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 National Institute of Open Schooling
ThAMATU 5 foy qoh{UT AYa/Registration Form for Assessment/Certification
au ART HIEKGTT A-2022-27/ New India l.iteracy Programme- 2022-27

Colored Passport
Se Photograph
of Learer

Name of State/UT:
pr/Dlstrict: S.No (3 Digit)
UDISE Code (11 Digit)
Registration No:
HFUIha qeroT ( )
Mode of Assessment: Please Tick Assessmnent Test (

Name of earner in English (in capital

letters)

Father's/Husband's Name of Learner:

Mother's Name of Learner

faarfe ( ) 4faqfp ( )
Marital Status of Learner: Marrled( ) Un Married( U

Age of Learner:
go( ) ffi ( )
Gender Male( ) Female ( )others ( )

Weather DIVYANG Yes( ) No()

Type of DIVYANG

Category HAGG ( ) H4FSUS ( )

General ( ) OBC0SC() sT ( ) Minority ( )

Mobile No. of Learner

F):
ADHAAR No. of Learner (lfavailable) :

Name and address of assessment

Centre/School of the learner
 0

Instructions to fill up the Form

I. Registration No should be of14 Digits

Registration No: (U-DISE Code) + (Sr. Number of learner in the list of GP/Village/Ward)
U-DISE CODE OF SCHOOL Sr. No of Learner in the list of
Village/Ward
0 0

State District Block Village/Ward School

Code Code Code code
Code

2. Please Tick in the appropriate box against the column for Mode of Assessment, Marital
status,Gender, Divyang and Category.
 LI
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