STATE COUNCIL OF EDUCATIONAL RESEARCH & TRAINING BIHAR, MAHENDRU, PATNA

(APPLICATION FORM)
STATE LEVEL NATIONAL TALENT SEARCH EXAMINATION, 2019-20
( For the Students Studying in Class X )

APPLICATION NO : 11911602

id
Date of Examination : 17th November, 2019 (Sunday)
Name & Address of the Agency for State Council of Educational Research & Training, Bihar, Mahendru,
conducting NTS Examination : Patna-6
Name of the State/UT : Bihar
Name of the School (where the candidate HANSRAJ PUBLIC SCHOOL, BLOCK-BODH GAYA, DIST-GAYA
is studying Class X) :
Application Fee (in INR) :
District Applying From :

Personal Details :
Name of Candidate :
Father's Name :
Mother's Name :
Date of Birth :
GAYA

KASHISH KUMARI
MISHRI CHAND
REKHA DEVI
21-02-2005
Pa
Rs. 150/- (Gen./EWS/OBC) / Rs. 75/- (SC/ST/Disabled) Candidate.

Gender : FEMALE
ot
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
N

Communication Details :
Address Line 1 : MANPUR SHIVCHARAN LANE PO+PS-BUNIYADGANJ GAYA
Address Line 2
State/Union Territory : BIHAR PIN Code : 823003

Name and address of the School/Institution in which studying at Class X level :

School Name : HANSRAJ PUBLIC SCHOOL
Address : VILL - KHARANTI, BODHGAYA
Post Office : AERODRAM PIN Code : 823004
Block : BODH GAYA
District : GAYA
School Type : PRIVATE UNAIDED
Area in which the School is located : URBAN
School Category : OTHERS
Medium of Examination :
At the State Level : ENGLISH At the NCERT Level : ENGLISH

Parental & Other Family Details :

Father's Education : UP TO PRIMARY
Father's Occupation : OPERATORS AND LABOURER, WORKER NOT CLASSIFIED BY THE ABOVE OCCUPATIONS
Mother's Education : UP TO PRIMARY
Mother's Occupation : OPERATORS AND LABOURER, WORKER NOT CLASSIFIED BY THE ABOVE OCCUPATIONS
No. of family members living in the house : 5 No of brothers : 1
No of sisters : 1 At what no is the candidate among his/her brothers and sisters : 3

id
Parental Annual Income (in Rs.) : Upto 2,00,000
Mobile Number : 8092841456 Telephone Number :
Email Address : kashaug21@gmail.com

Payment Details :
Payment Type Payment Mode

Document uploaded by the Candidate :

Income Certificate
N.A.

Declaration by Candidate :
Amount in Rs.

Pa Payment Date

Caste Category Certificate

11911602_caste.pdf
Merchant's Ref. No # Bank's Ref. No.

Disability Certificate
N.A.
ot
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.
N

Date : 2019-09-26 19:11:59 Uploaded Signature of the Candidate

Certification by the Head of the Institution :

Status : YOUR APPLICATION IS PENDING

Date :-