8

Annex 2

Details of StandardsClub
SI. No. Description Input
A. Institution Details

Full Nanme of Educational Institute

Jayahan Navodaya Vidyalaya lamj
2. Complcte Address, with Pin Code VIU- Bisnupun PO- hnupuR hid -Dhsmp
Pin- 781051 stat - Asam
3 Geo-Location Coordinates Lalitt 21.5218 o
Latitude &Longitnde) |Longitude q4-5191S2
4 Email ID dhemajjnv
invdwi @ nedifmail.
a gmail Com Com
Telephone No.
G0014184 60
6. Name & Designation of Head of
Institution Mns. Anjana CPinápal)
7 Recognition/ A
filiation Details 24 0020
Institute Category {School (includng
JrAnter Colleges) Engineering College/Science
College/ Poltechnics/ Professional Institution} Senion Secenday bcheel
9. Institute Status
(Govermment/Gover1ment-Aided! Private) Gevennment
10. Institute Type
(Co-Education/ Only Girls/ Only Boys) Co- &deatien
B. Mentor Details

11 Name of Mentor
MHs. Peeja Kumani Gqupta
12. Email ID
Piaupta 220 @qmail. con
13. Contact Number
97064y3220 1002356236
14. Subjects & Class Taught lases q to 12
15. Qualifications (Graduation onwards) M. Se. in Botny , B. td.
C. Details of Bank Account (Refer C1. 5.4.l of the Guidelines)

16. Name ofAccount Holder

Paaja Kuale Gupla
17. Account Number
05120 110194 62|
UcO Bk,
Pen - 184509Udalgwe.
Btale -POJDis-Udalguni
18. Bank Name and Branch & Address
ASsam
19. IFSC Code UCBA OO00512
D. Students' Details (Separate Sheets as per proforma)
Date: Sign and Stamp
Place: Head of the Institution
TTd/PRNCIPAL Vyalay
Navedeya
DrT 1Jawahar
frure tD0st-Dhemajl
eu Cishnupur
ost-
faIq?Assam- 707057
3rN
tm.
 Annex 3
Members of Standards Club

SI.
Name Member
No Class Gender Email ID Mobile No Status*
1
Bijoy Das M bijaythecode l4 @69O1275447
gmaili Com Alve
Membe
2.
Manali SondwalXI Sc manalisonouyalt bts8132801631 Active M
3
Denilre Gyohain XI Se. F chayanikadeibue
o4 qmal com 1846120052 Aciv eu!
4
Dodee Khekalay X1 Se ldodwrekhnkaty
mal. com Ho99122096| Acive M
5. Tina Newa Hinaneun2
Gmal Cam |4854621G8 AdveM
6
Sneha Kuli 5nehakui430@ 4395154633 Acive
mail. Cem
7
biayaly Chilia F 4yaychatial23
Qanail.cm10 1596614| Acive M
8.
Minmoyee Dultla XI Se. F indtals 2862
Mal. com |o44516394| Achfve Mmeme)
9
|Deaplina Konch deplinalI2345 @ 60004 8620 Mmbe
Achye (Cdhe ireup
Membe)
10.
Ritu Misheng X |b400@mal.
habeshnishongcon 99s40334Ative M
Teena Dera
11.
BineshbonahdryoaS54
qmail. com 581| AciveM
12. Ausikha boley X anust Khadoley 600160712| Acfve M
Amail.
13. Tanja lBharai X ftanujabhaai241aG00184928/
gail. com 8136084514 Acivee
14. Ral as Champadas 503
M
gmal cem @h6i8824152| Acive M
15.
Shyamat Boluy X M shyamaldeleli 69008483 Achvu
l6.Dixaj Pgu M Cam |9104364195 Acive
17.
Ralir Pazing 1X M biniapaging 1234 HO35969594 Akve M|
18. Debashis Ret M paloyinai
qmail cem a q45453443s Aive M|
19.RuaITyoli Tai! M qaustevtaid 1
Gmail. ce 739495GIA Actiye M
20. Bishnu Jysli Satkia M biujyeisakia
636@'gmail-com6003693216| Acve M
*Please indicate either Student leader/Core Group Member/
Member

Sign of the Mentor

Institute Stamp
TOYALA
 Annex 3
Men1bers of Standards Club

SI. Member
No Name Class Gender Email ID Mobile No Status*

inesh Pegu |dinshprgu 421 @Bu1243686 ymambe

Adive
Janvi SHahia |X F |manikasaahia @ laiol00 o16y |AciveM
9Mail. com
3.
Hangma lasumak F |icautibasumaane2495654
490@gmail com! Actire M.
4 |Chaxina Bakumalasy 9365381081| AsveM
Com
5 |Sachi kun Taid M |sachiKumantaid
76 ga CmB135941S0s| Acive
6 Tulbumani Konch M Hubumankanch
07@ mail. co H246884318 AckveM
7. Tradip Bnat M tridipbotah80
54gmal. com g486161394 Ave M
8 Lazar Doley lx M Hekhamoniudoley
57 @qmail-cbm 6003362504| AchveM
haganikamayugy |8812062134
9
|Ananya tazanika Ix F mail. cami
10. Yani Nake nilunake 68@
mal CAm 6o00526883 AveM Ahvememby
Welsuniibergoh
11. Kakal Kenoa |ain5691 gma.cn ai01814019| Ahve
12. |Byapli Arandhaa RMandharasalyayi
@qmal com o02551202 AchveM
13. Desctemana Pegu |desdimonapgu
qmal cam lqgst596044 Achve
14. Hema Malah F palimatlah
gmai Com37 6oO1845455 Achve
15. Kinen Gphan Kinangohain 2 @ 2460221s
qmail com AchveM
16.

17.

18.

19.
20.

*Please indicate either Student leader/ Core Group Member/ Member

Sign of the Mentor

Instit Stamp
TALAY
 10

Annex 4

FORMAT OF UNDERTAKING TO BE EXECUTED BY THE MENTOR OF

STANDARDS CLUB AT THE TIME OF-APPROVAL
(To be provided on non-judicial stamp paper of appropriate value)
UNDERTAKING
The undertaking is given at " ..Dhemayi.Place) on this
tebruary.Month) of
2024....(Year) by Shrí/SmtKu
Peja. KuMaai. Gaupla..Standards Clhub,
(Name of Tanahan.Naodaya.idyalaya,haa
Institution) which shall include its successors and assigns,
of Indian Standards (hereinafter referred to as "the Burcau") vide Letterrecognized by the Burau
dated No.f.1/ De/2023-NVS(SHR)/
03-1l-2023. in accordance to the Guidelines on Standards Clubs approved by the Director General
of the Bureau.
2 WHEREAS the said Standards Club is eligible for drawing an advance amount. towards
financial support for cach of the activities of Standards Club, on the terms and conditions
specified in the Guidelines.
3 Now, the Standards Club hereby agrees that whenever it received advance from the
Burcau for conduct of any activity of the Club, it shall abide by the following terms and
conditions:
i. To rcfund the advance amount in case the activity, for which it has becn paid by the
Burcau, is not completed by the Standards Club; and
ii. To refund the unspent amount of advance, if any, on completion of the
ii. To refund the advance amount in case the Standards Club is activity; and
derccognized by the Burcau.
4 It is hercby further agreed and declarcd that the said Standards Club
shall
amount of advance for any activity other than that has been approved by the Head ofnot spend the
JNV. Dheman Branch Officc of the Burcau. Hence, the amount of advance
shall be
Standards Club only for the purpose or purposes for which the amount was sanctioned.used by the
5. IN WITNESS WHEREOF these presents have becn executed by the
the day and ycar first above written. Standards Club on
6. The Standards Club has agreed to bear the stamp duty chargeable on this
document.
Witncss: Hcad of Institution

Signature of Signature of Head of Institution

Witness
Name: SUBHADIP DUTTA CHOWDHURY
Address: JNY DHEM AJI,ASSAM Name: MHs. Anjana
Id: arjana4T64 e gmail ca
Mobile No. 85388328 25 Mobile No. +9| 4 416446g44
Seal:
eWAL
R efruRre 1Jwahar Navodeya Vidyalays
forT Tt / Dit Dhemaji
TK: f g IPost- Bishnupur
3R IAssam. 7y7057