Application Form (For Abroad Students only) National Talent Search Examination-2021 For the Students Studying Abroad in Class X) ‘Read the instruction carefully given on the next page before filing the application form Space forthe ‘You may take the help from your teacher/parent fr filing up the application form Photograph (Passport Date of Examination 413" June, 2021 sive and Black & white) Name & address ofthe agency for conducting NTS Examination; NCERT Name of the Country The Photograph (where the candidate is studying in class X as a regular student) should be Name ofthe examination centre in india (State/City) endorsed by the (where candidate likely to appear in exam): Head of the Class Date of bith Date Month Year 1. _Name of the candidate (Do not write Miss Master) 2. _ Father's name (Do not write Mr. Dr. Prot) 3. Mother's Name (Do not write Mr.(Dr.'Prof) 4 Sex 5. Areatowhich candidates resides 6, Caste catagory of candidate 7, Disability status ae 1] [2 7 5 delGIE Mate female Real Cita GHen TT Retermerteattordetails ofcodes Nowe Please enclose a copy of the relevant certificate in support of information at Sr.No.6 &7) 8 Postal addres of the candidate for errepondencs (Do no Wee father's youe BMS) Pncote 9. Name andeaires ofthe ShotTesna in hich djing law lod 10.1ypr oft instion och djing Clas Xo Ban se Todas sched lool T] com. [2] soca 5] rrvncsiss CG] wrvatctmaas — wat V2 Medium of saint tsa ov thy theNCERT Host 13 Faber stain Se 15.Mother's Education 16, Mother's Qecupation 17 No. of family members living in the hou: CO 18, No, of roiners [] _]19.0. oF ses 20.4 ha is the case among hier bth an sisters 21. Parental anna! income 1 2 3 4 5 {p10 200.000 200.001 3.00000 3.00001 0.00.00 5.0900 6 HANA? than LO. 22. Telephone SID Code Phone 23, Femail tos 424. Mohie Numb (De not leave this column blank) “To be filed by the Hend ofthe Insitution Gazetted OMtcer Certified that (1) Master Miss, ar stadent of this School Institution snd he she iss secured % marks inthe lass LX annual exanin He ‘She has secured smarts (2) The particulars piven by hinvher in the application fry have (3) MasierMisy fFecords maintained in the tnstitation (ta be filled for SC'ST e cilia found in ord: sto Schesluled Caste Seleduled Tribe eateyory sper the ates ny lnistress Carer Offccr stuns oF the Heiss Wit scat Date se Instictinns Over ea Signature of the candidateCoding Plan ly before filing up the Application Form. Read instruction carefull Use only Blue o Black Ball Point pen WRITE IN Co sf loan baal for Physically Challenged Group of Students, ith benchmatk di roup of Students, with benchmark disabilities of which, one per cent cach shall be reserved for persons with benchmark disabilities under clauses (a). (b) and (e) and one per cent for persons with henchmark disabilities under clauses (d) and (c) ‘namely (2) blindness and low visions (b) deaf and hard of hearing: © ims and muscula (a) autism, intellectual disability, specific learning disability and mental illness: (e) multiple disabilities from amongst persons under clauses (a to (d) including deaf- blindness in the posts identified for Father’sName [| TT rr Postal Address: do not try to write complete address in one line. Break it appropriately as shown below: sae al bast PRIVATEAIDED A yenate dt PRIVAYLAINAIDUD frie Enel Sh i ad sae TTS] 7S] [MOUNT] TRO] A] Region | Sute0T Coie clulelyy ali a Non | Arnal Fas ssa 7 ‘Medium of Examination Education of Father or Mother Manipur ps (Refer to item 12) (Refer to item Nos 13 & 15) [—T eahalage Medium of Code | Education Cole Miron — 5 Examination Nagaland 76 Assamese T1_| No Formal Education T ic Sika 7 Bangla 12_[ Upto primary oe Tripora ina English T3_| Upper primary 3 a “ABN lands 0 Gujarat 14 | Seconda 4 Bikar (ao Hind T5_| Senior secondary 5 Thakand ED Kannada 16 | Graduation 6 [ors T= Marathi T7_| Post graduation 7 + Malayalam 18_{ Doctoral § Wonk | Oriya 19} Professional deeree saa ae (Engineering. Law. Tamme a Rie | 26 Medieaine, MCA, BA.) Taya 7 Baxi aa 5 —— Priimasnat Prades [35 Tamil 2 Pana > Telugu 2 Urdu B ikea cal (ctr tn Noe 418) com) Tee Fate i en a 1 a Gara 5 epee Tea z T eat ‘ee iy Takai at — Anthea Peaks Taran | ‘ Preece eee aut T Ramatakia WW ee 4 typeof Sbaaattion ee site S88) | Role ® COLRNMENE A Garten sce Ho wBh om bye Sate It 1 iakskabicae TF LOCA. wooy A Loe hr Sea wc am na “aint Si 8