Professional Documents
Culture Documents
(APPLICATION FORM)
STATE LEVEL NATIONAL TALENT SEARCH EXAMINATION, 2019-20
( For the Students Studying in Class X )
APPLICATION NO : 11911663
Personal Details :
Name of Candidate :
Father's Name :
Mother's Name :
Date of Birth :
id Rs. 150/- (Gen./EWS/OBC) / Rs. 75/- (SC/ST/Disabled) Candidate.
GAYA
PRITY KUMARI
KRISHNA PRASAD
MINA DEVI
04-12-2004 Gender : FEMALE
Pa
Area to which Candidate resides : URBAN
Caste Category : O.B.C. (Sub Cst.- E.B.C., State -BIHAR, Caste/Community-PATWA)
Disability Status : NONE
Studying in Class : CLASS X
Communication Details :
Address Line 1 : MANPUR SHIVCHARAN LANE PO+PS-BUNIYADGANJ GAYA
Address Line 2
State/Union Territory : BIHAR PIN Code : 823003
Payment Details :
Payment Type Payment Mode Amount in Rs. Payment Date Merchant's Ref. No # Bank's Ref. No.
ONLINE Wallet
Disability Certificate
N.A.
Pa
Declaration by Candidate :
I hereby declare that all data reflecting in this application form are correct. I also declare that all the statements made including all documents uploaded
in this application form are true, complete and correct to the best of my knowledge and belief and in the event of any information being found false/incorrect
my candidature is liable to be cancelled even after qualifying the State Level Examination.