Lord Buddha Education Scholarship 2015 SCHOOL CATEGORY APPLICATION FORM Conducting Organization: National Bureau of Professional Testing, Education Division PERSONAL AND CONTACT DETAILS: 1. NAME: Mr. / Miss............................................ 8. ADDRESS: .................................... 2. FATHER’S NAME: ............................................. ..................................................... 3. MOTHER’S NAME: ........................................... .................................................... 4. DATE OF BIRTH: ............................................... 9. TOWN/CITY: ................................ 5. GENDER: 10. STATE: ........................................ Male Female STUDENT’S PHOTO 6. EMAIL- ID: ....................................................... 11. PINCODE: .................................... 7. MOBILE: ........................................................... 12. STUDENT’S SIGNATURE: .......................................... SCHOOL AND CLASS DETAILS: 1. CLASS: ............................................................. 2. SCHOOL NAME: .............................................. ........................................................................ 3. AFFILIATION: CBSE ICSE STATE BOARD........................................ 4. TOWN/CITY: ................................................... 5. TEST DATE: 20-09-2015 FEE DETAILS: (For FEE payment, check instructions at the end of form) 1. Application Fee: Rs 200 Mode of Payment (Tick) NEFT/NET BANKING Cash Deposit at Union Bank IMPS Payment via ATM Any Other............................................ 2. Date of Fee Payment: ..................................... 3. Place: .............................................................. 4. Transaction/Journal Number: ........................ ........................................................................ INSTRUCTIONS:    The completed application form should be sent to the address below or submitted to school coordinator or Principal. NATIONAL BUREAU OF PROFESSIONAL TESTING, GCS-16, PLOT No: CGH-3, GOLD CREST TOWER, Vaibhav Khand, Indirapuram, GHAZIABAD, UP-201014 Please fill all details clearly with black/blue ball pen, before submitting/sending. Fee payment details: Payment of application fee is to be done:FOR THE CREDIT OF/ BENEFICIARY: NATIONAL BUREAU OF PROFESSIONAL TESTING ACCOUNT NUMBER : 640301010050050 (CURRENT ACCOUNT) BANK NAME : UNION BANK OF INDIA, KAUSHAMBI BRANCH, GHAZIABAD 201001 (U.P) IFSC CODE : UBIN0564036     Keep a copy for future reference. This is hand fill form for school Category of LORD BUDDHA EDUCATION SCHOLARSHIP 2015. Please do not attach anything with this APPLICATION FORM. Filling all particulars is compulsory.