ANDHRA PRADESH MODEL SCHOOLS

ANDHRA PRADESH:: IBRAHIMPATNAM, VIJAYAWADA

ENTRANCE EXAMINATION FOR 6 TH CLASS 2019-20

Personal Details
1 Reference Id : 19000709
2 Surname : MALICHI
3 Candidate Name : MALICHI NILIMA
4 Aadhar Number : 501531087562
5 Father Name : M VAMSI
6 Mother Name : M KEERTHI
7 Date of birth : 26/8/2009
8 Gender : Female
9 Address : KADALURU , TADA MANDAL
SPSR NELLORE DIST , Mandal : Tada
District : POTTI SREERAMULU NELLORE ,
Pin: 524121
10 e-Mail : APMS.TADA@GMAIL.COM
11 Mobile : 9550970660
12 Do You Belong to Andhra Pradesh State : Yes
13 Reservation Category : SC
14 SubCaste : MALA
15 Whether the Annual Income of Parent is Yes
below Rs.60,000 :
16 Whether Candidate is Local/Non-Local : Local
17 Are you a Physically Handicapped(PH) No
Person :
School applying for
18 District : POTTI SREERAMULU NELLORE
19 Mandal : TADA
20 School : GRADDAGUNTA
21. Education Details
S.No Year Of Study Class in which Medium of District in Whether the Whether the
Studied/Studyi study which school of School is School is
ng study is located (Govt./Govt located in
( District Name) Aided/ Govt Rural/Urban
Recognized)
1. 2017-2018 4th Class TELUGU POTTI Govt Rural
SREERAMULU
NELLORE
2. 2018-2019 5th Class TELUGU POTTI Govt Rural
SREERAMULU
NELLORE
22.Payment Details
Fee Amount Journal Number Payment Date
30 /- QUR27896877420 22/08/2019
DECLARATION
The information furnished above is true and to the best of my knowledge. I will produce the original certificates
as and when asked by the Department at the time of Admission. I am aware that any wrong information furnished by
me disqualifies my selection automatically

Signature of the Parent

Signature of the candidate.

NOTE: After Submission of online application the same print copy for admission must be submitted to the concerned
Principal of Andhra Pradesh model school in which the candidate is seeking admission.
Sd/-
MALICHI NILIMA ,22-08-2019 10:38:50 AM