NAVODAYA VIDYALAYA SAMITI

JAWAHAR NAVODAYA VIDYALAYA SELECTION TEST

CLASS VI - 2019
APPLICATION FORM

REGISTRATION NO.: 06220104065

State GUJARAT District ANAND

Name of the Candidate TULASIBEN VIKRAMBHAI SODHAPARMAR
Mother's Name KUSUMBEN Father's Name VIKRAMBHAI
Name of the Guardian KANUBHAI Relationship with FATHER
Guardian
Nationality of the INDIAN Date of Birth 05-Sep-2008
Candidate
Present Postal Address DARIYA VAGO,RASNOL.TA.ANAND. DIS.ANAND. : 388335
Telephone - Mobile No 9662828418
Gender FEMALE Category OBC
Marital Status UNMARRIED Identification Mark MOLE ON LIP
Medium of Examination GUJARATI
Disablility, if any No

Previous School Details

III Standard Details IV Standard Details V Standard Details

Name of the State GUJARAT GUJARAT GUJARAT
Name of the District ANAND ANAND ANAND
Name of the Block ANAND ANAND ANAND
Name of the Village RASNOL RASNOL RASNOL
Name of the School KANYASHALA RASNOL KANYASHALARASNOL KANYA SHALARASNOL
Recognized/Not RECOGNIZED RECOGNIZED RECOGNIZED
Recognized
School Location RURAL RURAL RURAL
Month/Year of Joining June - 2016 June - 2017 June - 2018
Month/Year of Passing May - 2017 May - 2018 -

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. I will produce all the certificates at the time of admission.

Signature of the Parent Signature of the Candidate