NAVODAYA VIDYALAYA SAMITI

JAWAHAR NAVODAYA VIDYALAYA SELECTION TEST

LATERAL ENTRY-CLASS IX - 2020
APPLICATION FORM

REGISTRATION NO.: 18020124

State ODISHA District DHENKANAL

Name of the Candidate SAI SANKAR MUDULI
Mother's Name SANJUBALA PARIDA Father's Name SARAT CHANDRA MUDULI
Name of the Guardian SUDHIR KUMAR PARIDA Relationship with UNCLE
Guardian
Nationality of the INDIAN Date of Birth 11-Nov-2006
Candidate
Present Postal Address MUNDI DEULI, KAMAKHYANAGAR, DHENKANAL : 759018
Telephone - Mobile No 8448690407
Gender MALE Category OBC
Marital Status UNMARRIED Identification Mark CUT MARKS IN CHIN
Disablility, if any NO

Details of school where candidate is studying his/her Class VIII during 2019-2020

Name of School ODISHA ADARSHA VIDYALAYA

Recognized / Not Recognized RECOGNIZED
District & State DHENKANAL & ODISHA
School Location(Rural/Urban) RURAL
Month & Year of Joining 01-Apr-2019
Expected Month & Year of Passing 31-Mar-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