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STATE COUNCIL OF EDUCATIONAL RESEARCH & TRAINING BIHAR, MAHENDRU, PATNA

(APPLICATION FORM)
STATE LEVEL NATIONAL TALENT SEARCH EXAMINATION, 2020-21
( For the Students Studying in Class X )

APPLICATION NO : 12021243

id
Date of Examination : 24th January, 2021 (Sunday)
Name & Address of the Agency for State Council of Educational Research & Training, Bihar, Mahendru,
conducting NTS Examination : Patna-6
Name of the State/UT : Bihar
Name of the School (where the candidate GOVT KANHAIYA INTER SCHOOL MARWA PAKRIBARAWAN
is studying Class X) : NWD, BLOCK-PAKRIWARAN, DIST-NAWADA
Application Fee (in INR) :
District Applying From :

Personal Details :
Name of Candidate :
Father's Name :
Mother's Name :
Date of Birth :
NAWADA

PRAKASH KUMAR
LATE DASO CHAUDHRY
LATE MINA DEVI
03-04-2005
Pa
Rs. 150/- (Gen./EWS/OBC) / Rs. 75/- (SC/ST/Disabled) Candidate.

Gender : MALE
ot
Area to which Candidate resides : RURAL
Caste Category : S.C.
Disability Status : NONE
Studying in Class : CLASS X
N

Communication Details :
Address Line 1 : VILL-AKAUNA PO-JIURI
Address Line 2 PS-PAKRIBRAWAN DIST-NAWADA
State/Union Territory : BIHAR PIN Code : 805124

Name and address of the School/Institution in which studying at Class X level :


School Name : GOVT KANHAIYA INTER SCHOOL MARWA PAKRIBARAWAN NWD
Address : VILL MARWA PO MARWA PS PAKRIBARAWAN
Post Office : MARWA PIN Code : 805124
Block : PAKRIWARAN
District : NAWADA
School Type : GOVERNMENT
Area in which the School is located : RURAL
School Category : OTHERS
Medium of Examination :
At the State Level : HINDI At the NCERT Level : HINDI

Parental & Other Family Details :


Father's Education : NO FORMAL EDUCATION
Father's Occupation : NOT EMPLOYED
Mother's Education : NO FORMAL EDUCATION
Mother's Occupation : NOT EMPLOYED
No. of family members living in the house : 9 No of brothers : 4
No of sisters : 3 At what no is the candidate among his/her brothers and sisters : 6

id
Parental Annual Income (in Rs.) : Upto 2,00,000
Mobile Number : 6299605093 Telephone Number : 6299605093
Email Address : [email protected]

Payment Details :
Payment Type Payment Mode

Document uploaded by the Candidate :


Income Certificate
N.A.

Declaration by Candidate :
Amount in Rs.

Pa Payment Date

Caste Category Certificate


12021243_caste.pdf
Merchant's Ref. No # Bank's Ref. No.

Disability Certificate
N.A.
ot
I hereby declare that all data reflecting in this application form are correct. I also declare that all the statements made including all documents uploaded
in this application form are true, complete and correct to the best of my knowledge and belief and in the event of any information being found false/incorrect
my candidature is liable to be cancelled even after qualifying the State Level Examination.
N

Date : 2020-12-18 15:42:45 Uploaded Signature of the Candidate

Certification by the Head of the Institution :

Status : YOUR APPLICATION IS PENDING


Date :-

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