SHETH VARJIVANDAS MADHAVDAS KAPOL BOARDING SCHOOL TRUST

573/74, Khushaldas Parekh Marg, Matunga (C.R.), Mumbai – 400 019

APPLICATION FORM

For Office Use Only

Form No. __________ Issued on ________________________

Name of the Student ________________________________________________________________________________

To be submitted before ________________________ Date of Submission _______________________

(Please fill the form in Capital Letters Only)

The Hon. Secretaries, Sign
Sheth V. M. Kapol Boarding School Trust, diagonally
Matunga, Mumbai – 400 019 across the
photograph
Respected Sir/Madam,

We hereby apply for admission in your Institution for pursuing further studies. We affirm that all
details in this application form are correct. We are ready and willing to furnish any additional information that
you may need. We have read the Rules and Regulations of the Institution as mentioned in the prospectus and
agree to abide by them and to any amendments in the same.
NOTE : Management has taken all due precautions as per new safety protocols due to Pandemic.
It will not be held responsible if any student contracts Covid - 19 or any other such Contiguous sickness
during his stay in the Boarding / Hostel. Students should be vaccinated with both the doses of Covid - 19.
If any student contracts Covid – 19 he will have to vacate the hostel immediately till he recovers and
provides a medical certificate.

All students will have to follow Standard Operating Procedure (SOP).

Yours Sincerely,

Signature of Local Guardian Signature of Local Guarantor (Applicant's Signature)

Date _______________________

(A) Personal Details

Full Name :
Surname Name Father’s Name

Permanent Address :

City : State : Pin Code :

Tel. No. ________ (M): __________________ (Email): ________________________________________

Age : Date of Birth : Place of Birth :

Nationality : _____________ Mother Tongue : _____________ Community : ___________________

(B) Information on Past Academic Performance

Month & Yr School / Board / Total Marks No. of Remarks

Examination %
of Passing College University Marks Obtained Attempts By Office
S.S.C
H.S.C.
Sem 1
Sem 2
Sem 3
Sem 4
Sem 5
Sem 6
Sem 7
Sem 8

Result of the Last Examination appeared

Last examination Conducted by

Appeared in Passed on

Total marks Marks obtained Percentage %

I enclose herewith self attested copies of results of all examinations.

(C) Course proposed to be pursued

Name of the Course :

Duration of the Course : Year ( 20 to 20 )

Name of the College / Institution with Address :

Fee Amount Rs. Receipt No. & Date

(D) Hobbies / achievements in academics, sports, literature, etc. (please attach relevant certificates)

(E) Medical History Blood Group :-

Illness / Surgery / Treatment / Medicines taken in Past / Present. Chest Infection and Allergy to any medicines.
(Attach Final Covid – 19 Vaccination Certificate along with physical fitness certificate from Doctor.)
(F) Formal Confirmation from the Parents / Guardian (Guardian permitted only if both Parents not alive)

Name : __________________________________________________________________________________
Surname Name Father / Husband

Relation with student : Father / Mother / Guardian Occupation

Annual Family Income Rs. __________________/- No. of family members ________________
Residence Address : Office Address :
________________________________________ __________________________________________
________________________________________ __________________________________________
________________________________________ __________________________________________
Tel. No. ________ (M): __________________ (Email): ________________________________________
I affirm that all information given in the form is true. If my ward is admitted in the Institution, I shall be responsible for his
studies, performance, behavior, discipline and, for his expenses and shall pay the dues as and, when they become due.

Date ________________ Place _____________________ Signature _____________________

(G) Information about Local Guardian (Please Note : He / She should be minimum of 35 years old and
provide a xerox copy of self-attested Aadhar Card.)
I will remain present personally during interview for admission along with student and I take full
responsibility for student’s good behavior and for all his dues during stay in the institution.
Full Name of Local Guardian : _______________________________________________________________
Relationship with Student : ___________________ Occupation : ______________________________
Residence Address : Office Address :
________________________________________ _________________________________________
________________________________________ _________________________________________
________________________________________ _________________________________________
Tel. No. ________ (M): __________________ (Email): ________________________________________
I affirm that all information given in the form is true. If my ward is admitted in the Institution, I shall be responsible for his
studies, performance, behavior, discipline and, for his expenses and shall pay the dues as and, when they become due.

Date ________________ Place _____________________ Signature _____________________

(H) Recommendation from prominent and reputed individual who is residing in Mumbai (Please Note :
He / She should be minimum of 35 years old and provide a xerox copy of self-attested Aadhar Card.)
I will remain present personally during interview for admission along with student and I take full
responsibility for student’s good behavior and for all his dues during stay in the institution.

I know the applicant and his family personally for _________ years. He bears a high moral character and is law
abiding. All information given in this for is true to my belief and understanding.

Full Name of Guarantor : ___________________________________________________________________

Residence Address : Office Address :
________________________________________ _________________________________________
________________________________________ _________________________________________
________________________________________ _________________________________________
Tel. No. ________ (M): __________________ (Email): ________________________________________
I affirm that all information given in the form is true. If my ward is admitted in the Institution, I shall be responsible for his
studies, performance, behavior, discipline and, for his expenses and shall pay the dues as and, when they become due.

Date ________________ Place _____________________ Signature _____________________

NOTES :

1. It is obligatory to answer all questions in the form. Mutilated or incomplete form will not be entertained.

2. Mutilated or incomplete forms without necessary attachments will not be considered.

3. Students should submit form before the due date. The form shall be accompanied by the certificates of mark

statements of all the examination mentioned in the form, fee receipt from the college for the course to be

pursued and other certificates. If some requisite details are not readily available at the time of submitting the

form, they may be furnished afterwards as soon as they become available.

4. If the admission of the applicant in the college is not finalized before the due date for submission of the form,

the fee receipt and other details shall be furnished as soon as the same become available. Admission in such

case will be provisional subject to submission of the fee receipt and other relevant documents.

5. The Management reserves the right to call for any additional information as they deem fit.

6. The Management reserves the right to reject any application for admission without assigning any reason

whatsoever.

7. It is Mandatory for Applicants / Parents to furnish all medical history of the applicant with attachments.

8. Loud music or celebrations causing disturbance to anyone will not be allowed.

For Office Use Only

Admitted / Not Admitted For Academic Year : ______2024 – 2025

Remarks : ______________________________________________________________________________

_____________________
Hon. Secretary

Date of Admission : __________________________

Fee Receipt No. : ____________________________

Fee Receipt Date : ___________________________

_____________________
Superintendent
ANTI-ALCOHOL / DRUG ABUSE POLICY ACCEPTANCE FORM

FORM TO BE SIGNED BY THE STUDENT, PARENT, LOCAL GUARDIAN AND GUARANTOR AT THE
TIME OF SUBMISSION OF THE ADMISSION FORM TO THE INSTITUTION.

I, _____________________________________________ (Student’s Name) son / ward of Mr. / Mrs. / Ms.

_________________________________________(Parent’s Name) if admitted to ________________(Course & Year)
in Sheth V. M. K. Boarding School Trust during the academic year 2024-2025 & hereby agree to the
following terms:
1. I hereby admit that I am aware that the purchase, possession, use, consumption, sale, distribution
or storage of any alcoholic beverage, controlled substance or illegal drug are wrong and harmful &
are strictly prohibited in the hostel premises.

2. I understand that any involvement, whether direct or indirect, in ragging and/or bullying
within the hostel premises will result in immediate dismissal from the institution. In such
cases, I acknowledge that my fees will not be refunded under any circumstances

3. I shall refrain from using, being under the influence of, possessing, distributing, selling or
conspiring to sell or possess, or being in the chain of sale or distribution of any alcoholic beverage,
controlled substance or illegal drug.

4. I shall report to the authorities of the hostel of any irregular behavior that I observe in relation to
the possession, use, sale and distribution of any alcoholic beverage, controlled substance or illegal
drug which may have occurred at the hostel.

5. I am aware that I will be permanently dismissed from the hostel if I am found under the influence
of, possessing, distributing, selling or conspiring to sell or possess, or being in the chain of sale or
distribution of any alcoholic beverage, controlled substance or illegal drug. In case of dismissal, the
security deposit & the fees paid will not be refunded under any circumstances. The decision taken by
management will be final.

6. I shall have no objection to random searching of my hostel room, including my belongings

without infringement to my privacy, by authorized personnel of the hostel.

Date: ___________________

Name of Student: ___________________ Name of Parent: ___________________

Signature: ___________________ Signature: ___________________

Mobile No. : ___________________ Mobile No. : ___________________

Name of Local Guardian: ___________________ Name of Guarantor: ___________________

Signature : ___________________ Signature : ______________________

Mobile No. : _________________________ Mobile No. : ____________________