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SIMULTALA RESIDENTIAL SCHOOL (JAMUI, BIHAR) ENTRANCE EXAMINATION 2013

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Page 1: SIMULTALA RESIDENTIAL SCHOOL (JAMUI, BIHAR) ENTRANCE EXAMINATION 2013

f{ffi fuqrf,q qfre+r HEfr, qdqTffi vw- 15./zots

frUf,ildr orr+rs?T fdqrf,q, fugaoar, qE{ (frflr)rieT qfteTr q-qrm{ o-rqld'q - fuETq ff,ilErq rssr rrfrfr,-q-eqT- 17

+nrdu tutr , F-frffi,5i'#6'*#ffi-#-#H3#'#"- or,-sq rdqrd-q(3r-ffi qqq) d qe qri rra zors ti qd:r t ftr en+rc qa eirqBo fuT rnd t r rd-qiq€terT ol {rapa1 f}-,0fr_ilrdq qfrar rrffi, s'drT-17 d arr fu-qr w ru B t

i. En gq unrsrl d fti\ rlrd-rrld qftd FrTiR-d B r

2. rTqif,a uffi-+| 3;5ur Reservarion Act.2003 (Bihar Act.16 ol 200i) d 3r'f,rfd oftqrrZMox ftqiflrr rli-'fisTiR-d d-

(A)fro g0 ut-{ St7I

1 qTqrs (GEN) 30 30

2 eqrfi-o wffi (sc) 11 09

3 3r$il?n w{wfr (sr) 1 0'1

4. 3r.qa fiu-sT crt (rec)erqqq - | 11 11

E fiue-r q,f lacyeraou - t t 7 7

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cb-EI :I 60 60

(B) Physically Handicapped -3 lrfdqf, (rCm aitr :-8tq"r <is, EE dq silr el.s- en{lRm fil+mrrdr ,l

3m.ff,) t qt'qrq t erqor <tut Tq Ek e)tr d eiqfliqi d ftr 3{rqps'fi ffiq zq+rsn {dj Eti -.i on'r{s +)nft d 3r?qffi ol nrqrf,a r$l ftqT qT rrqr-f,T d I e+n' Physically Handicapped N} i i'fr,+,srq qrfiRo fuoeiro oifa d sr+qfoH fl nmpqrq fr ftrql uil {rqjrrT t t srq qrftRfi ffiqoretE d ai-<Ffd qqF{a unTur*rer} or ffirror o-r K{ +o cfu{ro Gralcfi sq{ +fl

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5. qtn. d flr qfren d q!q) tqrqft-fi.rpretirlinar') \q tw/ Main) H sqltro eH) t

6. qzrq qfietT (rrRmTPrelinrinar,v) fuqm- 0e.062013 d erqsT{q oz,oo qd q) o+,oo qG oo d e)il I 02 rr,,o1 qften d tzo sgffizn flgftB qpc Eti f}-afl fi'rnwc Sq !-ft-N t e}n-(o) kl-so qc-r 1.,,r,

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7. {sr qfrfli d f,d qri qrd sq{ RET{ s{{+-r{ gr{ ffi oeTT (fi d fAf fqqftd srd{Fs w enufto elirB. 5w rfren d ftr qRrqiMI @T q-q1 erEFro qfrel fr d-"ulo) d e+urq rrs d.oftnr fu-ql qttqr I tw q{]el

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Page 2: SIMULTALA RESIDENTIAL SCHOOL (JAMUI, BIHAR) ENTRANCE EXAMINATION 2013

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Page 3: SIMULTALA RESIDENTIAL SCHOOL (JAMUI, BIHAR) ENTRANCE EXAMINATION 2013

BIHAR SCHOOL EXAMINATION BOARD, PATNAAPPLICATION FORM FOR ENTRANCE TEST,2OI3

(For Office use only)

District Code ttrGender nCategory [-T-TSerial xo l-I-l-Tl

Signature of the Dealing lncharge

5. Sex (Tick the relevant)

ldq (q-{B-d o} (/) frkd olfr\)

For

S I M U LTALA AWAS IYA VI DYALAYA(ENGLtSH MEDTUM), STMULTALA, JAMUI

fr5-dildr ornrfrq fr-o.rf,q (3r}m qwq), frTf,ildr, ETi(To be filled in English and Hindi)

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sld q't 1b sra t1'l

q 6a rcr e)

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1. Candidate's Name (Use Capital Letter

(cTilEn or flq) :

Fee Paid (Journal No., Amount & Date) : .............................

g@ Trdra (wr+o qo, vtfu f,rll fcrns)

J.

Male

5sq

Female

qkdT tlAre you a Domicile of Bihar State(Tick the relevant) :

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Category (Tick the relevant) offr FKfud oi (/) frko dfuq) :

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*";* t-t;; E ft;; E#; EgHf;q oISoqT0

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I Date of Birth

(qq fttu)

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hallenged

t-TrDay

tegory :Ye

r-T-lMonth

tl No rfr

Year

11 . Class

oflI :

12. Class Roll no.

oqtT m-qrf,

cri {E w (Back page)

Page 4: SIMULTALA RESIDENTIAL SCHOOL (JAMUI, BIHAR) ENTRANCE EXAMINATION 2013

oTriffi or enfr qdr :

l4.Address for Correspondence With Telephone no./ Mobile no./ E-mail lD

q-il=N ?DT qiil \q wrrTq/qla-f,f,/{-trd u(o so

sfl-tqfi oI EffiIqR (Candidate's Signature)

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(trtam) vEIFIIEIItfo

(orwuqw fr-{rcrq d sflqrilq-o)

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Page 5: SIMULTALA RESIDENTIAL SCHOOL (JAMUI, BIHAR) ENTRANCE EXAMINATION 2013

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