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    Abhishek Chauhan
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    1. The document appears to be an application form for admission to the Simultala Awasiya Vidylaya (English Medium) school in Simultala, Jamui, Bihar for the year 2012. 2. The application form requests information such as the candidate's name, parents' names, date of birth, category, address, and contact details. 3. It also requires the candidate to declare that the information provided is accurate, and warns that providing false information could result in cancellation of admission or legal action.

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    1. The document appears to be an application form for admission to the Simultala Awasiya Vidylaya (English Medium) school in Simultala, Jamui, Bihar for the year 2012. 2. The application form requests information such as the candidate's name, parents' names, date of birth, category, address, and contact details. 3. It also requires the candidate to declare that the information provided is accurate, and warns that providing false information could result in cancellation of admission or legal action.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as PDF, TXT or read online from Scribd
    Flag for inappropriate content
    Download as pdf or txt
    7 views2 pages

    Application Form

    Uploaded by

    Abhishek Chauhan
    1. The document appears to be an application form for admission to the Simultala Awasiya Vidylaya (English Medium) school in Simultala, Jamui, Bihar for the year 2012. 2. The application form requests information such as the candidate's name, parents' names, date of birth, category, address, and contact details. 3. It also requires the candidate to declare that the information provided is accurate, and warns that providing false information could result in cancellation of admission or legal action.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as PDF, TXT or read online from Scribd
    Flag for inappropriate content
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    of 2

    vkosnu i= dk k:i

    SIMULTALA AWASIYA VIDYALAYA (ENGLISH MEDIUM), SIMULTALA, JAMUI

    fleqyryk vkoklh; fo|ky; vaxzsth ek/;e] fleqyryk] teqbZ


    APPLICATION FORM FOR ADMISSION, 2012 (To be filled in English and Hindi)
    (ukekadu] 2012 gsrq vkosnu-i=

    1.
    2.
    3.
    4.
    5.

    Candidates Name (Use Capital Letter Only)


    (vkosnd dk uke )
    Mothers Name (Use Capital Letter Only)
    (ekrk dk uke)
    Fathers Name (Use Capital Letter Only)
    (firk dk uke )
    Fee Paid (Bank Draft no. & Date)
    ('kqYd Hkqxrku cSad MkV ua rFkk fnukad)

    :-

    Sex : (Tick the relevant)

    :-

    :::-

    fyax % lacaf/kr dks fpfUgr dhft,


    6.

    Are you a Domicile of Bihar State? (Tick the relevant)

    :-

    vki fcgkj jkT; ds ewy fuoklh gS? lacaf/kr dks


    fpfUgr dhft,
    (D;k
    7.

    :-

    Category(Tick the relevant)

    dksfV% lacaf/kr dks fpfUgr dhft,


    8.

    Physically Challenged Category (Tick the relevant)

    9.
    10.

    11.

    Male

    Female

    iq:"k

    efgyk

    Yes

    No

    gk

    ugha

    Gen.

    SC

    ST

    EBC

    BC

    lkekU;

    vuq
    tkfr

    vuq
    tutkfr

    vR;ar
    fiNM+k
    oxZ

    fiNM+k
    oxZ

    :-

    (fodykax dksfV% lacaf/kr dks fpfUgr dhft,


    Date of Birth
    :(tUefrfFk )
    Choice of only one District of Bihar as Centre of :Preliminary Examination
    (kjfEHkd ijh{kk ds fy, fcgkj ds dsoy ,d p;fur
    ijh{kk dsUnz ftyk dk uke)
    School Name & Address (In Which Currently Studying in :Class V or above the Vth class)
    (fo|ky; dk uke ,oa irk ftlesa vkosnd d{kk ikpoha
    ;k ikpoh ls mij dh d{kk esa v/;;u dj jgk@jgh gSA)

    Yes

    No

    gk

    ugha

    12.

    Class
    :(d{kk )
    13. Class Roll no.
    :(d{kk ekad )
    14. Permanent Address of the Applicant
    :(vkosnd dk LFkk;h irk )
    15. Address for Correspondence With Telephone no./ Mobile :no./ E-mail ID
    (i=kpkj dk irk ,oa nwjHkk"k@eksckbZy@bZ&esy vkbZ
    Mh )
    ?kks"k.kk@
    k.kk@DECLARATION
    eSa ?kks"k.kk djrk@djrh gw fd esjs iq=@iq=h }kjk nh x;h tkudkjh lgh gSA ;fn dHkh Hkh esjs }kjk nh x;h mijksDr tkudkjh xyr ik;h tkrh gS] rks esjs
    iq=@iq=h dk ukekadu Lo;eso jn~n gks tk;sxk vkSj esjs fo:) dkuwuh dkjZokbZ dh tk,xhA
    .
    fnukad
    Date

    .
    vkosnd dk gLrk{kj
    Candidates Signature

    .
    Ekkrk @firk dk gLrk{kj
    Parents Signature

    pkSFkh d{kk esa mkh.kZrk ds i'pkr~ lEfr vkosnd----------------------] bl fo|ky; ds -------------- d{kk esa v/;;ujr gS] ftldk@ ftldh ukekadu la[;k------------rFkk
    dksfV lkekU;@vuqtkfr@vuqtutkfr@vR;ar fiNM+k oxZ@fiNM+k oxZ) gS] ,oa oskiath es bldk@bldh tUe frfFk-----------------------------------vafdr gSA
    vkosnd dk jaxhu
    QksVks tks fd gky
    gh esa [khpk x;k
    gks] /kkuk/;kid ls
    vfHkekf.kr
    djkdj fpidk,A
    [k.M fk{kk lkj inkf/kdkjh@ftyk fk{kk inkf/kdkjh (B.E.O./D.E.O.) ls vfHkekf.kr

    lR;kfir ,oa vxzlkfjr


    gLrk{kj.
    /kkuk/;kid
    v/;;ujr fo|ky; ds /kkuk/;kid
    eqgj ds lkFk

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