NAVODAYA VIDYALAYA SAMITI

JAWAHAR NAVODAYA VIDYALAYA SELECTION TEST

CLASS VI - 2020
APPLICATION FORM

REGISTRATION NO.: 18111800152

State ODISHA District GANJAM

Name of the Candidate AMBIKA PATRA
Mother's Name ARATI PATRA Father's Name RAMESH PATRA
Name of the Guardian - Relationship with -
Guardian
Nationality of the INDIAN Date of Birth 20-Apr-2010
Candidate
Present Postal Address KANASUKA,GANJAM : 761118
Telephone - Mobile No 9178731142
Gender FEMALE Category OBC
Marital Status UNMARRIED Identification Mark A BLACK MOLE
Medium of Examination ORIYA
Disablility, if any No

Previous School Details

III Standard Details IV Standard Details V Standard Details

Name of the State ODISHA ODISHA ODISHA
Name of the District GANJAM GANJAM GANJAM
Name of the Block BUGUDA BUGUDA BUGUDA
Name of the Village KANASUKA KANASUKA KANASUKA
Name of the School NUPS KANASUKA NUPS KANASUKA NUPS KANASUKA
Recognized/Not RECOGNIZED RECOGNIZED RECOGNIZED
Recognized
School Location RURAL RURAL RURAL
Month/Year of Joining April - 2017 April - 2018 April - 2019
Month/Year of Passing March - 2018 March - 2019 -

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