NAVODAYA VIDYALAYA SAMITI

JAWAHAR NAVODAYA VIDYALAYA SELECTION TEST

CLASS VI - 2019
APPLICATION FORM

REGISTRATION NO.: 07210103778

State HARYANA District PALWAL

Name of the Candidate PRACHI
Mother's Name HEMLATA Father's Name PARMOD
Name of the Guardian - Relationship with -
Guardian
Nationality of the INDIAN Date of Birth 05-Aug-2008
Candidate
Present Postal Address H NO DJ 426 RAM NAGAR PALWAL : 121102
Telephone - Mobile No 9671851818
Gender FEMALE Category OBC
Marital Status UNMARRIED Identification Mark A MOLE ON FACE
Medium of Examination ENGLISH
Disablility, if any No

Previous School Details

III Standard Details IV Standard Details V Standard Details

Name of the State HARYANA HARYANA HARYANA
Name of the District PALWAL PALWAL PALWAL
Name of the Block PALWAL PALWAL PALWAL
Name of the Village PALWAL PALWAL PALWAL
Name of the School DAV PUBLIC SCHOOL DAV PUBLIC SCHOOL DAV PUBLIC SCHOOL
Recognized/Not RECOGNIZED RECOGNIZED RECOGNIZED
Recognized
School Location RURAL RURAL RURAL
Month/Year of Joining April - 2016 April - 2017 April - 2018
Month/Year of Passing March - 2017 March - 2018 -

CERTIFICATE BY CANDIDATE/PARENT/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 abide by the decision of the Samiti. I will produce all the certificates at the time of admission.

Signature of the Parent Signature of the Candidate