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8/26/2016

KVPY2016Form

ThanksforsubmittingyourApplication
Form16145250whichcanbeusedforall
futurecorrespondence

Amount:
PaymentTransactionNo:

1000.00
GUR24707038640

Note : Your Application form is Successfully Submitted.


ApplicationForm

Stream Applied
StreamName: SX

Personal Details
ApplicationNumber: 16145250
NameofApplicant: ANSHULBATRA
DateOfBirth: 01/01/1999
Category: General
Personwithdisability: No
Nationality: Indian
Gender: Female
Presentlystudyinginclass: Class12th

Present Address
AddressLine1: 77,OfficersEnclave,Newmodeltown
AddressLine2: GTRoad,Chheharta,Amritsar
City: Amritsar
District: Amritsar
State: Punjab
Pincode: 143105
MobileNo: 8568929163
EmailID: anshul_batra99@ymail.com
TelephoneNo: 01832259359

X Standard Exam Results


ExamBoard: ICSE
Aggregate%ofMarksinallSciencesubjects
andMathematics: 93
Intheacademicyear201617,Ihavejoined: 01/03/2016

School/College Details
Name: THESENIORSTUDY2
Address: PUTLIGHARCHOWKGT.ROAD,AMRITSAR
City: AMRITSAR

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8/26/2016

KVPY2016Form
State: Punjab
Pincode: 143001

Exam Preferences
PreferredExamLanguage: English
PreferredCity1: Jalandhar
PreferredCity2: Chandigarh
PreferredCity3: Ambala

Online Payment Details


Payment_mode: online
Amount: 1000.00
TransactionNumber: GUR24707038640
ReceiptNumber: 20160826

Declaration
Ideclarethattheinformationprovidedabovearetruetothebestofmyknowledgeandbelief.IunderstandthatifitisfoundthatIdonotmeettheeligibilitynorms
atanypointoftimeImayfacedisqualificationfromtheKVPYprogram.

Candidate Signature
Version 11.01.00

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