Application Form (For Abroad Students only) National Talent Search Examination, 2020 For the Students Studying in Class X) ‘Rea te istuction carly ghven on the next page bf ling the aplication frm, ‘Yu may ake the el from yout eacherparent oiling p he aplication fom, ‘Space for the Photograph Date of Examination 10 May, 2020 [Passport siz) ‘Namo & addres of te sgency for conducting NTS Examination NCERT" Name ofthe County i “The Photograph should be {Where the emote studying in cass X as. ep stun) dors bythe Head of ‘Name ofthe examination enn Indi (StateCity) sisranraiasssteeeseeeecnie the Inscuten/Gazeted (Where candidate likely to pes in exam) Apolication fe NIL Class Date of birth Date Month Year 1, Name of the eandidate (Do not write Miss/Master) 2. Father's name (Do nat write MrJDr/Prof) 3. Mother's Name (Do not weite Mr/Dr/Prof) 4 Sex 5, Area lo which candidates resides 6. Caste category of candidate 7. Disebilty status 170 EB JQ) BUG dea Male Female Ror Urban Genel OBC SC ST EWS BLV DH LD AID MD NONE ‘Non Creamy Layer Refer overeat fr dts afar 6b. Do you belong to OBC Category (Pease Refer denis given on www.nchenicinfusr_panel/centallisstateview ase) of Central ist? Yes[i] No[2] state ‘oBc Name (Please enclose a copy ofthe relevant certificate in support of information at Sr. No. 6 &7) 8, Postal address of the candidate for correspondence (Do not write father’s or your name) 9,__ Name and address ofthe SchooVIntitution ia whieh studying at Class X level Pin Coa 1, Type ofthe institution in which studying at Class X (see definition overleat*) 1. Area in which the schoo is located T] con [2] Local Body [3] Privateaided [2] Private Unaided T]Rurat [2] Urban 1a, Ave you Student of Kendriya Vidyalaya / Navodaya Vi alaye? Hyes write [E] 1¢No write [2 top. Fyes waite for [21] Kendriya Vidyalaya [2 ] ror Navodaya Vidyalaya 12, Medium of examination (@)at the state Level (b)at the NCERT Level 13, Father's education [] 14, Pather’s Occupation 15, Mother's education 16, Mother's Occupation| 17. No.of family members living inthe house 18. No, of brothers 19, No.of sisters [] _] 20, At what no. isthe candidate among hisher brothers and sisters 21, Pareatal annual income. 7] 2 5 a 5 0200001. 2000011340000 3.40001 $0,000 .0n601 6 10.4R,000 2, Teephone—T TT [Deccooraometoreeee ed] sib Coe 3 24, Mobile Do not eave hs cour Ban) ‘To be fled by he Head of the Tnsaton/Gazewed Oficer Certitied that: (1) MasterMiss “ {is arogular student ofthis SchooVInsttution an he/she has secured [—T—] % marks in the class IX annual examination, i ¢., when he/she was promoted from class IX to Class X. HerShe has secured marks out of. (2) The particulars given by him/her inthe application from have been verified and found in order. (G) MasterMiss. son belongs to Scheduled Caste/Scheduled Tribe category as per the records mainiained in the Intttion (tobe ilied for SC/ST eandidates only) aa Signature ofthe Weadmaster/ Headmistress/Gazetted Officer With eal Signature ofthe candidate (see Instructions Overleat)a ae Coding Plan Read instruction carefully before fling ap the Application Fort. ‘Use only Bue or Black Ball Pint pen, WRITE IN CAPITAL LETTERS. Do ne ark or write cutsdetheboxes, [Leave one Box Blank beeen two Words. Lk your mameanaior address thi he space provided for, Pca see example as give blow Crossa} any one ofthe appropiate boxes in tess. 43,67, 10,1) and Please write code sumer ters nos 12, 13,1, 18 and 16 as givenoveth, eis he vesposibity ofthe candidate andthe principal ofthe schoo! to epi th fie in frm with the ste concer Ose foe the as ‘hee. No request fs condoning day submisivan le enerained wheter it diet he fl ofthe Candidate othe Hessmaser Pisa! of hisher sittin. 5 Ineamplete er dreasiveapplesions ae able wo brite 4% for Physically Challeoged Group of Students, with benchmark disabilities of witch, one per cent each shall be reserved for persons with benchmark disabilities under clauses (a), (b) and (c) and one per cent for persons with benchmark disnbiliies under ‘clauses (¢) and () namely (0) blinginess andl low vision (BLY); (b) deaf and hard of hearing (DH); {6} locomotor disability including cerebral palsy, leprosy cured, dwarfism, acid attnek vietims and muscular Dystrophy (LD): (@) autism, intellectual disability, specific learning disability and mental iliness (AID) (©) maltiple disabilities from amongst persons under clauses (2) t0 (4) including deaf: blindness in the posts Identiied for each disabitities' (MD) Example for writing Name and Address. FathersName [OT | *[_] OP UT PFT Postal Address: do not try to write complete address in one line, Break it appropriately as shown below: Teer ye MPOTUINTT] Te ]O TA] © Region | Save Code clulels| stale pm} orth Arnos Peder ‘Assam iz [Medium of Examination Educsiion of Father or Mother Menipar (Refer to item 12) (Refer to item Nos 13 & 15) ‘ephalaya Medium of Code | Education Code Mizoram Examination ‘Nagaland ie] again [ Assamese T1_[ Na Formal Education 7 Sm iD Bangle 12_[ Up to primary a 7 English a 13” | Upper primary ai : Guar ia Secondary + East [ARN isands cm Hind 15 [Senior secondary 3 Bihar cm Kennada 16_{ Graduation 6 Tarkan ar | 17_| Post graduation i ‘Odishe ca 18_| Doctoral 5 z West Bengal B 19 | Professional dearee ° EnancctnbLee Noah | Chendigath 24 L : Medicaine, MCA, BA.cte) tL Deh EE Panjabi 0 Tarama & Kashmir [26 Tamil 2t Haryana 2 Telugu 2B Himachal Pradesh [28 a piace aaa Puri w Rajestion 3 te Seon TEaEeEREE FEETTTC (rer tier Ne 18616 oe ee i Hoste = toe ‘Uiarakhand =| Pall er 7 West) Ciatigare 3 ane a AT By Danan Die 4 | Caer 7 — 7 aN Havel 3s eae TET = i Goa 36 FS a aR ae 7 Tian 7 ‘ ae ; Madhya Pradesh Eg Maharastra w "Hyg otSetottestton (fore item Na South | Aan Pradesh ao | OVERNMENT A Goverment ch hat wih iam by he Sit Karnataka W Gove ai Ses neti a Anon a 2 ‘nizaon compl sna! ye Goverment : LOCAL BoD 2 Los Boy Sebo at wie ra by Pos Ra Pee te seo hy tin 6 2s Psd ms Poducheny a] Const, awislComta,Ntie ea Tama Comite Canoe Hod PRIVATE AIDED Api ded scoot wi ia bya nia ‘Telangana ff ss ive nd ese om Abroad 7 verso es PRIVATEUNAIDED Pret Ui Schoo itt wich imaged by en Invi or apate canztion and does ee my to goverment ria Ey.