CHESS OLYMPIAD 2022 -TAMILNADU

( Department of School Education )

CHESS
ENTRY FORM
Under - 11 / 14 / 17 / 19 (BOYS / GIRLS )

Name of the Name of the

School: BLOCK

Educational REVENUE
District: DISTRICT:

S.No. Name of the Student Std EMIS No. Signature of the Students

[Two copies of Individual Photo Identity to be produced along with the Entry Forms]

TEAM MANAGER (PD/PET) HEADMASTER

 INDIVIDUAL PHOTO IDENTITY FORM FOR
CHESS OLYMPIAD COMPETITION - 2022
1 Sports / Game CHESS
Passport Size
2 CATEGORY Boys / Girls recent Photo
with School
3
Name of the Student Uniform
(in BLOCK LETTERS ) (Attested
4 by Head Master/
Standard & Section
Principal with
5 School Seal)
EMIS Number

Date of Birth in figures

6
Date of Birth in words

Name of the School

7 with Address[ With PIN ]
.

Residential Address with

8 pincode
Contact Number

9 Name of the Block

10 Name of the Education District

11 Name of the Revenue District

1.
13 Identification Marks
2.

In English :
14 Signature of the Student
In Tamil :

I certify that the particulars furnished above have been verified with reference to the Information
registered in the school record and found correct.

TEAM MANAGER(PD/PET) HEAD MASTER