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JAWAHAR NAVODAYA VIDYALAYA SELECTION TEST 2013-14 LATERAL ENTRY CLASS IX

APPLICATION FORM

Roll No.

LATERAL ENTRY – CLASS IX APPLICATION FORM Roll No. (To be left blank. To be filled
LATERAL ENTRY – CLASS IX APPLICATION FORM Roll No. (To be left blank. To be filled
LATERAL ENTRY – CLASS IX APPLICATION FORM Roll No. (To be left blank. To be filled
LATERAL ENTRY – CLASS IX APPLICATION FORM Roll No. (To be left blank. To be filled

(To be left blank. To be filled by the Office of Principal, JNV)

1. Name of the Candidate (in block letters)

2. Father’s name (in block letters)

3. Mother’s Name (in block letters)

4. Name of the Guardian (in case Father/Mother is not guardian)

5. Relationship with Guardian

6. Nationality of the Candidate

7. Present Postal Address :

Passport size photograph of the individual attested by Head of the school where candidate

studying in class

VIII

…………………………………………………………………………………….

…………………………………………………………………………………….

…………………………………………………………………………………….

Tel :

STD Code

/

Number

Mobile

No

8. Tick ( √ ) the appropriate Box :

(a)

Sex

Boy

Girl

(b)

Category

Gen.

SC

ST

OBC

 
 
   
   
   
   
   
 

(c)

Marital Status :

 

Married

 

Unmarried

 

9. Date of Birth (in figures)

(a)

 
 

Date

  Date Month Year          

Month

Month

Year

         

Date of Birth (in words)………………………………………………………

(b)

Identification Mark…………………………………………………………

 

10. Name of the school where candidate was studying his/her class VIII during 2012-2013 :

…………………………………… …………………………………………………

(b) Whether recognized

(Tick appropriate)

Yes/No

11. Medium through which candidate is studying in Class VIII :

Hindi

through which candidate is studying in Class VIII : Hindi English 12. CERTIFICATE BY CANDIDATE/GUARDIAN Certified

English

which candidate is studying in Class VIII : Hindi English 12. CERTIFICATE BY CANDIDATE/GUARDIAN Certified that

12. CERTIFICATE BY CANDIDATE/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.

found incorrect, I will abide by the decision of the Samiti. Signature of Father / Guardian

Signature of Father / Guardian (With date)

of the Samiti. Signature of Father / Guardian (With date) Signature of Candidate (With date) 13.

Signature of Candidate (With date)

13. Certified by the Head of the School where candidate has studied in Class -VIII during 2012-13 :

This is certified that Master/Ms……………………………………………………

S/o, D/o Shri…

….was

studying in the School since ………………………………and he/she has passed /appeared for his/her Class VIII examination from this school.

As per school record his/her date of birth is……………………… …

(in figures)

…………………………………………………………………………(in words)

belongs

is……………………………….

He/She

to

SC/ST/Other

category

and

his/her

caste

This is also certified that entries made by the applicant in the application form are correct as per school record.

Date :…………………………….

Signature of the Head of School

(with official stamp)

JAWAHAR NAVODAYA VIDYALAYA SELECTION TEST- 2013-14 LATERAL ENTRY CLASS IX

ADMIT CARD

Day & Date of Examination Sunday 23 rd June 2013

Time 10.00 Hrs. (Candidates to report 30 Minutes before)

Venue :

Jawahar Navodaya Vidyalaya

………………………………………….

………………………………………….

Roll No.

…………………………………………. Roll No. Passport size photograph of the candidate duly attested by
…………………………………………. Roll No. Passport size photograph of the candidate duly attested by
…………………………………………. Roll No. Passport size photograph of the candidate duly attested by
…………………………………………. Roll No. Passport size photograph of the candidate duly attested by

Passport size photograph of the candidate duly attested by head of the school where candidate studying in Class

VIII.

(1)

Name of the candidate………………………………………………………

(2)

Father’s Name………………………………………………………………

(3)

Date of Birth……………………………………………………………… ………………………………………………………………………(Words) ……………………………………….(Figures)

(4)

Category : (Encircle appropriate)

(i)

Boy / Girl

Signature of the candidate in the presence of HM/Principal of the school where the candidate is studying in her/her class VIII during 2012-13.

candidate is studying in her/her class VIII during 2012-13. (ii) Gen. / SC / ST /

(ii)

Gen. / SC / ST / OBC

To be left blank for obtaining signature of the candidate in the presence of Center Supdt. /Invigilator on the day of exam.

presence of Center Supdt. /Invigilator on the day of exam.

-------------------------------------------------------------------------------------------------------------------------------

ACKNOWLEDGEMENT

Receipt No

Received application form from Master/Ms D/o

Student

of

S/o

School in Jawahar Navodaya Vidyalaya Selection Test Lateral Entry IX, 2013-14.

for admission

PRINCIPAL

J.N.V

State