Scribd Logo
Upload

Welcome to Scribd!

  • 4 views

    Reg Form

    Uploaded by

    Amit Dadhich
    1. Deepak Sharma is applying for online admission to NIOS for the academic year 2011-12. He is providing personal details like name, father's name, date of birth, address, and contact information in the application form. 2. He is applying for senior secondary level of education in Hindi medium. His annual family income is less than Rs. 50,000. 3. He is submitting requisite fees of Rs. 450 through a bank draft and required documents like marksheets of previous board exams, certificates, and self-certification for admission.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as PDF, TXT or read online from Scribd
    Flag for inappropriate content

    You might also like

    Reg Form

    Uploaded by

    Amit Dadhich
    4 views3 pages
    1. Deepak Sharma is applying for online admission to NIOS for the academic year 2011-12. He is providing personal details like name, father's name, date of birth, address, and contact information in the application form. 2. He is applying for senior secondary level of education in Hindi medium. His annual family income is less than Rs. 50,000. 3. He is submitting requisite fees of Rs. 450 through a bank draft and required documents like marksheets of previous board exams, certificates, and self-certification for admission.

    Original Description:

    Copyright

    © Attribution Non-Commercial (BY-NC)

    Available Formats

    PDF, TXT or read online from Scribd

    Did you find this document useful?

    Is this content inappropriate?

    Report this Document
    1. Deepak Sharma is applying for online admission to NIOS for the academic year 2011-12. He is providing personal details like name, father's name, date of birth, address, and contact information in the application form. 2. He is applying for senior secondary level of education in Hindi medium. His annual family income is less than Rs. 50,000. 3. He is submitting requisite fees of Rs. 450 through a bank draft and required documents like marksheets of previous board exams, certificates, and self-certification for admission.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as PDF, TXT or read online from Scribd
    Flag for inappropriate content
    Download as pdf or txt
    4 views3 pages

    Reg Form

    Uploaded by

    Amit Dadhich
    1. Deepak Sharma is applying for online admission to NIOS for the academic year 2011-12. He is providing personal details like name, father's name, date of birth, address, and contact information in the application form. 2. He is applying for senior secondary level of education in Hindi medium. His annual family income is less than Rs. 50,000. 3. He is submitting requisite fees of Rs. 450 through a bank draft and required documents like marksheets of previous board exams, certificates, and self-certification for admission.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as PDF, TXT or read online from Scribd
    Flag for inappropriate content
    Download as pdf or txt
    of 3

    2/1/12

    RegForm

    Online Admissions-2011-12 (Stream IV) Note :1. The candidate must send the Form Individuall and on top of Envelope write Application for On Line Admission. 2. Kindl Send two printout of the Application form within 5 Da s of Registration along with the Documents and requisite Fees To, Incharge On Line Admission Cell, NIOS, A 24/25, Sec. 62, NOIDA, UP - 201307

    P in hi Page

    Applica ion Refe ence No. D0811305579 Da e of Regi a ion: 1-Feb a -2012 18:9:19

    Pa e he e o pho og aph of i e 4 3 cm in hi bo onl . Do no e pin o aple

    1. 2.

    Plea e fill he Fo m ONL AFTER eading he in c ion Plea e en e o eligibili fo admi ion a gi en in he Info ma ion Page. Yo Signa e

    1.

    Name of Candida e in CAPITAL Le e

    DEEPAK SHARMA 2.
    Fa he ' Name in CAPITAL Le e (In ca e o do no ce ifica e, plea e en e XXXXXXXXXX he e.) an Fa he ' Name o be p in ed in he

    BANESH KUMAR SHARMA 3.


    Mo he ' Name in CAPITAL Le e (In ca e o do no ce ifica e, plea e en e XXXXXXXXXX he e.) SARITA DEVI G a dian' Name in CAPITAL Le e XXXXXXXXXX) Po al Add e in CAPITAL Le e ) an Mo he ' Name o be p in ed in he

    4. 5.

    (Applicable onl if bo h Fa he ' and Mo he ' name a e

    JAI MUKUND DHARM KANTA WALI GALI,RAILWA STATION, CHIRAWA,DIST.-JHUNJHUNU RAJASTHAN Pin Code

    333026

    onlinecd.nios.ac.in/niosreg_region/RegForm.asp?medit=1&preview=1&pr

    1/3

    2/1/12

    RegForm

    6.
    7. 8. 9. 10. 11. 12. 13. 14. 15.

    E-Mail bindass.bo 0005@gmail.com Da e of Bi h 3-November-1992 Gende Ca ego Di abili Di ad an aged G o p Co e Applied Fo Medi m of S d Mo he Tong e Na ionali Religion

    Telephone 16.

    7737426139 More than XII Post Graduate Upto Secondar Semi-rural An Other Unemplo ed Sports Upto 50,000 No

    Male General Not Applicable Not Applicable Senior Secondar Hindi Hindi Indian Hindu

    Yo P e io Q alifica ion Fa he ' Ed . Q alifica ion 18. Mo he ' Ed . Q alifica ion 19. Place of Re idence 20. Yo Geog aphical A ea 21a. Emplo men 21 b. E a C ic la 22. An al Famil Income 22a. Pe ing Pilo Licence

    17.

    23.

    Choo e S bjec

    (Minim m 1 and Ma im m 7)

    Mathematics (311) 22-March-2012

    23a. 24a.

    E am Cen e : NIOS HQ, NOIDA, NCR P e io Boa d E am (a) Yea of Appea ing (c) Boa d

    2009 (b) Roll No. 1539464 Raja han Boa d of Seconda Ed ca ion, Ajme 2007 (b) Roll No. 0402351 Raja han Boa d of Seconda Ed ca ion, Ajme
    + E amina ion 200.00 Fee Bank D af S a e Bank of India 311870 28-1-2011 480 (Indian R pee ) SASTRI NAGAR,JAIPUR + La e 0.00 Fee +TOC 0.00 Fee = To al 450.00 Fee

    24.

    X h Boa d E am (a) Yea of Pa ing (c) Code of he Boa d

    26.

    To al amo n of fee paid (a) Admi ion 250.00 Fee Mode of Pa men Name of Bank D af No. Da e of Bank D af Amo n Place of I e

    COL MN FO 27. 28.

    E-ADMI

    ION/

    AN FE OF C EDI

    Whe he

    o a e appl ing fo T an fe of C edi

    No

    Fo E -S den of NIOS / CBSE / CISCE / S a e Open School / S a e Boa d of Ed ca ion a pe ec ion 2.6 onl (a) En olmen No. (c) Code of he TOC Boa d De ail of bjec pa ed fo accep ed fo TOC) (b) Yea of E am.

    0
    ill be

    29.

    hich an fe of c edi i op ed (No Lamina ed Ma k hee

    S.No. 1. 2. 3. 4.

    S bjec Code of NIOS

    Ma k Ob ained Theo P ac ical To al

    onlinecd.nios.ac.in/niosreg_region/RegForm.asp?medit=1&preview=1&pr

    2/3

    2/1/12

    RegForm

    SELF CERTIFICATE (to be filled b all those not enclosing School Leaving Certificate) Ce ified ha I ha e died e gh be ab e e Sec da e e c e. Sig a DECLARATION BY APPLICANT ( TO BE FILLED BY ALL APPLICANT) I he eb dec a e ha I ha f he c ef hich I i f a i c ec . I ha i iab e be ca ce ed b i eadi g i c ec a Da e e ead a d de d he c di i f e igibi i a d I f fi he c i e ia ee ad i i . I ha e f i hed a he ece a d c e a d e fi ed hi f i ha d i i g. I de a d ha ca dida e NIOS i he e e fa i f ai a dd c e i be f d a age. i acce he e a aid d i he ec . e

    C
    Pa

    e Sig a
    a e Add e

    e f Pa e /G a dia

    Sig a

    e f Ca dida e

    Bank details for Dr. Ambedkar National Scholarship (applicable for SC and ST onl ). F de ai ea e ee ec i 4.11 Bank Name : Pin : T P i ed - i e fi ed i a ica i f T ece c a i e 2. h g a h a ed he i ed a ica i f 1. 3. Ce ifica e f Da e f Bi h 4. Ce ifica e f 5. Ta ch SC/ST he a Se f Ce ifica e ega di g ed ca i a a ifica i Ph Ca c f Ma hee f XB a d E a i a i Bank Address :

    7.

    8.
    9.

    fe Ce ifica e f a e ded f f Re ide ce

    Ce ifica e f he E e f E -Se ice e Ce ifica e f aG e e 10. H i a f a ha dica ed e O igi a Fai e/C a e 11. Ma hee f C a X XII f TOC

    6. P

    onlinecd.nios.ac.in/niosreg_region/RegForm.asp?medit=1&preview=1&pr

    3/3

    You might also like