G0VERNMENT OF KERALA

DIRECTORATE OF GENERAL EDUCATION (HIGHER SECONDARY WING)

APPLICATION FOR ADMISSION TO THE HIGHER SECONDARY COURSE (2O22-2O23)
APPLICATION NO: 2209106468

Name: SAFA JASMIN P Guardian Name: SULAIMAN

Mother's Name: SAFIYA Father's Name: SULAIMAN

Date of Birth: 25-10-2005 Sex: Female

Aadhaar No: 692XXXXXX453 Enrolement No: -

Board Passed: Yes Scheme: SSLC (2021-2022) Register Number: 297760

Month of Pass: 3 Year of Pass: 2022

Category Name: Muslim OEC: No

Caste: MUSLIM Religion: Islam

Resident State: Kerala Resident Local Body: Ananganadi

Resident District: Palakkad Resident Taluk: Ottappalam

Permanent Address: PARAMMEL, PANAMANNA AMBALAVATTAM PO, Communication Address : PARAMMEL, PANAMANNA AMBALAVATTAM PO,

679501, PALAKKAD 679501 679501, PALAKKAD 679501

2
Blind: No Deaf No OH: No

IEDC : - MR/Brain Diseases: No Health Club: No

Linguistic Minority:

Jawan Priority:

NTSE Qualified:
No

No

No
Minority Language:

NCC or Scout / Guide(Puraskars)

NMMSSE Qualified:

O
No

No 2 Jawan Killed In Action:

Scout / Guide Participation :

USSE Qualified:
No

No

No

2
LSSE Qualified: No Student Police Cadet: No Red Cross: No

Forestry Club: No Environment/Nature Club: No IT Club: No

Maths Club:

Oratory Club:
No

No
Debating Club:

Science Club:

- No

No
Philatery Club:

Social Science Club:

No

No

P
Little KITES Members With A Grade: No

SPORTS AND YOUTH FEST SL-I D-I / A D-II / B D-III / C DLP STATE FAIRS A-Grade B-Grade C-Grade D-Grade E-Grade

A
Sports Fest 0 0 0 0 0 State Science Fair 0 0 0 0 0

Youth Fest 0 0 0 0 0 State Social Science Fair 0 0 0 0 0

C
E-Mail ID: - State Maths Fair 0 0 0 0 0

Phone Number: 8156945810 State IT Fair 0 0 0 0 0

Chance Number:

SSLC School:

PAPER NAME
1

s
9047 L S N GIRLS HSS, OTTAPPALAM, PALAKKAD

h
State Work Experience Fair 0 0 0 0

State Level First(SL-I), District First or A-Grade(D-I / A), District Second or B-Grade(D-II / B), District Third or C-Grade (D-III / C), District Level Participation(DLP)

CANDIDATE GRADE DETAILS

MARK GRADE GRADE POINT
0

First Language- I NA A+ 9

First Language- II NA A+ 9

English NA A+ 9

Hindi NA A+ 9

Social Science NA A+ 9

Physics NA A+ 9

Chemistry NA A+ 9

Biology NA A+ 9

Mathematics NA A+ 9

Information Technology NA A+ 9

IT Services : NIC Kerala Page 1 / 2 IP : 59.99.138.177 - Date & Time : 12/07/2022 07:30:42 PM
 CANDIDATE OPTION DETAILS (MAIN)

Pref School Code Course Pref School Code Course Pref School Code Course Pref School Code Course

No. Code No. Code No. Code No. Code

1 9047 1 3 9033 5 5 9137 1

2 9033 1 4 9043 1

.......................................................................................................................................................................................................
DECLARATION
I SULAIMAN, Parent of Master/Kumari SAFA JASMIN P do hereby declare that all the information furnished in the application
are true to the best of my belief. I know that the allotment got by any false information furnished in the application will results in the
cancellation of Allotment and Admission.

Name and Signature of Parent/Guardian

Place :
Date : 12-07-2022

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IT Services : NIC Kerala Page 2 / 2 IP : 59.99.138.177 - Date & Time : 12/07/2022 07:30:42 PM