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.
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— 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
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Gender | Boy Gia_| Transgender _
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‘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.
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(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
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‘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