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नवोदय िव ालय सिमित

Navodaya Vidyalaya Samiti

( An Autonomous Body Under Ministry of Education) Government Of India

Registration No. 14010101933

Personal Detail

District in which the

candidate is studying in
class V(2020-21)
State in which the candidate is
MANIPUR THOUBAL
studying in class V(2020-21)
Candidate is eligible for admission only in
th same district

Name of the School in which THE

Block in which the candidate is
THOUBAL the candidate is studying in SANGIYUMPHAM
studying in class V(2020-21)
class V(2020-21) PRIMARY SCHOOL

Name of the Candidate

MOHD JAID
(Name as on class V certificate)

MOHD
Mother's Name SAFARJAN Father's Name
KAYAMUDDIN

Relationship with Guardian

Name of the Guardian (Optional)
(Optional)

A SMALL MOLE
Nationality of the Candidate INDIAN Identification Mark
ON NECK

Gender Male Category(GEN/SC/ST/OBC) OBC

Medium of Examination*
(JNVST question paper will be Manipuri (Meitei Mayek) Date Of Birth 01/04/2010
provided in this language only)

Disability,if any
(Less than 40% will not be None Disability Percentage NA
accepted)

If Others, please specify the

Religion Islam
Religion

Aadhar Number 508710258652 Annual Income of Parents 45000

Communication Details

Present Postal SANGAIYUMPHAM PinCode 795148

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Address(Residential Address is PARTI, PO WANGJING,

collected THOUBAL DISTRICT,
only for official correspondence MANIPUR
purpose. However
the District of class V study is the
criteria for
Registration/Selection/Admission)

Residential State MANIPUR Residential District THOUBAL

Telephone - Mobile No. 8787506144

EmailID safarjanleika@gmail.com

Previous School Detail

III Standard Details IV Standard Details V Standard Details

Name of the State MANIPUR MANIPUR MANIPUR

Name of the District THOUBAL THOUBAL THOUBAL

Name of the Block THOUBAL THOUBAL THOUBAL

Name of the Village SANGAIYUMPHAM SANGAIYUMPHAM SANGAIYUMPHAM

THE THE
THE SANGIYUMPHAM
Name of the School SANGIYUMPHAM SANGIYUMPHAM
PRIMARY SCHOOL
PRIMARY SCHOOL PRIMARY SCHOOL

Recognized/ Not Recognized Recognized Recognized Recognized

School Location Rural Rural Rural

Year/Month of Joining January/ 2018 January/ 2019 January/ 2020

Year/Month of Passing December/ 2018 December/ 2019

Candidate Photo Candidate Signature

Parent Signature Certificate

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