ANNEXURE –I

Format: CBSE Expression Series Submission Form

(You need to write all these details on the each sheet you use for submitting the entry.)

Fill all details. All fields are mandatory: Name of Participant: Saina Priyadarshini Class: V
Section B Gender:M/ F / Other Differently Abled: Yes/ No(tick one) Name of the School
with complete address: Dr. ANK DAV Public School, Basanti Colony . Rourkela -12,
Sundargarh, Odisha

Name of City/Village: Rourkela State: Odisha Contact Number of participant/parent(whichever

is applicable):9040088550 Contact No. of School 9040542458 Email address of
participant(whichever is applicable): aj.arijita@gmail.com .