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JAWAHAR NAVODAYA VIDYALAYA SELECTION TEST - 2020 CERTIFICATE Last date of submission of online application form ts 1S September 2019, ed thatthe information given below are correct it rexpect of KIRTTEPRLYA KISHIN (Name of Salat who studying in Cass Vin SARASWAT StisHy VEDYA. OOAMBLR i (Name of School) and interested to apply for Jawahar Navodaya Vidyalaya Selection Test 2020. Ns — Ne ‘Name of Candidate (IN BLOCK LETTERS) — | KTRTTE PRIYA KISHAN [Fate + Neme IN BLOCK LETTERS) F SURENDRA_KUMAR, KISHAN, | Mother” #Name (IN BLOCK LETTERS) PUSPA LATA _KISHAN Name of We Guardian and relationship, Wany Date of Bith | Iofigure D|DIM[M[Y[¥[¥[¥ THOUSAND. LIS {ols (Zo (710 - Gender | Boy Gia_| Transgender _ Please put ST one (mark ¥v J ‘Nature of sabi, any! Physically] Visually] Hearing Please put (¥) musk against the respective handicapped | impaired _| impaired estezory dentification mark bedt check Prevent o Small mole [ pt/P0~ GoPINATHPUR, vid REMAVETA , PS- GoNATGARH , Dis SUNORRGARH resent Postal | ‘py p zee! ‘dress | Moviene EA LQe9 3A eT wma, Prrmostkumansa hes gmail com National NOLAN. [iRetigion.. REROE. Medivm of Examination «ODT A==-= (Pleas indicate one language out of languages forthe state concemed piven inthe prospects) [Particutar Chiat CaselV Clas Name of he School (sudied = TH ATV and [SHRBSUR SKisu wad Shh studying W) and village/place dye Mardin aha peak a Sco! Loraion Rural / Urban Rural Rese [ Montane Vea ff Tinaerch 201% hs march 30/9 Nosh xarofFasing "| roach aol | mares seip [= ‘Name of the Block Bonen Bona Bona Name of te District 3 Senay garh | Sendai ee pier | Seopa Z| | certify thatthe school (s) in which my ward studiedstudying is a recognized school sand fulfills all the eligibity

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