NAVODAYA VIDYALAYA SAMITI

JAWAHAR NAVODAYA VIDYALAYA SELECTION TEST

LATERAL ENTRY-CLASS IX - 2021
APPLICATION FORM

REGISTRATION NO.: 24011077

State UTTAR PRADESH District BAREILLY

Name of the Candidate CHETAN SINGH
Mother's Name LATA DEVI Father's Name AMBIKA PRASAD
Name of the Guardian - Relationship with -
Guardian
Nationality of the INDIAN Date of Birth 28-Jul-2005
Candidate
Present Postal Address CHAK MAHMOOD BAREILLY : 243006
Telephone - Mobile No 9319878871
Gender MALE Category SC
Marital Status UNMARRIED Identification Mark NO
Disablility, if any NO

Details of school where candidate is studying his/her Class VIII during 2020-2021

Name of School SSV INTER COLLEGE

Recognized / Not Recognized RECOGNIZED
District & State BAREILLY & UTTAR PRADESH
School Location(Rural/Urban) URBAN
Month & Year of Joining 02-Jul-2020
Expected Month & Year of Passing 06-Aug-2020
Medium through which candidate is studying in Class VIII ENGLISH

CERTIFICATE BY CANDIDATE/PARENT/GUARDIAN
Certified that the information given above is true to the best of my knowledge and belief. In case any of the information given
above is found incorrect, I will abide by the decision of the Samiti

Signature of the Parent Signature of the Applicant