Application form
JAWAHAR NAVODAYA VIDYALAYA SELECTION TEST 2015-16
LATERAL ENTRY_ CLASS IX
Passport
of
individual
attested by Head
APPLICATION FORM
the
of the
Roll No.
Name of the Candidate
(in block letters)
2.
Father's name
(in block letters)
3.
Mother's Name
(in block letters)
4.
Name of the Guardian
(in case Father/Mother is not guardian)
5.
6.
Relationship with Guardian
Nationality of the Candidate
7.
Tel
STD
B.
Code
Number
Tick the appropriate Box
(a)
(c)
9.
Mobile Number:
:
:
(b)categorvgEEg
Sex
Maritalstatus:
E;'.d l@..'.dl
(d) Area
[n,*rl
F,*l
(a) Date of Bi rth (in figures)
Date
(b) Identification Mark.
school
where candidate
studying in class
VIII
(To be left blank. To be filled by the Office of Principal, INV)
1.
size
photograph
Year
2
0
::1::
l0'
)::::::T.:"noot
(b)
where candidate was srudving hisarer class
Whether reco gntzed
YesA{o
(Tick appropriate)
Medium through which candidate is studying in Class
Hindi
English
11.
12.
vrrr during 2014:2015:
VIII
:
CERTIFICATEBYCANDIDATE/GUARDIAN
certified that the information given above is true to the
best of my knowledge and belief In case
any of the information given above is found incorrect,
I will abidJ by the decision of the Samiti.
Signature of Father / Guardian(with date)
13.
Signature of Candidate (With date)
certified by the Head of the school where candid ate has
studied
durin g 2014-lS :
in class -VIII
This is certified that Master/Ms...,...
S/o, D/o
Shri..
.. ..was
studying in the School since
and
he/she has passed lappeared,for his/trer Class
As per school record his/her date of birth
vIII
examination from this school.
is......
....(in figures)-
...(in words)
HeiShe belongs to SC/ST/Other category and
his/her caste
is......
This is also certified that entries made by the
applicant in the application form are
correct as per school
record.
Date:.
Signature of the Head of School
(with officiat stamp)
JAWAHAR NAVODAYA VIDYALAYA SELECTION TEST- 2015-16
LATERAL ENTRY
ap[/tr
-
CLASS IX
cA.Rp
Day & Date of Examination
Sundav 7th June" 2015
Roll No.
Time 10.00 Hrs.
(candidates to report 30 Minutes before)
Passpost size
photograph of the
Venue
:
candidate duly
attested by head of
the school where
Jawahar Navodaya Vidyalaya
candidate studying in
ao.aa
Class
VIII.
(1)
(2)
(3)
(4)
(i)
Boy / Girl
(ii)
Gen. / SC / ST/OBC
Signature of the canaiOate
HM/Principal of the school where the
candidate is studying in his/her class VIII
during 2014-15.
Receipt No.
Received
appli.uti
D/o
Sh.
(iii)
Rural/Urban
To be left blank for obtainrng srgntture of
the candidate in the presence of center
Supdt. /Invigilator on the day of exam.
r.
S1o
Student
of
chool for admission
in Jaw ahar Navod aya Vidyalt
.)
PRINCIPAL
J.N.V.
Distt.
State
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