NAVODAYA VIDYALAYA SAMITI

JAWAHAR NAVODAYA VIDYALAYA SELECTION TEST

CLASS VI - 2019
APPLICATION FORM

REGISTRATION NO.: 06220104057

Application is Considered under URBAN Category

State GUJARAT District ANAND

Name of the Candidate MAHEJBEEN
Mother's Name SALMABANU Father's Name JAKIRKHAN PATHAN
Name of the Guardian - Relationship with -
Guardian
Nationality of the INDIAN Date of Birth 28-Jan-2009
Candidate
Present Postal Address 77/5590, BAKROL COLONY ,BAKROL PART ,ANAND : 388315
Telephone - Mobile No 9879943134
Gender FEMALE Category GENERAL
Marital Status UNMARRIED Identification Mark TO HAVE A SCAR ON THE
RIGHT SIDE OF FOREHEAD
NEW EYE
Medium of Examination GUJARATI
Disablility, if any No

Previous School Details

III Standard Details IV Standard Details V Standard Details

Name of the State GUJARAT GUJARAT GUJARAT
Name of the District ANAND ANAND ANAND
Name of the Block ANAND ANAND ANAND
Name of the Village BAKROL BAKROL BAKROL
Name of the School N P SCHOOL N P SCHOOL N P SCHOOL
BHAIKAKANAGAR BHAIKAKANAGAR BHAIKAKANAGAR
Recognized/Not RECOGNIZED RECOGNIZED RECOGNIZED
Recognized
School Location URBAN URBAN URBAN
Month/Year of Joining June - 2016 June - 2017 June - 2018
Month/Year of Passing May - 2017 May - 2018 -

CERTIFICATE BY CANDIDATE/PARENT/GUARDIAN
Certified that the information given above is true to the best of my knowledge and belief. In case any of the information given
above is found incorrect, I will abide by the decision of the Samiti. I will produce all the certificates at the time of admission.

Signature of the Parent Signature of the Candidate