243 G. T.

Road(N) Liluah, Howrah - 711204 Tel - (033) 2654-3387/89

EMAIL - [email protected] - WEB - https://www.mckv.edu.in

REGISTRATION FORM 2025 - 2026

(Overwriting on this form may lead to its rejection)
STUDENT INFORMATION
Date 07/01/2025 Form No. 22406 Unique ID No.
Admission for Class ELEVEN
Affix a recent stamp
Stream Science size colour
Subject Combination Selected: photograph of
Candidate
Option 1 Physics Option 2 Chemistry Option 3 Mathematics
Option 4 Computer Science
Name Naitik Lala Gender M
Date of Birth 18/02/2009 Nationality Indian
Place of Birth Rishra Aadhar Card No. 488714067042
Identification Marks, if any
Caste Category General Second Language Hindi
Religion Hinduism Mother Tongue Hindi Staff Ward N
Previous School

Name Stepping Stone School(high),rishra

Previous Board ICSE
Contact Details

Mobile no. of parents for SMS alert 7439652553 Email of parents [email protected]
Residential Address for Correspondence

House No/Building /Apartment Name 45/4

Street/ Road/Lane N.k Banerjee Street , Rishra
City/Town Rishra Pin 712248 State West Bengal
Area / Locality Rishra Dist. Hooghly
Land Phone Distance of residence from School More than 2 km
Permanent Address

House No/Building /Apartment Name 45/4

Street/ Road/Lane N.k Banerjee Street , Rishra
City/Town Rishra Pin 712248 State West Bengal
Area/Locality Rishra Dist. Hooghly
Land Phone

Details of ICSE/CBSE/Madhyamik/Equivalent Examination Marks

Pre-Board / Equivalent Examination Marks ICSE /CBSE / Madhyamik Marks

No. Subject Grade Marks Obtained Grade Marks Obtained
1. English 58
2. Second Language 63
3. Mathematics 79
4. History, Civics & Geography 54
5. Science 55
6. Commercial Studies / Economics 0
7. Other Subjects;if any
8. Computer 89
% of Marks(Best of English + any 4 subjects) 68.80 0.00

Page 1 of 5
 PARENT INFORMATION - FATHER

Father's Name Babul Lala

Qualification POST GRADUATE Father's Aadhar No. 506260502781
Other Qualification (if any) Affix a recent stamp
size colour
Nationality Indian photograph of Father
Occupation Private
Designation Engineer
Organisation Name Gulf Marine Services Annual income in Rs. 720000
Past Pupil No Institute MCKV
Office/Business Address

House No/Building
International Towers
/Apartment Name
Street/ Road/Lane 24th (karama) Street
City/Town Abu Dhabi Pin 046046 State Overseas States
Phone (O)
Contact Details

Mobile 9748485896
PARENT INFORMATION - MOTHER

Mother's Name Barkha Lala

Qualification XII Mother's Aadhar No. 734849320833
Other Qualification (if any) Affix a recent stamp
size colour
Nationality Indian photograph of Mother
Occupation House Wife
Designation
Organisation Name
Annual income in Rs.
Office/Business Address

House No/Building
/Apartment Name
AddressLine 2
City/Town Pin State West Bengal
Phone (O)
Contact Details

Mobile 7439652553
LEGAL GUARDIAN OTHER THAN PARENTS (Please submit supporting documents, if applicable)

Guardian's Name Kalee Lala

Qualification GRADUATE
Affix a recent stamp
Other Qualification (if any) size colour
Relationship with child Sister photograph of
Guardian
Nationality Indian
Occupation State Govt.
Designation
Organisation Name
Annual income in Rs. 48000
Office/Business Address

House No/Building /Apartment Name

Street/ Road/Lane
City/Town Pin State West Bengal
Phone (O)
Contact Details

Mobile 9007542917

Marital Status of the parent Married Rights on child (Please submit supporting documents, if applicable) Both if other

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 Details of own brothers & sisters of student

No. Full Name Age Class School/College

1. Kalee Lala 20 College 2nd Year Bhawanipur Education Society College
2.
3.
4.

Area in which parents could contribute to enrich school life in terms of time, skill etc.
Academic Sports

ENCLOSURES (The original must be produced whenever a self-attested photocopy is submitted)

1. following documents are required to be submitted along with the Registration Form.

a. Duly completed Registration Form.

b. Photocopy of the Admit Card/ Birth Certificate of a child (attested by the parent).
c. Photocopy of the results of Pre-Board Examination / Final term or First term examination of Class X/ Selection Examination of Madhyamik 2024-
2025 (attested by the parent).
d. Photocopy of the Class IX Final Examination Report Card (attested by the parent).
e. Three recent stamp size colour photographs to be affixed wherever indicated (one each for the child, the child’s mother and the child’s father).
f. Medical Form (Page no.4 of the Registration form), with Doctor’s full name stamp and registration number with all relevant reports (attested by the
parent) like blood group, blood glucose (fasting and post prandial) and eye test reports (if any), etc.
g. Photocopy of the Aadhar Card of the child (attested by the parent) and parents (Self-attested).
h. Self-attested proof of residential address (Aadhar Card/Ration Card/Voter Identity/Passport/latest Electricity Bill/latest BSNL Landline Telephone
Bill). In case of rented house, photocopy of lease deed/rent agreement/rent receipt to be submitted.
i. Self-attested copy of parents' Income Certificate (recent Salary Slip / Income Tax returns 2022-2023 or 2023-2024). Income proof should match the
amount mentioned in the Registration Form.
j. SC/ST/OBC Certificate in the name of child (if applicable).

2. At the time of Admission or After the declaration of the Board results:

A photocopy of the Board result (attested by the parent).

A photocopy of the Pass Certificate (attested by the parent).
Transfer Certificate, Character Certificate & Migration Certificate (if applicable) in original.

Admission criteria and conditions:

Admissions will be granted on merit.

Applications will be accepted from all students who are going to appear for the ICSE/CBSE/Madhyamik Examination 2025, and who have qualified in
English plus four subjects as per the Council pass criteria in their Pre-Board Examination/First Term or Final Term Examination of Class X/Selection
Examination of Madhyamik 2024.

Candidate will appear for an Admission Test.

Provisional Admission will be granted on the basis of the Admission Test results, interactions with the School authorities, Report Card of Pre-Board
Examination/First Term or Final Term Examination of Class X/Selection Examination of Madhyamik 2024-25 and Class IX Final Examination,
conduct, co-curricular activities, etc.

Students who were issued a Transfer Certificate on the grounds of breach of Code of Conduct by M. C. Kejriwal Vidyapeeth at any point are not
eligible to apply. If applications are received from such students, they will be rejected.

Outstation candidates will not be considered for admission.

Provisional Admission will be confirmed only after receiving the pass certificate of ICSE 2025.

For students from other boards, admission will be confirmed only after the Council for the Indian School Certificate Examinations confirms the
eligibility of the candidates.

Page 3 of 5
 UNDERTAKING BY THE PARENTS

We hereby certify that the information given in the Registration Form is complete and accurate. We understand and agree that misrepresentation or
omission of facts will justify the denial of admission or cancellation of admission, and later, if our child has been given admission in the school, even
expulsion. We also understand that submission of this Registration Form in no way implies a guarantee of admission for our child in this school.

Signature of Father Signature of Mother Signature of legal Guardian (if applicable)

FOR OFFICE USE ONLY

Interaction held on by

ID No. Date of Admission Admitted to Class

Document Checklist:

Documents received after admission

At the time of submission of Registration Form: Signature Signature
offer:

i) Registration Form i) Board results

ii) Birth Certificate ii) Pass Certificate
iii) Admit Card iii) Transfer Certificate in original
iv) Pre-Board Examination / First term Examination Mark Sheet iv) Character Certificate
v) Migration Certificate in original (if
v) Class IX result
applicable)
vi) Candidate's Aadhar Card vi) Agreement Form
vii) Father's Aadhar Card
viii) Mother's Aadhar Card
ix) Income Certificate
x) Proof of Residential Address
xi) ST/ SC/OBC
xii) Medical Form with all relevant reports like blood group, sugar test (both pp and
fasting), eye test etc.

Payment Transaction ID No.: pay_PeElbfsDijHRE6

Page 4 of 5
 243 G. T. Road(N) Liluah, Howrah - 711204 Tel - (033) 2654-3387/89
EMAIL - [email protected] - WEB - https://www.mckv.edu.in ADM/F/003

MEDICAL FORM
FOR THE SESSION 2025 - 2026

Write in Capital Letters Affix a recent

stamp size
Note: Please keep us informed about changes colour
in address and telephone number and photograph of
also about any development related to the student
health of your child.

FAMILY INFORMATION
Student's Name Naitik Lala
Date of Birth 18/02/2009 Class ELEVEN
Father's Name Babul Lala
Mother's Name Barkha Lala
Residential Address Phone Nos.
45/4 Residence
N.k Banerjee Street , Rishra
Office
Rishra-712248
Dist. :Hooghly , West Bengal Emergency 7439652553

MEDICAL INFORMATION

Blood Group Report (attach photocopy) A+

Allergies to medicine and food No
True Glucose(Fasting)
True Glucose(Post Prandial) Report
Blood Pressure Report
(attach photocopy)
(attach photocopy)
Physical Disability (specific) No
Is your child using spectacles? if yes, Latest eye
Vision - Right Eye 0.0 Vision - Left Eye -2.0
report
Colour Blindness no Weight 55 Height 5'8"
History of major illness, including Epilpesy, juvenile diabetes, Asthma etc.
Any other information that the institution may need to have regarding the child's health & medical background.

No

Signature of Father Signature of Mother Signature of Legal Guardian (if applicable)

Signature of Doctor Reg. No. with stamp & date

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