STATE COUNCIL OF EDUCATIONAL RESEARCH & TRAINING BIHAR, MAHENDRU, PATNA

(APPLICATION FORM)
STATE LEVEL NATIONAL TALENT SEARCH EXAMINATION, 2021-22
( For the Students Studying in Class X )

APPLICATION NO : 12104595

Date of Examination : 16th January, 2022 (Sunday)

Name & Address of the Agency for State Council of Educational Research & Training, Bihar, Mahendru,
conducting NTS Examination : Patna-6
Name of the State/UT : Bihar
Name of the School (where the candidate DAV PUBLIC SCHOOL RATWAR MOHANIA, BLOCK-BHABUA,
is studying Class X) : DIST-KAIMUR (BHABUA)
Application Fee (in INR) :
District Applying From :

Personal Details :
Name of Candidate :
Father's Name :
Mother's Name :
Date of Birth :
id Rs. 150/- (Gen./EWS/OBC) / Rs. 75/- (SC/ST/Disabled) Candidate.
KAIMUR (BHABUA)

KRISH AGRAWAL
VISHNU AGRAWAL
RESHMI AGRAWAL
01-09-2006 Gender : MALE
Pa
Area to which Candidate resides : RURAL
Caste Category : GENERAL
Disability Status : NONE
Studying in Class : CLASS X

Communication Details :
Address Line 1 : NEAR GURUDEV ULTRASOUND
Address Line 2 BEHIND REFFERAL HOSPITAL
State/Union Territory : BIHAR PIN Code : 821109

Name and address of the School/Institution in which studying at Class X level :

School Name : DAV PUBLIC SCHOOL RATWAR MOHANIA
Address : RATWAR MOHANIA
Post Office : MOHANIA PIN Code : 821109
Block : BHABUA
District : KAIMUR (BHABUA)
School Type : PRIVATE UNAIDED
Area in which the School is located : RURAL
School Category : OTHERS
Medium of Examination :
At the State Level : ENGLISH At the NCERT Level : ENGLISH

Parental & Other Family Details :

Father's Education : SECONDARY
Father's Occupation : SALES OR SERVICE WORKER
Mother's Education : GRADUATION
Mother's Occupation : NOT EMPLOYED
No. of family members living in the house : 8 No of brothers : 0
No of sisters : 1 At what no is the candidate among his/her brothers and sisters : 2
Parental Annual Income (in Rs.) : More than 10,00,000
Mobile Number : 9113325434 Telephone Number :
Email Address : reshmiagrawal150@gmail.com

Payment Details :
Payment Type Payment Mode Amount in Rs. Payment Date Merchant's Ref. No # Bank's Ref. No.
ONLINE Wallet

Document uploaded by the Candidate :

Income Certificate
N.A.
id 150.00 28/11/2021 09:55:17

Caste Category Certificate

N.A.
110344927501 202111281112128001101686301
69920519

Disability Certificate
N.A.
Pa
Declaration by Candidate :
I hereby declare that all data reflecting in this application form are correct. I also declare that all the statements made including all documents uploaded
in this application form are true, complete and correct to the best of my knowledge and belief and in the event of any information being found false/incorrect
my candidature is liable to be cancelled even after qualifying the State Level Examination.

Date : 2021-11-26 14:40:25 Uploaded Signature of the Candidate

Certification by the Head of the Institution :

Certified that :
1. Master/Miss KRISH AGRAWAL is a regular student of this School/Institution and he/she has secured 91.80% marks in the class
IX annual examination, i.e., when he/she was promoted from Class IX to Class X. He/She has secured 459 marks out of 500 marks.
2. The particulars given by him/her in the application form have been verified and found in order.
3. Master/Miss KRISH AGRAWAL belongs to GENERAL as per the records maintained by the Institution.
4. His/Her Aadhar Number is 582094695538

Status : YOUR APPLICATION IS APPROVED

Date :- 2021-12-04 10:22:05