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: Dibyashree Mahakul
Class: VIII Section D 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): 9439077523 Contact No. of School 9040542458 Email address of participant (whichever is
applicable): aj.arijita@gmail.com .