Navodaya Certificate 2022

JAWAHAR NAVODAYA VIDYALAYA SELECTION TEST - 2022 CERTIFICATE (REVISED) Last date of submission of online application form is 30th November 2021.

Certified that the information given below are correct in respect of

Affix Passport size photo of the candidate

(Name of Student) who is studying in Class V in (Name of School) and interested to apply for Jawahar Navodaya Vidyalaya Selection Test 2022

Name of Candidate (IN BLOCK LETTERS) Father’s Name (IN BLOCK LETTERS) Mother’s Name (IN BLOCK LETTERS) Name of the Guardian and relationship, if any. Date of Birth In figure D D M M Y Y Y Y Gender Please () mark

Boy

Girl

Transgender

put

Nature of disability, if any. Please put () mark against the respective category

In words ………………………………………………………………………… ………………………………………………………………………… Category Gen. SC ST OBC

Physically handicapped

Visually impaired

Hearing impaired

% of Disability

Identification mark ………………………………………………………………………………………………….. Present Postal Address

Mobile No. ………………………… Email……………………………..

Nationality …………………………… Religion ………………………….. Medium of Examination …………………….. (Please indicate one language out of languages for the state concerned given in the prospectus) Particulars

Class-III

Class-IV

Class-V

Name of the School (studied – III & IV and studying V) and village/place School Location : Rural / Urban Month and Year of Joining Month & year of Passing Name of the Block Name of the District Name of the State

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I certify that the school (s) in which my ward studied/studying is a recognized school and fulfills all the eligibility criteria as per NVS requirements. I also understand that even if the candidate has studied in urban area for even a single day in any of the classes III, IV & V, the student will be treated as urban candidate. If any of the information provided is found to be wrong, the candidature of my ward will be forfeited at any stage even after admission in JNV. I also submit that no change in aforesaid data shall be requested by me in future and I agree that in case of mismatch in the online and offline data, the data submitted THROUGH ONLINE mode shall be treated as final.

Signature of the candidate

Signature of the Parent

Note: In respect of NIOS students, area will be decided on the basis of residence of the candidate.

The above details of candidate are verified from school records and found correct. Signature of Head Master with Seal