APPLICATION FORM - 2010

Your application for "SP -Basic" has now been incorporated into our system and you have been

assigned the Application number 984357.

984357
Stream SP -Basic
Application No.

1 Name of Candidate (as in 10th Marks Card) : HIMANSHU PANDIT

2 Date of Birth (dd/mm/yyyy) : 05/06/1992
3 Category : General
4 Nationality : Indian
5 Gender : Male
Exam Board Science Maths Physics Chemistry Biology Others Aggregate
6 X Std Madhya Pradesh 68 86 N/A N/A N/A N/A N/A
(% marks)
7 XII Std Madhya Pradesh N/A NA NA NA NA NA NA
(% marks)
8 Discipline under which project has been done (SP- : Ph
Basic only)
9 Title of the Project (SP-Basic only) : CURRENT ELECTRICITY

10 In the academic year 2010-2011:

SP-Basic: I am pursuing XII Std

11 Name of College/Institution : shri agrasen vidyalaya

12 Address of College/Institution : 41-51 SNEH NAGAR INDORE
603
KHATIWALA TANK

INDORE
Madhya Pradesh
452014
09425311881 Candidate Signature:
himanshupandit161@gmail.com

CERTIFIED BY THE COLLEGE/INSTITUTION

Mr./Ms HIMANSHU PANDIT is a bonafide student of shri agrasen vidyalaya and his/her date of joining to

a. XI / XII Standard in Science Subject is on (indicate in which standard):

b. I/II Yr. B.Sc / M.Sc (Int.) / I/II Year B.E./B.Tech/B.Arch is on:

and the information furnished by the applicant is correct.

Date: Signature of the Head of the Institution

Place: Name:

Institution Seal:

However, your application is not complete until you do the following:

1. Take a print out of this Application Form and make sure that it is complete with a number then
affix your signature. Please also obtain your School / College Principal’s signature and seal in
the appropriate place. Do not make any changes / alterations to this page.
2. Application Fee: Processing fee for application is Rs. 200/- (Rs. 100/- for SC/ST) by
means of remitting Rs. 200 (Rs. 100/- for SC/ST) “to any core banking branches of STATE
BANK OF INDIA, payable at all branches in India.
Paid into the credit of Administrative Executive, KVPY A/c. No. 10270577392” and send
the “pay-in-slip” (Applicants are instructed to down load the “pay-in-slip” from KVPY web
site – http://www.kvpy.org.in/ ) along with the Application, clearly indicating the stream (SA,
SB+2(SX), SB, SP). Ensure that you write the Application Number on the reverse of the Pay-
In-Slip as well as other documents that you send along with this application.

* Girls students are exempted from payment of processing fee.

** Physically challenged candidates are also exempted from payment of the fee and
should provide the certificate issued by the competent authority.

3. For Stream SB+2 (SX) – The student aspiring to join undergraduate program in Basic Sciences
for the session 2011 – 2012.
4. Streams SP-Basic Sciences and SP-Medicine/Engineering – The application must be
accompanied by two recommendation letters in the prescribed forms one form from Teacher /
Instructor in your College/University and the other from the Advisor/Supervisor of your KVPY
project (Bio-Medical Project). Each recommendation letters must be placed in different
envelopes, sealed and with signature of the person giving the recommendation across the
sealed envelopes. These sealed envelopes must accompany with your application.
5. Enclose the following:
o Caste certificate in the case of SC/ST candidate
o Project report in the case of SP – Basic Sciences / Medicine
o Original Pay-In-Slip of the Processing fee of Rs. 200/- (Rs. 100/- for SC/ST).
o Attested copies of your marks statement of the qualifying examination(self attestation
is acceptable ) for Stream SP only
6. Send all the above documents to
The Convener, KVPY
Indian Institute of Science
Bangalore – 560 012
on or before 10/09/10
7. Last date for closing of online application is 9th September 2010 at twelve O’ clock midnight
8. You may check to see that your application is complete and all documents received at the KVPY
office by going to http://www.kvpy.org.in/ . Please allow at least 20 days after sending your
documents for postal delays for status information.
9. Issue of hall ticket – through KVPY website (for online applicants only for SA, SB+2(SX), SB)

Website URL: http://www.kvpy.org.in/

Login ID – Application number
 Password – Date of Birth

Download additional project report document for SP-Basic Sciences (right click on link and select save
as), to be completed and sent along with this page.