SAMSI AL-HAI MISSION

Student Information

Please provide the student's personal details as per official records.

Name of Student *

Date of Birth * Date of birth is required

Gender * Please select gender

Blood Group

Nationality

Guardian & Address Details

Provide parent/guardian information and residential address.

Parent/Guardian Name * Guardian name is required

Relationship * Please select relationship

Village / Street *

Post Office *

Police Station *

District *

Pin *

Contact Number * Valid contact number is required (10+ digits)

WhatsApp Number *

Academic Information

Tell us about the student's previous school and academic background.

Previous School Name

Last Class Passed

Class Applying For

Medium of Instruction of Previous School

Academic Achievements (if any)

Documents & Consent

Upload a photograph and required documents, then provide your consent.

Student Photograph

Click to upload student photograph

JPG or PNG, max 2MB

Required Documents

Click to upload documents

Birth certificate, previous marksheet (PDF, max 5MB)

Verification *

What is 7 + 5 ?

Incorrect answer, please try again

I hereby declare that the information provided above is true and correct to the best of my knowledge. I understand that any false information may lead to cancellation of admission.

You must accept the declaration

Application Fee Payment

A one-time, non-refundable application fee is required to process your application.

Application Fee

₹500INR

Non-refundable • Valid for one application

Application Processing Fee₹450

Payment Gateway Charges (GST)₹50

Total Payable₹500

Select Payment Method *

Credit / Debit Card Visa, Mastercard, RuPay UPI GPay, PhonePe, Paytm Net Banking All major banks

Card Details

•••• •••• •••• ••••

Card Holder YOUR NAME

Expires MM/YY

Card Number * Enter a valid 16-digit card number

Card Holder Name * Card holder name is required

Expiry Date * Enter valid expiry (MM/YY)

CVV * Enter 3-digit CVV

Secure Payment: All transactions are encrypted with 256-bit SSL. We do not store your card details.

256-bit SSL PCI-DSS Compliant Verified Gateway

Review & Submit

Please review your application details carefully before submitting.

Student Details

Full Name—

Date of Birth—

Gender—

Blood Group—

Nationality—

Guardian & Address

Guardian Name—

Relationship—

Contact—

Email—

Address—

Academic Information

Previous School—

Last Class Passed—

Applying for Class—

Stream—

Payment

Application Fee₹500 (Paid)

Payment Method—

Transaction ID—

Application Submitted Successfully!

Thank you for applying to Smart Academy. Your payment of ₹500 has been received. Please save your reference number for future correspondence.

SMA-2026-00000

Payment Confirmed • Transaction ID: —

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Online Application Form

Student Information

Guardian & Address Details

Academic Information

Documents & Consent

Application Fee Payment

Application Fee

Card Details

UPI Payment

Net Banking

Review & Submit

Application Submitted Successfully!