NAVODAYA VIDYALAYA SAMITI

JAWAHAR NAVODAYA VIDYALAYA SELECTION TEST

CLASS VI - 2020
APPLICATION FORM

REGISTRATION NO.: 18110300436

Application is Considered under URBAN Category

State ODISHA District GANJAM

Name of the Candidate S.SUNANDA DORA
Mother's Name S PADMABATI DORA Father's Name S NILANCHAL DORA
Name of the Guardian - Relationship with -
Guardian
Nationality of the INDIAN Date of Birth 02-Apr-2009
Candidate
Present Postal Address KHALIKOTE,GANJAM : 761030
Telephone - Mobile No 9337560366
Gender FEMALE Category OBC
Marital Status UNMARRIED Identification Mark BLACK MOLE
Medium of Examination ORIYA
Disablility, if any No

Previous School Details

III Standard Details IV Standard Details V Standard Details

Name of the State ODISHA ODISHA ODISHA
Name of the District GANJAM GANJAM GANJAM
Name of the Block KHALIKOTE KHALIKOTE KHALIKOTE
Name of the Village KHALIKOTE KHALIKOTE KHALIKOTE
Name of the School SSVM KHALIKOTE SSVM KHALIKOTE S.S.V.M KHALIKOTE
Recognized/Not RECOGNIZED RECOGNIZED RECOGNIZED
Recognized
School Location URBAN URBAN URBAN
Month/Year of Joining August - 2017 April - 2018 April - 2019
Month/Year of Passing March - 2018 March - 2019 -

CERTIFICATE BY CANDIDATE/PARENT/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. I will produce all the certificates at the time of admission.

Signature of the Parent Signature of the Candidate