National Institute of Open Schooling

Online Admission Form 201617 (Stream 2 for October 2016 Exam)

NIOS COPY

B1416209342

ReferenceNo
Region :

Dehradun

Candidate's
Name

KMPREETI

Fathers Name

SANJAY

Mothers Name

SHASHI

DateofRegistration:29June2016
7:52:13

Onerecentcolour
passportsize
photographspasted
(NOTTOBE
STAPLED)onthe
printedapplication
form.The
Photographshould
havenameofthe
Learnerandthedate
ofphotographtaken
elsetheformwillbe
rejected

Guardians Name
Postal Address

C/ONITINSHARMA,F10
FIRSTFLOOR,SURYA
COMPLEX
RANIPURMORE,JWALAPUR
HARIDWAR
UTTRAKHANDPincode:249407

YourSignature

Subjects Already
Hindi(201),English(202),HomeScience(216),ScienceandTechnology(212),SocialScience
Studied
(213)
Subjects Offered
Hindi(201),English(202),ScienceandTechnology(212)
AIs (study Centre) Selected are 1.SHIVEDALE SCHOOL (340168) 2.ADARSH SHISHU NIKETAN
UCHACHATTAR (340165) 3.Kendriya Vidyalaya No.1 (340031)
Date of Birth:6April1998

Telephone:

Mobile:9319121508

Gender:Female

Category:General

Disability:Notapplicable

Course Applied For:Secondary

Medium:Hindi

Nationality:Indian

Admission under Dual enrolment:NO

Email:preeti.1122@rediffmail.com

Previous Qualification:IX

Mode of Payment:DEBIT_CARD>Admission Fee:1250.00+Examination Fee:870.00+Change/Add.Sub Fee:0.00+TOC Fee:

300.00=Total Fee including RS. 50 as cost of application:2420.00
Bank Transaction Reference No:rw4sh4
Transfer of Credit: YES >Enrolment No:16014392Year of Exam:2016 > TOC Board:UttarakhandBoardofExamination,Nanital
S.No.

Subject Code of NIOS

1.

Marks Obtained
Theory

Practical

Total

HomeScience(216)

36

18

54

2.

SocialScience(213)

27

18

45

3.

4.

Declarationbyapplicant:IherebydeclarethatIhavereadandunderstoodtheconditionsoftheeligibility.Ihavefurnishedallthenecessary
documentsandinformationcorrectly.IunderstandthatmycandidatureisliabletobecancelledbyNIOSintheeventofanyinformationor
documentistobefoundmisleadingorincorrectatanystage.IaccepttheadmissionruleslaiddownbyNIOS.
SignatureofParent/Guardian_____________________Date:_____________SignatureofCandidate:______________

Enclosures (Please (Tick) as applicable) :

1.OnePrintedOnlinefilledinapplicationform
2.Onerecentcolourpassportsizephotographspasted(NOTTOBESTAPLED)ontheprintedapplicationform.ThePhotographshouldhavenameoftheLearnerandthe
dateofphotographtakenelsetheformwillberejected
3.AttestedcopyofproofofDateofBirth
4.AttestedcopyofCertificateforSC/ST
5.TransferCertificatefromthelastschoolattended

6.OriginalFailure/CompartmentMarksheet(notlaminated)ofClassXorXII(foreligibilityofAdmission)
7.AttestedcopyofMarksheetofClassXBoardExamination
8.CertificatefromthecurrentEmployerforExServiceman
9.CertificatefromaGovernmentHospitalforahandicappedperson
10.OriginalFailure/CompartmentMarksheet(notlaminated)ofClassXorXIIforTOC

For Office Use only

Dated:___________________Checked&VerifiedSignature:_______________NameoftheOfficial______________
Reference No: B1416209342

Enrolment No.:_________________________

GeneratedBy(Name):____________________Signature:_______________
CUTFROMHERENEATLY
INSTRUCTIONS TO BE FOLLOWED AND RETAINED BY THE LEARNER
1.ReadtheinstructionscarefullybeforeformisbeingdispatchedtoNIOS.
2.SendtheNIOSCopyofOnlineAdmissionForm201415(Stream2)alongwiththerequireddocumentsandbankdraftofrequisitefees,incase,feeispaidthroughBankDraft
within5daystotheNIOS.
3.KeepphotocopyoftheNIOS CopyofFilledinonlineadmissionformwithyouforallfuturereference.
4.FordispatchoftheformtoNIOS,pastetheaddresssliponanenvelopekeeptheOfficeCopyofOnlineAdmissionFormalonwithenclosuressafelyintheenvelope.
a.LaminatedMarksheetwillnotbeacceptedforTOC
b.TheCBSECandidatesofyear2010onwardsmayentertheSubjectGradepointsforTOC
5.PleasenotethisReferenceNumberB1416209342 carefully for all future correspondence and monitoring the status of your candidature.
6. Kindly note the following in case of confirmation of admission:
(i) Enrolment Number will be issued through Email and on the Net through Public Comment.
(ii) ICard will be dispatched at your address.
7. The first examination for Stream 2 will be held inOctoberl 2016.
8. Only one Form be send in one envelope.
9. Contact numbers are : 0120 2404914/2404915/2404916
10. For any queries Contact Learner Support Centre at 18001809393.
11.AddressProofaspertheAnnexurementionedintheAdmissionform

ADDRESSSLIP
CUTFROMHEREANDPASTEONTHEENVELOPE

Application for On Line Admission 201617 Stream 2

Reference No: B1416209342

From:
KM PREETI,
C/O NITIN SHARMA, F10FIRST FLOOR, SURYA COMPLEX
HARIDWAR
UTTRAKHAND249407

To,
National Institute of Open Schooling
Regional Centre Dehradun
69/106, Niranjanpur,
Opp. I.T.I, Dehradun 248001