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APPLICATION FORM. STATE LEVEL NATIONAL TALENT SEARCH EXAMINATION 2019-20 (For the students studying in class X) ‘aio ay soa Wa TET ira apseon 11 eit Number Stata Lovel ‘State Coce CenterCode—_SefalNo(Oficstof) 2. Fathers Nati [Dont we NEIDET PT aE a @ a ees Ose bl 3025 Sy IS aie erak tegen meatal eaalmaemntsna eels? De ee EE Dasara tsepnctsamaonserno Yond Ones wtb ‘Geperl candi Postal ares correspondence (Donate fater'seryour name) Pin Code Pin Code 10.Typeitheinatuvonin which staying Clas X ve ee defnionovereaP) toca Prat Peale a sesy CE) Ait TE) aid 1 araineiche coaisiocatad Fut 1 uve 20 10a. Are you Student of Kendriya Vidyalaya Navodya VidyalaIfyeswrite1#Nowrite2 — [] ‘0b Myes wre 1 ForKensiyaVdylaya 2ocNovadayaViyalays — C] ‘2Mesumoterannaton(aattesiaoiew! CT ]manencerrioe [fa raverseveaten eFaheroccipaton []stoteresicaion Cf Monerscoapaton F7eoteniynenters — CT] tanmbercttenes —[] te Nenberetaites Bo. Avnstumoersacantilie = 2 ‘mong hs herbroherandsiter 21.Parentaannualincone: Lupi=200.000 200,001%3.00.000 200,01» 800.000 _s00.00112 100,000 Moretran 100,000 ae Coin O71) 24. Mobie : : "Tobe Wlled aby the Head af he Tnsitlon Ceniostnat (DMsto iss is arogulr student ofthis schoolInsituon andholshe has soured ‘umarksin the ass ‘Rana oxaranaicn wien aise was promoted tom XtoX Helsho cours mane outet (Gandiate nt a he ctr announces tie Siaia/ UT). i iegrigaa vents inharin ne appcatontoe ave been etalon ete oe {nation (Tobe ied er OBCISCISTHEWS candidates iy) ee ‘aie Signe ita cadmas wan Seat ‘Signature ofthccandioe (Ses instruction Overt) CODING PLAN Read Instruction carefully before filing up the Application Form Use onl ue Black Bal PointPen. WRITE INCCAPITAL LETTERS. Donotmarkor wit ouside thaboxes. LUsve oe box blank between to word. Linyeur name andaderessyrhn tne space prowdedord, Please ee example as genbelow. Coss(X) oniyane ofthe appropriate boxesintomnos 56,760, 10, "120821 Pease wre code rumor eros 03, 10b, 12, 3, 1,18 and 18. ven below and wie be name OBC in Sb at appropiate bo. [isthe esporatity of he eangiates and tn prin oe soa te cepost ne ed fom athe concemad exarsnaton cane fr he ‘st (se the page 5) bere th as date No request er condoning delay submission wl be elertainedbeber fis oe tthe fat tthe ‘anddate or the Headmastor/Pnipal ths Merintiton, 309-2019 ast date of submission ftom, Incomplete or defoctve appt are fabio boreectoa 27% quata is reserved for the students Belonging 19 OBC Catogary (Non - Creamy Layer a cen ist aval ‘oerpane centalistatate view aapx {810% uaa is reserved for economical weaker secon (EWS) those who have not covered under the resoraton scheme or SCHSTS Joacs, {ator physcaly challenged group of students th bench mark dlssiies of whieh ona percent each shal be reserved for person wh ‘benchmark asabily unde clauses (a) (b)ande, and one percat or person wih benchmark dlosblies under clauses) and) namely. (oybindnessandiow vison (LY) (0) deatandhardothearng(OH) {c)ocomotr ast ncudig cerebral pals leprosy cred dwarfism acd atlackvisins and muscular dystrophy. (LD) {chautemintalectual Saab, specteleaming Seaby sndmental lines, (ID) {@) multiple dsablies fem amangs! persons under dausos (ato) ncn de blindnessinthe posts dante foreach sbi. (MD) ‘example torwnng name anaacccess Famerseame + (OTPLTSUINIGTE] 2 omtrTHelal Telolatol TTT) Pinf2 DT Toles) elalabalsIea LT Tul Tel TT TTI elu of fxariaton Eacaton of Falher or Maher FatherstMothers Oonupaton iRoterta tem 12) (Roterto tem No. 13815), iRoterta tem No. 14818), Tredm of Eavcaton ‘code Eroneaton Code | TnoFomalEaueion 1 || Occupation Cote Sette Mt) Tipo Priny 2__| | Protesiona 1 Banga 7 — 5 aa 1 [eserves ‘rou and managerial z Seedy « Ciera 3 Si ‘tT Serer Senda 5 Hing 6 | 7 [Basins 4 Karas a 7] | Aarts, Fishery 5 neat | Pr 7] rroose @ = a alain and Tanepat Fates ae al Operators and Labourer 7 ce 181) (engretrg Metin Pai 2] | ca wea we) | [Retemptyed 8 Tei FA Teun z Vas zB Region State ‘code Nox tar Pradesh 31 “TYPE OF SCHOOL INSTITUTION (refer item no. 10) (GOVERNMENT ‘AGovernment Schoolis thatwhich is run by the State Govenment or Central ‘Government of Public Sector Undertaking or an Autonomous Organisation completely Financed by the Government, LocALsopy ‘ALocal Body Schoolis that whichis run by Panchayati Raj and local body institutions ‘such as Zila Parishad, Municipal Corporation, Municipal Committee, Notiied Area. ‘Committee ang Cantonment Board. PRIVATEAIDED. ‘APrivate Aided Schoo! s that which srun by an individual or private organization and ‘receives grant from government orlocalbody. PRIVATEUNAIDED: Private Unaided Schoo is that whichis managed by an indlvidualora private ‘organisation and idoes not receive any grant either rom government or local body. ELIGIBILITY ‘Studentof class X studyingin eecagnized school are eligible to appear forthe respective lass_Xstage | examination conductedby te states/UT in which the school are located. ‘Therewillbe no domicile restriction EXAMINATION Each district ofthe state has been alloteda examination centre, students are required CENTRE themselves o submit their application forms at the allotted centre of the istrict after Torwarded by he Prncipalol the institution where tney are stuaying. Listor the ‘examination centre ofeach districts given onthe page No.5 of application form. please

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