KARNATAKA SCHOOL EXAMINATION AND ASSESSMENT BOARD - KSQAAC, BENGALURU

NMMS APPLICATION FORM FOR THE YEAR 2023-24

SATS Number: 015626488

Candidate Name: GADDEMMA
Father Name: AMARESH
Mother Name: SUNANDA
Date of Birth: 04/09/2009
Gender : Female
1. Candidate Locality Rural 2. Caste CAT 2A
3. Religion Hindu 4. Physical condition None
5. Disability No 6. Address Line 1: GADDEMMA D/O AMARAPPA
Certificate
Enclosed
7. Address Line 2 AT ANEHOSUR POST 8. Address Line 3 TQ LINGASAGUR
ECHNAL
9. Pincode 584122 10. Father Education No Formal Education
11. Father Occupation Agriculture, Fishery 12. Mother Education No Formal Education

13. Mother Occupation Not Employed - -

14. Annual Income less than or equal to 3,50,000/- 15. Land Line Number -
16. Candidate - 17. Caste Certificate RD2038762050060
Email ID RD Number
18. Income Certificate RD2038762050060 19. Class Studying 8
RD Number
20. UDISE Code 29060500803 21. District Name RAICHUR
22. Block Name LINGASUGUR 23. Percentage in 89
previous class
24. School Address LATE DEVARAJ URS H 25. School Address LATE DEVARAJ URS H
Line 1 S,ANAHOSUR Line 2 S,ANAHOSUR TQ:LINGASUGUR
,LATE DEVARAJ URS H
S,ANAHOSUR TQ:LINGASUGUR
26. School Address - 27. School Pincode 584122
Line 3
28. School Landline - 29. Type of Institution Private Aided
Number
30. Student Bank 10519101039814 31. Student Bank IFSC PKGB0010519
Account Number Code
32. Student Bank ANEHOSUR
Name & Address

Report generated Date & Time: 11/10/2023 1:23:33 PM

Student / Parents Head Master

Signature Seal & Signature