| School Name & Location | |||
| 1. Medium | |||
| 2. Mother Tongue | |||
| 3. Language Group | 1st Language | 2nd Language | 3rd Language |
| 4. Student Name (Eng) | |||
| Student Name (Kan) | |||
| 5. Father Name | |||
| 6. Mother Name | |||
| 7. DOB | Gender | ||
| 8. Child admitted under RTE quota | |||
| 9. Blood Group | Religion | ||
| 11.Child Aadhar | |||
| 11(a).Father Aadhar | |||
| 11(b).mother Aadhar | |||
| 12. Category | |||
| 13. Student Caste | |||
| 14. Father Caste | |||
| 15. Mother Caste | |||
| 16. BPL | Card No | ||
| 17. Bhagyalakshmi Bond | |||
| 18.Child with special need | |||
| 19. Special Category | |||
| TC NOT PRODUCED SECTION | |||
| 24. Student Caste | |||
| 25. Father Caste | |||
| 26. Mother Caste | |||
| 27. BPL | Card No | ||
| 28. Bhagyalakshmi | |||
| 29. Special Need | |||
| 30. Category | |||
| 31. Pincode | 32. District | ||
| 33. Taluk | 34. City | ||
| 35. Locality | |||
| 36. Address | |||
| 37. Student Mobile | |||
| 38. Father Mobile | |||
| 39. Mother Mobile | |||
| 40. BMTC Pass | |||
| Signature | |||