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Example for writing Name and Address 1 2. 3. Use only Blue or Black Ball Point Pen. Write in CAPITAL LETTERS, Do not mark or waite outside the Oxes. Leave one box blank between two words. Limit your name and /or address within the space provided for it. Please see example as given below. EXAMINATION SCHEME CODE - NMMSS - 1, Dr. S.N. Nautiyal & State Merit - 2, Both-3 For filling District. and Centre code refer page no. 4. e.g., If Distt is Dehradun, code 05 and the centre is GLC. Kalsi, centre code 30 then Distt. and Centre code will be[oys] [So Candidate Name R[E[K]#[4_ [N[e[e[i Father's Name: Postal Address : Do not try to write complete address [a] 4] s/o] Mo WE NET ROAD in one line. Break it appropriately as shown.APPLICATION FORM (Prac) NATIONAL MEANS-CUM-MERIT SCHOLARSHIP & DR. SHIVANAND NAUTIYAL & STATE MERIT (SRIDEV SUMAN) SCHOLARSHIP EXAMINATION 2020 (For the Students Studying in Class VIII of Govt., Govt. Aided and Local Body Schoo!) Read the instructions carefully before fiting the application form Date of Examination: (ter fA) 08 November 2019 (Sunday) Photo (08 digit Roll Number (o be tiles by he BE.O ates) eer he Fret ads a ols Exam Code Distet Code Centre Code Serial No. (tobe filed by the B.E.O offce) Class Date of Bh ad, @ndaado wala gre He et) oe rst RRL 8 1. speed} ar art (ft = go = Rl) Name ofthe Cancdate (do not write Masters) Father's Name (Do nol write MisDrProf) 2 Raw ae 3 maa fn = FR) Mother's Name (Do not wie Mis /OrPro) (oe wom 4 ‘ft 4. fn (Sex) ser wal) 7] 6, sruet si) (Caste Category of candidate) 140m) [7 ] asm 8 Gao wT renale) [2] we gua) [1] st (rtan) 1 {0)[3] sonst) [E] EWS) []omrepedie "71_=7r = fir Postal adkoss for corespondence (Do not wie father’s or your name) fram =) 5. soem} a sare Sa (Area where candidate resides) Rarsirn Raid (isabity status) Veualylngared None [=] PINGODE 98. ie weer # ano ug we B eer 3a (Name and aderess of the institution in which studying at Class Vi level) PINGODE 10. RTEPY | HER Type ofthe ntnaon 11. Pare aiel Rat & Area i whieh te schoo! i loated fem ; (Gow) vt 150000 [—] 13. geuri/statde 9 Telephone/Mobile No. emer 5 1] (toca! aeayy [2] (cout aides) 12, tar # afer sr Gouge YE) Parental annual income ( ¥ appropriate box) (HI St ems a BO fj (Urean) more tran 150000 [_] 14 Ge) mal adores 18, Ban 7 wr Sram sitet (Percentage of class Vi safhorcer @ eee 16, TET Boarder []] saat Non Boarder [2 ven 3 esr To be filled in by the Head of the Institution satis fear rar & A T/T We den 4 ven e 8 ooerne tw oS aR tet wr A a oh fren sRRRech AG gre oii) we Gh a Ey sar ere SPAR & Ry ew weer #1 Date ‘Signature ofthe B.E.O with otfice seal ‘Signature ofthe Principal with atfice sealDISTRICT AND CENTRE CODE FOR NMMSS, DR. SHIVANAND NAUTIYAL & STATE MERIT (SRIDEV SUMAN) SCHOLARSHIP EXAMINATION 2020 won| o See Te oe |G1C. Karanprayag zo] Pithoragarh [G:C Kanalichhina [67 omnes] oe ERECT PB | emene | re jehrachan [SBM1C, Rishikesh a Tehri 11 [@e Aindolakhal 7S Ts , eee Jo1.6, tam Noga @ Gre Pots | 9 TYPE OF SCHOOL/ INSTITUTION (Refer to item No.10) GOVERNMENT: A Government School is that which is run by the State Government or Central Government or Public Sector Undertaking of an Autonomous Organization completely Ananced by the Government LOCAL BODY A Local Body School is that which is run by Panchayati Raj and Local body istitutions such as Zila Parishad, Municipal Corporation, Munieipal Committee, Notified Area Comunittee and Cantonment Board, PRIVATE AIDED: A Private Aided School is that which is run by an individual or private organization and receives grant from government or local body, 4NATIONAL MEANS-CUM-MERIT SCHOLARSHIP & DR. SHIVANAND NAUTIYAL & STATE MERIT (SRIDEV SUMAN) SCHOLARSHIP EXAMINATION 2020 VERIFICATION FORM Space for the State level 08 digt Rott Number ve aeby 20 ume [TTT TTT} | toga tone ase fads eras a uate) oat eae gente Dialer ng os acne 1. ged wr a1 = gp Se Name ofthe Cancale one Wle Mins Mate} we 2 "to Father's Name (Do not write Mr. /Dr/Prof 5. Ei Bea) Wate Name ho nat wake i /DeT Pra 4 saReDseolbi TTP 4 ger al) 2] ef Female) [7] sft (eur) [—] ‘red (Utan) [—] 7 seed a (Cats Cag o can) Resin Re (Oust tan ‘xGer) [_] sionse) [_] 4ST) [_] fe=1(08c) [7] Onhopedic [—_] Hearing [_] Vixaly rpated [—] None[—] 6. ex mer (ese et Postal areas for correspondence (Do not wre aero your name 10, Rew era A wo Hey ear 4 We) Name and addeas ofthe nsutuon in which studying at Cle va eel Paper Signature of the Candidate Signatur ofthe Invigilator MAT SAT signature ofthe Candidete Signature the Block Education Oficer with date and Office seal NATIONAL MEANS-CUM-MERIT SCHOLARSHIP & DR. SHIVANAND NAUTIYAL & STATE MERIT (SRIDEV SUMAN) SCHOLARSHIP EXAMINATION 2020 Name of the State/(TT: UTTRAKHAND ADMIT CARD / TH wa PStocanhe State level 08 digit Roll Number (o eit byte 31.0 atic) (Passport size and "Tobe filed in by the applicant) oe ate TE | een a at Aft | ———— ‘should be at Name of the applicant Father's Name Sri tested by the N ‘ppl "Head of the fener a: $$$ gee a ar | ——— Tnstitution Name of School Name of district By sa He A PRR AF Aw 1a OER BT TT ———— Full Postal Address PIN code, Date of Examination: 03 November, 2019 (Sunday) Time of Examination: 1- MAT- 10:00 A.M to12:00 PM 2- SAT- 01:30 P.M.to 03:30 PM. Place of Examination centre (Given By B.E.O. Office) aff) & sith 81 (Is permitted to appear for the above said Examination) Signature of the Block Education Officer with Office Seal