tUl« 2024

muɪ¤ f© kU¤Jtkid
(nfhtš ouÞ£)
ó®¤â brŒj É©z¥g¥ got¤ij mU»š cŸs muɪ¤ f© gÇnrhjid
ika§fËš bfhL¡fyh« mšyJ Ñœ¡f©l KftÇ¡F mD¥gyh« 2 khj¤â‰FŸ
vL¤j
1, m©zhef®, kJiu - 625 020, òif¥gl«
ngh‹: 0452-4356100, 4356500
ïilÃiy f©Âaš gÂahs® gƉá¡fhd É©z¥g¥ got«
f© kU¤Jt cjÉahs®, ÉÊ xË MŒî cjÉahs®,
kU¤Jt¥ gânt£L¤Jiw cjÉahs®, nehahËfË‹ kU¤Jt Mnyhrid cjÉahs®, f© f©zhofŸ jahÇ¥ò
k‰W« ÉÃnahf cjÉahs®, bgáÈ£o (trâ) xU§»iz¥ò cjÉahs®, MŒtf cjÉahs®, kUªJ¡fil cjÉahs®,
cgfuz§fŸ, guhkÇ¥òJiw cjÉahs®, g©lfrhiy Jiw cjÉahs®
1. bga® : ____________________________________________________________
2. ãwªj njâ, taJ : ______________, _____ Mjh® v© :
3. fšÉ¤jFâ : ____________________ jhŒbkhÊ :_____________________________
4. jf¥gdh® bga® : _________________________ jhah® bga® : ___________________
5. bg‰nwh® ïšiybaÅš
fh¥ghs® bga® : ____________________________________________________________
6. Éyhr« : fjî v© : ______ bjUbga®: ___________________________________
»uhk«: ___________________________ t£l«: ____________________
kht£l«: ________________________ ã‹nfhL: __________________
7. bjhiyngá v© 1. (jªij) ________________________ 2. (jhŒ) _____________________
3. (fh¥ghs®) ______________________ 4. (cwÉd®) _________________
8. TLjš jFâfŸ : f«¥ô£l®/j£l¢R/k‰wit

9. bkhÊfŸ bjǪjit jÄœ M§»y« bjY§F kiyahs« Ϫâ k‰wit

thá¤jš
vGJjš
ngRjš
10. 11M« tF¥ò kâ¥bg©fŸ: nj®¢á njhšÉ tUl« :
11. 12M« tF¥ò kâ¥bg©fŸ: nj®¢á njhšÉ tUl« :

gŸËÆ‹ bga® k‰W« KftÇ ghl§fŸ 12M« tF¥ò kâ¥bg© nj®¢á/njhšÉ

Name and address of the School Subjects 12th Marks/100 Pass/Fail

gŸËÆ‹ bga® :

ïl« :

kht£l« :

ã‹nfhL: bkh¤j
kâ¥bg©fŸ
Aravind Eye Hospitals & Postgraduate Institute of Ophthalmology AEH/HR/PR/F/2A
12. ghl¥ãÇî: fÂj«/m¿Éaš/fiy/k‰wit ________________________
13. cau« : vil: ïu¤j¥ãÇî :
14. m«ik jL¥óá ngh£L¡bfh©O®fsh?: M«/ïšiy
15. bghGJngh¡F m«r§fŸ: Éisah£L/njh£l ntiy/ïir/eld«/k‰wit _____________
16. FL«g Égu§fŸ:
cwî ãwªj ntiy
bga® taJ Mjh® v©
Kiw njâ Égu«
m¥gh

m«kh

fh¥ghs®

17. cl‹ ãwªjt®fŸ g‰¿a Égu« :

âUkz« Mdt® ntiy

bga® taJ cwî Kiw fšÉ Égu«
M« ïšiy Égu«

É©z¥g¤Jl‹ bfhL¡f nt©oa efšfŸ:

- 10th, 11th, 12th tF¥ò kâ¥bg© g£oaš (mark sheets) - kh‰W¢ rh‹¿jœ (Transfer Certificate)
- gƉá bgWgt® Mjh® fh®L* - jf¥gdh®, jhah® Mjh® fh®L
- nuõ‹ fh®L - t§» nrÄ¥ò fz¡F ïUªjhš ghÞò¡ Kjš g¡f efš

nk‰T¿a Égu§fŸ mid¤J« c©ik v‹W cWâ mË¡»nw‹.

__________ _________________________ ________________________

njâ bg‰nwh®/fh¥ghs® ifbah¥g« gƉá bgWgt® ifbah¥g«

* gƉá¡F nru tU«bghGJ bga® k‰W« ãwªjnjâ 12« tF¥ò kâ¥bg© rh‹¿jÊš cŸsgo
Mjh®fh®oY« ïU¡f nt©L«. Mjh® fh®oš j‰nghJ ga‹gh£oš cŸs rÇahd bkhigš v©
ïU¡f nt©L«.

F¿¥ò
- É©z¥ã¡f f£lz« VJ« ïšiy. É©z¥g§fŸ ïytrkhf tH§f¥gL«.
- mid¤J muɪ¤ f© gÇnrhjid ika§fËY« É©z¥g¥ got§fŸ »il¡F«
- ïil¤juf®fŸ ahU« »ilahJ.
- Mjh® fh®L 15 taJ¡F nkš kh‰w« brŒâU¡f nt©L«