I.

Personal Details
School Name : District : Registration No

Full Name :
Father Name : Photo & Signature
Mother Name :
Gender :
Date of Birth :
Medium Of Examination : Photo

Medium Of Examination (at NCERT

level) :
Community :
OBC Category : -- MobileNo :
Parental Income : EmailID :
AadharNo : 9 class % :
Are You Having Disability ? :
Disability : Percentage of Disability :
If the candidate already enjoying scholarship of NMMS Mention Hall Ticket No and Month &
Year :

Postal Address Family Details

Address 1: Father's Education :
Address 2: Father's Occupation :
District : Mother's Education :
Mandal Mother's Occupation :
No.of family members living in
PinCode
the house:
Area of candidate resides No.of Brothers
At what number is the
candidate among his/her No.of sisters
brother and sister
school Address
School Name: Management Type
School Address 1: Management Belongs
School Address 2: Area in School Locate :
Student of Kendriya Vidyalaya / Navodaya
School District :
Vidyalaya? :
School Mandal School PinCode

Declaration: (To be filled in by the Head of the Institution)

(1) Master / Miss.........................................................................................................is a regular student of this School/Institution
and he/she has secured…….….% marks/grade in the class IX Annual examinations i.e., when he/she was promoted from Class IX to class X.
(2) The particulars given by him/her in the application form have been verified and found in order.
(3) Master / Miss.....................................................................belongs to Scheduled Caste/Scheduled Tribe category as per the records maintained in the Institution.
(caste/disability certificate may be enclosed along with application form in respect of SC/ST and disability candidates)
Signature of the candidate
Signature of the Head of the Institution With Seal
Date
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