IAPT JUNIOR SCIENCE-2017

Student Registration Form

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Students (Born between 01/01/2003 and 31/12/2004) studying in classes 8th, 9 and 10 who wish to appear for the IAPT Junior
Science 2017 Examinations are to fill the below given details in BLOCK LETTERS only and Hand over the Registration Form to their
School/ Institution.

Name of the Student :

Gender : (Male / Female)

Class / Standard : .……………….……………………………………………………………………………………..........................

School Name : .……………….……………………………………………………………………………………..........................

Place & Pin Code : .……………….………………………….......................................................................................

DD MM YYYY
Date of Birth :

Language Preferred : English : Hindi :

Note: Select the Language by ticking in the respective column.

Mobile No : .……………….…………………………………...............................................................……………

E-Mail ID : .……………….……………………………………………………………………………………........................

Declaration: I hereby declare that the details furnished herein are true to the best of my knowledge.

Date:

Place: (Signature of the Student)

Acknowlegement (To be handed to the Student)

Applied for NSEJS Received Rs: 100 /-

Centre Registration No.: ………………. Institution Seal Signature of Centre In-charge