rdhrenevehege ery
(riPrafasafeerera:)
56-57, FRA UH, ‘St wis, wey, We Re110 058
weeded ter tg aie WT
ENROLMENT FORM FOR PRATHAMA/DWITIYA/TRITIYA DIKSHA
wre ARiewy : 2015-2016 aot
Serial No. ora
am € 4. UKoR rater
Centre Code No.
orivartts egr Rerr dx a vat a nese et i oka nef
Address of N.F.S.E. Centro BAER, SAIS)
1. onde ar arr (Ret A) Bee
Name of Applicant (In Hindi) Ser can yan
2. ante at ant (sft Aare ont A) First Name: YTo [ale ls.
Name of Applicant ‘Second Name: [UM a 1
(In English-In Capital Letters) SurName:[3 Te [WTA [N]q [A IN
3. fit (Sex) : JeT (Male) ] et (Female)
4. Rea ar ar (feat) » age were zap
Name of Father/Husband (In English) STAT [eT Sea TSA [Y)
5. AER (iat a aah a) + RATE (Date).46 m1 (Month)..O6 at (Year).4973
Date of Birth (In Figures & Words)
6. TEBE at oat (Bet A) So. FEL, ae YEE BE, WAM = 267
ee + BRACE LHISD,
5 4aTh, ~
Address for Correspondence clo [mje [vu [rleletalolo[M >
(In English-In Capital Letters) CeRTA Te Ty TaT- [ely Ta wlan tale
Sih TA In Tr TKTOIN IS TCT TED
7. UREAAT (Nationality) . : ENDED
8. ait cere vier at aT : : Tech:
‘Name of the Highest Examination Passed B.Tech: ( camp. Tech) & lies (#66)
9. BREATH (Occupation) : WH cat fam (antago 1)
10, aft (Caste) 1 SLT (S.C) AAA (8.7) ST (Others)
11. et (Religion) : a
g 4 aii
Rearg (Date). 20-12-2015 wee BeTAT
Signature of applicant
Corer pe fot sr PS ones 4 oer gow B Re B ah aR x He eo
This is to certify that the applicant has paid the registration fee and ie has been admitted at the centre,
Reaig (Date) daenvdattiins F FART
‘Signature of Centre Incharge/Centre Co-ordinator
@w
‘Rarer waiter, aiebraeg, earey (See)
‘WHT : 9411025012
E-mail : vande.sanskrit@yahoo.in
Gf aera: a: / wa: / &: / a) ——_>
[afereafa|
Updeiiy
OG | We / a: / US: / BH: / VAL / He / (aH) | ————» | [Aa
eat. | anfere jar ue / at / weet / re / RQ] ————> [raed
sae, | EAA / A / Ue / Fer
Gf earereat: / 8 / UAB / eA: / TL
eat | arferent:/ at: / Wat: / Set: / WaT: / TAA, — [ra
ag, Laren / art; aah / a —> [aa
HATA: - BATAAN AUT 130 STP THT |
re: Fa Reger tee ree, oe ane, SaTeMT, Wag WIN: O1a4-B204z, 254THray
wey
we
wIsd
weg
frag
feraq
aq
wea
wag
frag
ag
areg
arg
ay
sqoitg
wag
wag
War,
rary,
siray
‘safererg
BRE
at:
‘anita’ sft cara soe franca Geen waa t
aan - ator aft Frat watt sere aia
~ Beene
Sara: — veTSea atssare feraraarai a aTentat 10,000 TENA TAZ |Brerereel eee ence asauasaaua ay
| ene te ——,
qe dep Peat aalt dep aati
earn dept Gee at AEATAIT Il
aepaea wanna asi af qaraeyt
AEP aa at aes TER ATTATA
aeperea Fa cas depres Fa TA
Saga A aS ATTA
fegert aaa ufeai desi ae
area aq gaia we eaye ga:
TAPER ER Sepa —fRerHvy |
a8 Rate-sraia—oRert saree Sey
areertingra erent i
Rrerep-aART-a: |
gare, ura, eaagiea, areafear wR |
STG, a veep uP |
eeperrTsrary oneyPrepenfecarai Warrerra |
‘aretTebT TAT |
Smee ww
BES
POMC lee rie eleEc ee Cee en uauaaunuausune aa
Peer cele ele L ell el ele ce Cra aaEnaUaeo sa