDENT'S RESIDENTIAL ADDRESS: -------------------------------------------------------------------------------------4. DATE OF BIRTH: -----------/----------/-------------
COUNTRY OF BIRTH: --------------------------
5. NAME OF local SCHOOL/COLLEGE: ----------------------------------------------------------------------------------------6.LEVEL IN SCHOOL/COLLEGE: --------------------------------------------------------------------------------------------------
PART II: PARENT’S PARTICULARS 7. NAME OF PARENT/GUARDIAN: MR /MRS/DR/MISS: -----------------------------------------------------------------8. PARENT'S/GUARDIAN'S RESIDENTIAL ADDRESS: -----------------------------------------------------------------------9. TEL NO: HOME -----------------------------------------------FATHER (Mbl Num) ----------------------------------- MOTHER (Mbl Num)------------------------------------------------10. E- MAIL-ID (If any): -----------------------------------------------------------------------------11. PARENT’S OCCUPATION: ------------------------------------------------------------------------------
SIGNATURE OF PARENT / GUARDIAN: -----------------------------------------------------------------
DATE: --------------------------------------------