KENDRIYA VIDYALAYA SEcTOR 5 DWARKA, NEW DELHI

CLASS XI(2022-23) OPTION FORM SHIFT-|

Ao23-4
1. Name of theapplicant: YASH GAUTAM
Z. a) DOB: O9-o3 - 2007 b) Aadhar Number 7370 4597 Z55 T
3. a)i)Father's Name BRAJESA kymARGANTAy
Service Category YASH GAUTAM
4. ii) Occupation...BLISI N.Es5..CPR)NA ÍE).. 29.09.2021
b) i)Mother's Name MAMTA GA4ÜHy
i) Occupation.teuS4£.É.. Service category.

Admission No.
5. Previous Year Class X(2021-22) Section A
6. Category (Gen/SC/ST/OBC/PH) (attach self attested certificate )VSC
7. Correspondence Residential Address G GALI No4, RAJA puRI
8. Mobile No. 1.e33475L Mobile No. 2. &6 70333
9. Result of class X (a) CBSE Roll Number 4 4S13O
b) Marks Obtained :(attach self attested copy of class Xdigilocker marksheet)
Maths Science English Social Science Hindi Total Percentage

52 A7 52 265 53/
10. Participation Certificate (Tick) if any Adventure
S. No. Scouts Sports
Rastrapati Pursashkar SGFI 10 Days
KVS National/State Camp
2 Rajya Purashkar with 7 Badges
3 Tritya Sopan with Sbadges KVS Regional/District

NOTE: Atach Self attested certificate of participation (if any)

11. Subject Option
Optional Tick
S. No. Stream Compulsory subject
English, Physics, Chemistry, Maths, , Ph. Edn CS/HindiCore
Science English, Physics, Chemistry, Biology, Ph. Edn Maths(Hindi Core
2 Science
English, Accounts, Business Study, Economics, Ph. Maths/ Hindi Core/1P
3 Commerce
Edn
Humanities English, Hindi, History, Geography, Ph. Edn Economics/ Pol Sc

Undertaking
option form is submitted for
Ido hereby undertake that my ward will not change the stream/subject once the
admission in class XI

Dated:2OMAY 223 Signature of Parents/ Guardian

NOTE: All the documents must be attested by parents.

For office use only
Subjects opted (1) English (2) (3) (4) (5)
(6) Physical Education

) Section Allotted

Admission In-charge Principal

Signature Signature
OFFICE OF THE DEPUTY COMMISSIONER
S.No. :Sq9/967/4024/27/9/2013/90519671146101
(SOUTH WEST DISTRICT, DELHI
Dated :14/12/2013
SCHEDULED CASTE/SCHEDULED TRIBE CERTIFICATÆ
This Is to certify that, Sh. /Sot./ Kunmad
S91ALI YA`H GAUTAM S/o, D/o, W/o
NOARAURIVITANNAAAR
Tribc which is recognised as a schedoled NEWDELHIbf Shri.BRAJESH
the State KUMAR GAUTAM Resident of
U.T De!ht bekngs to tha
Caste/ Trlbe JATAVA LE
Thà Constitution (Scheduled Castés
The Constitution (Scheduled order, 150. asUnder:
The Constitution (Scheduled Tribes) Order, 1950.
-The Constitution Castes) (Union Territory) Order, 1951.
(Scheduled Tribes).(Union Tefrltory) Order, 1951.
(As amended by the Scheduled
Castes & Scheduled Tribes Lists
1960. The Punjab Reorganisation Act, 1966. The (Modification), 1956, the Bombay reorganisation Act,
STate of Himachal
Reorganisation Act 1971 and the Scheduled Caste and Pradesh Act, 1970. The North Eastern Areas
Scheduled Tribe order
The Constitution (J&K) SCorder 1956. The (Amendment) Act, 1956.)
(Dadar & Nagar Haveli) S.C. order 1962. The Constitution (Andaman & Nicober Island) S. T. order 1959, The
(Pondicherry) SC order 1964, The Constitution Constitution (Dadar & Nagar Haveli) S.T. order 1962.The Constituticn
(UP) ST order 1967. The
order. 1968.The Constitutíon ((Nagaland) ST. order Constitütion
Constitution (Goa, Daman and Diu) SC &ST
Order, 1978. The Constitution ()&K)S.T. Order i970, The Constitution(sikkim) Scheduled Tribes& Schedule Caste
Constitution (ST) order. (Amendment)PÁCts, 1991. 1989. The Constitution (SC) Order (Amendment) Acts1990.Hhe
59RICDELHOF
Applicable in the case of Scheduled Castes / Tribes person who have NTRIOT DEESOE
mlgrated from other state/0.TAdmilnistratlon
This certificate I_ Issued on the basls of the
BK.GAjTAM Father of Sh./Smt/Kumari Y¬SH Scheduled Caste/Tribe certificate Issued to Shri RSRCHDELHY
belongs!toJATAVA ribe in the StateU.T: UP resident oftheDISTT:MAINPURI UTTAR/SmtKümari
GAUTAM
Z5/07/ issuedby TEHSILDAR Vide their PRADESH N 3-D:tad
who
Shri 7 Smt. / Kumari YASH GAUTAM and his /
PURI UTTAM NAGAR NEW DELHI. her family members ordinarily resides at
G-91GAL0 N0-14 RÁJA
I:ifirate i_ issted on the
b
fJavit
subrmitted by An!
Verification by' r.wt
bWNR
Executive MagistraeDWARKAJRAWA
Exec1 Aagisu
SDM OfComplex
CTo-Dehi
NajatgarhNEDemË 1 0 43
A 258246
 http://cbseresults.nic.in

Central Board of Secondary Education

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CENTRAL BOARD OF SECONDARY EDUCATION

Secondary School Examination (Class X) 2023
Roll No: 14145130
Candidate Name: YASH GAUTAM
Mother's Name: MAMTA GAUTAM
Father's Name: BRAJESH KUMAR GAUTAM
Date of Birth 09/03/2007
School's Name: KENDRIYA VIDYALAYA SECTOR 5 DWARKA NEW DELHI

sUB NAME 1.A/ POSITIONAL

SUB CODE THEORY PRACTICAL TOTAL
GRADE
184 ENGLISH LNG &LIT. 024 020 044 D2
002 HINDICOURSE-A 032 |020 052 D2
241 MATHEMATICS BASIC 050 020 070 A2
086 SCIENCE 032 020 052 C1
087 SOCIAL SCIENCE 027 |020 047 D2
ADDITIONAL SUBJECT
ARTIFICIAL
417
INTELLIGENCE
024 050 074 D1

Result: PASS

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Note: Abbreviations used against Result:
R.L. - Result Later (Your result is under preparation and it will be declared soon), N.E. - Not Eligibile, R.W. -
Result Withheld, ABST - Absent
cOMP - Compartment, UFM - Unfairmeans, XXXX - Improvement, SJD - Subjudice, N.R. - Not Registered

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