CBSE J N V RESULT SHEET FOR SELECTION TEST FOR ADMISSION IN CLASS VI SESSION DATE : PAGE NO : 1

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1 CBSE J N V RESULT SHEET FOR SELECTION TEST FOR ADMISSION IN CLASS VI SESSION DATE : PAGE NO : 1 STATE : 18 ODISHA DISTRICT : 17 NABRANGPUR SNO BLOCK CENTRE ROLL NAME SEX CATEGORY AREA D.O.B CODE CODE NUMBER *** URBAN DISABLE SEAT *** I01126 SWASTIK BEHERA BOY GEN RURAL 15/09/ J01548 DHANIRAM GOUDA BOY OBC RURAL 25/05/ K01201 BIJU HARIJAN BOY SC RURAL 17/07/06 NO. OF CANIDATES : 3 *** URBAN OPEN SEAT *** A00404 TARINI PRASAD PATNAIK BOY GEN URBAN 01/02/ B00431 RUPESH PARIDA BOY OBC URBAN 22/04/ C00458 GOURAV HALDAR BOY SC URBAN 05/06/ C00465 PRAMIT BAROI BOY SC URBAN 16/02/ F00565 SWATAHA PRABHA SAHU GIRL OBC URBAN 08/08/ H00615 PRIYA DARSANI MAJHI GIRL ST URBAN 15/07/ H00618 ANJALI ZENIFER BARLA GIRL ST URBAN 11/07/06 NO. OF CANIDATES : 7 *** URBAN SC SEAT *** C00455 ANIRBAN BISWAS BOY SC URBAN 20/12/ G00119 PRANATI BHAKTA GIRL SC URBAN 25/07/ G00577 ESHA DAS GIRL SC URBAN 08/02/06 NO. OF CANIDATES : 3 *** URBAN ST SEAT *** D00501 JITENDRA MAJHI BOY ST URBAN 24/09/ D00502 ROHIT KUMAR GOND BOY ST URBAN 29/11/ D00504 MOHANISH KUMAR HALBA BOY ST URBAN 24/03/ D00514 BIBHUTI BHUSAN MAJHI BOY ST URBAN 30/09/ D00518 TULARAM BHATRA BOY ST URBAN 05/11/ H00622 GEETANJALI GOND GIRL ST URBAN 27/03/ H00632 TEJASWINI BHATRA GIRL ST URBAN 20/03/07 NO. OF CANIDATES : 7 *** RURAL OPEN SEAT *** I01120 Y SIDDHARTH BOY GEN RURAL 09/10/ I01702 KUMANDANA MEHETA BOY GEN RURAL 05/01/ I01705 NITISH KUMAR THAKUR BOY GEN RURAL 09/09/ I03511 OMVEER TRIPATHY BOY GEN RURAL 12/03/ J00151 PITABAS BISSOYI BOY OBC RURAL 12/04/06

2 CBSE J N V RESULT SHEET FOR SELECTION TEST FOR ADMISSION IN CLASS VI SESSION DATE : PAGE NO : 2 STATE : 18 ODISHA DISTRICT : 17 NABRANGPUR SNO BLOCK CENTRE ROLL NAME SEX CATEGORY AREA D.O.B CODE CODE NUMBER *** RURAL OPEN SEAT *** J00152 ASUTOSH SAHU BOY OBC RURAL 16/11/ J01734 SRUTIPRAJNA DAS BOY OBC RURAL 20/01/ J03530 RANJEET KUMAR BISOI BOY OBC RURAL 06/07/ K00710 SURAJ MANDAL BOY SC RURAL 24/11/ K02055 TUSHAR RANJAN NAYAK BOY SC RURAL 20/11/ K02367 SAHIL SUTAR BOY SC RURAL 12/12/ K03040 KOUSIK SIKDAR BOY SC RURAL 02/04/ L00756 TRIPATI MAJHI BOY ST RURAL 10/03/ L00768 RAMESH BHATRA BOY ST RURAL 02/11/ L00783 ANANTA MANDINGI BOY ST RURAL 07/02/ L01613 NRUTYA PUJARI BOY ST RURAL 14/12/ L02140 BISHAM BHATRA BOY ST RURAL 05/02/ M00242 AMRITA AKANKSHYA GIRL GEN RURAL 09/03/ M01629 NIBEDITA PATTANAYAK GIRL GEN RURAL 24/04/ M02658 GAYATRI SUBHASMITA MOHANTY GIRL GEN RURAL 22/01/ M02810 TEJASWAINI SWAIN GIRL GEN RURAL 20/03/ M03242 SANDHYARANI PANDA GIRL GEN RURAL 22/08/ M03244 EPSITA TRIPATHY GIRL GEN RURAL 18/09/ N01102 FRANCISCA GARADA GIRL OBC RURAL 16/04/ N01645 BABITA BISI GIRL OBC RURAL 23/01/ N02178 PAYAL BISWAL GIRL OBC RURAL 19/10/ N02523 BISWARUPA NAYAK GIRL OBC RURAL 22/06/ N02829 ALVI PATRA GIRL OBC RURAL 09/06/ P00281 REWA SUNDI GIRL ST RURAL 16/12/ P01406 PRIYANKA MAJHI GIRL ST RURAL 20/04/06 NO. OF CANIDATES : 30 *** RURAL SC SEAT *** K01419 SUMIT BEHERA BOY SC RURAL 23/08/ K02369 SAJAN GAIN BOY SC RURAL 10/08/ K02999 KAILASH MRUDHA BOY SC RURAL 15/06/ K03035 TUFANSARDAR BOY SC RURAL 28/09/05

3 CBSE J N V RESULT SHEET FOR SELECTION TEST FOR ADMISSION IN CLASS VI SESSION DATE : PAGE NO : 3 STATE : 18 ODISHA DISTRICT : 17 NABRANGPUR SNO BLOCK CENTRE ROLL NAME SEX CATEGORY AREA D.O.B CODE CODE NUMBER *** RURAL SC SEAT *** K03039 DIBYENDU MONDAL BOY SC RURAL 10/01/ K03041 BITTU MONDAL BOY SC RURAL 06/10/ K03042 AMLAN MONDAL BOY SC RURAL 03/09/ O03291 MANISA MALLICK GIRL SC RURAL 03/06/ O03315 ROJEE BISWAS GIRL SC RURAL 13/06/06 NO. OF CANIDATES : 9 *** RURAL ST SEAT *** L00852 SUKADEB GOND BOY ST RURAL 20/04/ L01239 BIKASH HEMBRAM BOY ST RURAL 24/04/ L01259 ANSUMAN NAYAK BOY ST RURAL 20/05/ L01600 DALESWAR NAYAK BOY ST RURAL 12/02/ L02082 KHIROD KUMAR NAYAK BOY ST RURAL 26/09/ L02139 PRAHALLAD BHATRA BOY ST RURAL 02/02/ L02445 BHAGATRAM BHATRA BOY ST RURAL 07/01/ L02457 MAHENDRA BHATRA BOY ST RURAL 02/04/ L02768 RAJENDRA BHATRA BOY ST RURAL 12/05/ L03054 NALINDRA GOND BOY ST RURAL 01/03/ L03062 CHANDHAN GOND BOY ST RURAL 08/04/ L03065 SUSANTA GOND BOY ST RURAL 28/03/ L03087 RABINDRA GOND BOY ST RURAL 22/03/ L03117 KESIDHAR GOND BOY ST RURAL 18/02/ L03172 ROHAN DHURUA BOY ST RURAL 23/05/ L03176 MALAY RANJAN BISHI BOY ST RURAL 12/03/ P01393 RASMIPRIYA BEHERA GIRL ST RURAL 13/11/ P01957 MANJULA MAJHI GIRL ST RURAL 06/06/ P02213 HEMADEI SANTA GIRL ST RURAL 05/11/ P03344 PUNAM NETAM GIRL ST RURAL 10/08/ P03409 KADAMBINI GOND GIRL ST RURAL 10/06/06 NO. OF CANIDATES : 21

4 JAWAHAR NAVODAYA VIDYALAYA AT/PO:KHATIGUDA,DIST.NABARANGPUR,ODISHA,PIN An Autonomous Organization under Ministry of Human Resource Development Department of School Education & Literacy, Government of India Ph.No (Office), & Web-site : CBSE Affl.No & Sch.No Ref. F.No.2-1/JNV/KTG/NBPR(O)/ / Dated: 28 th June, 2017 BY REGD. POST WITH ACK. DUE To,,. Sub:- Provisional selection of candidate for admission into class-vi for the academic year in Jawahar Navodaya Vidyalaya Regarding. Sir, I am glad to inform you that on the basis of selection Test for admission to Jawahar Navodaya Vidyalaya conducted by CBSE, New Delhi held on , your son/daughter Master/Kumari Roll No.: has been provisionally selected for admission into Class VI of JNV, Khatiguda, Dist. Nabarangpur, Odisha for the academic year, His/Her admission will be finalized subject to the fulfillment of conditions and submission of documents as required by Navodaya Vidyalaya Samiti, Noida. Therefore, you are requested to report this Vidyalaya along with your son/daughter on (Sl.No.01 to 40 of Result Sheet)/ (Sl.No.41 to 80 of Result Sheet) at A.M. with the following enclosed proformas duly filled. Annexure I : Bio-data form certified by Head of the School from where class V th is completed Annexure II : Urban/Rural Area Certificate of the school in which class V th is completed Annexure III : Medical Certificate Annexure IV : Residence Certificate by Parent Annexure V : Residence Certificate issued by Tahasildar Annexure VI : Affidavit by the Parent on Rs.10/- Non - Judicial stamp paper duly attested by notary. Besides the above, you are also required to submit the following documents for verification. 1. The caste certificate issued by the competent authority (in case of SC/ST/OBC Candidates only). 2. The disability certificate issued by the competent authority (in case of PH/VI/HI Candidates only) 3. Adhar Card 4. Ration Card issued by Competent Authority. 5. Govt. Recognition Certificate of the institution in case of Private School. After verification of the above documents submitted by you, a decision will be taken regarding final admission of your ward and the same will be intimated to you separately. Admission will be cancelled for submission of false information, documents and records and also action shall be initiated as per the rule. Please note that the TRANSFER CERTIFICATE of the candidate has to be submitted only after verification of the above documents and confirmation of your ward's final admission. Thanking you, Yours faithfully, 1 PRINCIPAL

5 Navodaya Vidyalaya Samiti Noida NOTICE Select list of students for admission to Class VI through JNVST-2017 has been released. The following activities may be taken up by the parents/guardians after selection of students for admission to Jawahar Navodaya Vidyalaya: 01 Select list may be downloaded from the website. 02 Formats for the submission of details may be downloaded 03 Filled in formats are to be submitted to the Principal of JNV concerned. 04 Certificates from the competent authority in respect of Rural, OBC, SC, ST and Disability are to be submitted to the JNV for documents / eligibility to confirm admission to Class VI. verification of It is informed that admission will be given only to the selected candidates after due verification of the documents. Parents are advised not to take TC from previous school until the admission is confirmed. Admission to JNVs is done free of cost. No fee is to be paid to school authority for admission to Class VI. The parents/students are required to approach directly to the Principal of the concerned JNV. For any complaints in the process of admission, may be sent to

6 (To be filled in by the Parent/Guardian of the Candidate with the help of the Headmaster/mistress of the School from where the candidate passed Class V Examination) 1. Name of the Candidate: Aadhar Number: 2. Sex Male Female TG PHOTO of student 3. (a) Category Gen OBC SC ST (b) Caste 4. Date of Birth : Date Month Year In Words : 5. Father s Name : 6. Mother s Name : 7. Name of the Guardian and relationship with him/her, if applicable : 8. School(s) from where the candidate passed Class III,IV and V. C L A S S E S (A) (i) Month & Year of Joining (ii) Month & Year of Passing (B) (i) Name of the School (ii) Is It a recognized school? (YES/NO) (C) Name of the Village or Town in which t school is located. (D) Name of the Block (E) Name of the District (F) Location of the School Indicate RURAL/URBAN III IV V (Separate certificate is to be obtained if the candidate had studied classes III, IV & V in different schools)

7 CERTIFICATE (BY PARENT/GUARDIAN OF THE CONCERNED CANDIDATE) Certified that the information given above is true to the best of my knowledge and belief. In case, any part of the information furnished by me is found incorrect, the admission of my child/ward may be cancelled. I am ready to produce the relevant certificates issued by Competent Authorities as and when asked for. Entries verified, certified and found correct. Signature of the HEADMASTER/HEADMISTRESS Name : Signature of PARENT/GUARDIAN Desgn.: School Seal : NOTE FOR THE HEAD OF THE SCHOOL: Dear Sir/Madam, The above mentioned information is required for admission of the candidate in the Jawahar Navodaya Vidyalaya, District You are therefore requested kindly to check and verify personally all the entries from the school records and issue the certificate given below:- CERTIFICATE BY THE HEAD OF THE SCHOOL Principal JNV Certified that the information given above is found correct as per our school records. It is also certified that Master/Kumari was admitted in this Shool in Class on (date) and passed Class on (date). Signature of the Head of Institution last studied with School Seal Date :

8 UNDERTAKING BY THE PARENT/ GUARDIAN Certified that the information given in the application form for admission into Class VI in Jawahar Navodaya Vidyalaya, District: for the academic year for my ward is true to the best of my knowledge and belief. In case any part of the information furnished by me is found incorrect, admission of my ward may be cancelled at any time. I am ready to produce relevant certificates issued by the competent authority to your office when asked in support of my original application entries Signature of the parent/guardian Address of parent/guardian: Name: H.No: Street Village Mandal/Block Pin Code: STD Code: Phone No Mobile No: UNDERTAKING I, (Father/ Mother/ Guardian) of Kumari/Master who got selected for admission into Class VI in Jawahar Navodaya Vidyalaya,.District hereby give an undertaking that I am ready to pay Rs (Rupees Two hundred only) per month or revised amount or as charged by the Navodaya Vidyalaya Samiti, Noida from Class IX to XII. Signature of the parent/guardian Note: This is not applicable to SC/ST categories and all girl students and the parents whose Income is below poverty line.

9 UNDERTAKING FOR MIGRATION (TO BE FILLED BY PARENT IN PRESENCE OF PRINCIPAL, JNV) I, Father/Mother/Guardian of Kumari/Master who got selected for admission in Class VI in JNV, District hereby give an undertaking that I understand that, for promotion of National Integration and as per the scheme at JNVs, 30% of the students of class IX from one JNV have to migrate to another JNV from non-hindi speaking area to Hindi speaking area and vice-versa and I agree to abide by the rules of NVS in this regard. Signature of the parent/guardian Full name: Address: Mobile No: Land line with STD code:

10 JAWAHAR NAVODAYA VIDYALAYA: DISTRICT: MEDICAL FITNESS CERTIFICATE 01. Name of the candidate : 02. Father s name : 03. Address : 04. Date of birth 05. Height 06. Weight 07. Abdomen 08. Chest 09. Vision LEFT RIGHT 10 Ears 11. Throat 12. Locomotor system 13. State of vaccination 14. Skin 15 Blood Group 16 Dental Hygiene 17. Remarks of Medical Officer : Recommended/not recommended for admission/recommended to C.M.O for Verification if any. PHOTO OF THE STUDENT CIVIL SURGEON

11 DISABILITY CERTIFICATE If the candidate is selected under disabled quota he/she should bring the certificate issued by the competent authority. COMMUNITY CERTIFICATE Community certificate in the prescribed format from the competent authority is to be submitted by the candidate, wherever necessary. RURAL CERTIFICATE (To be issued by the Revenue Officer of concerned Block) This is to certify that Master/Kumari Son/daughter of Shri studied classes III, IV & V In (Name of the school) of block and the school is located in the village which belongs to RURAL AREA of District;,State:. (Signature of the Revenue Officer) Block: District. Office Seal: Dated:

12 ANNEXURE-II RURAL /URBAN AREA CERTIFICATE Certified that School in which Chi/Kum. son/daughter of has studied classes from to is located in RURAL/URBAN AREA AS PER 2011 CENSUS. Place: Date: TAHASILDAR NAME: OFFICE SEAL NOTE: If the student studied classes III, IV and V in different Schools, Rural/Urban Area certificates in the above proforma should be enclosed for each school separately. 2

13 RESIDENCE CERTIFICATE ANNEXURE IV (To be furnished by the father/mother of the qualified children at the time of admission to JNV) As per Jawahar Navodaya Vidyalaya, Khatiguda, Dist. Nabarangpur, Odisha letter No., dated my ward Mast./Kum. has qualified the entrance examination for admission to Class VI at JNV, Khatiguda, Dist. Nabarangpur, State-Odisha during the session I am residing along with my son/daughter (whose name is mentioned above) at following address since (mention years or date) Village : Town : District : State : Pin Code : Certified that the information furnished by me is true and no fact has been concealed. Place: Date: Signature of Father/Mother Full Name Address House No. Street Name: Village: Block: District: PIN: ANNEXURE V CERTIFICATE (To be filled up by the District Authorities and issued under the signature of SDM/Tahasildar to the parents of the child selected for admission to Class VI in JNVs through JNVST) This is to certify that the above information furnished by Shri/Smt. father/mother of Master/Kum. a candidate selected for admission to Class VI in JNV, Khatiguda, District: Nabarangpur has been verified from the records and is found correct. The area where residence is located falls under (rural/urban) area of District. Round Seal Signature of SDM/Tahasildar Name : Official Seal : 3

14 ANNEXURE VI AFFIDAVIT (An affidavit to be furnished by parents on Rs.10/- Stamp paper duly attested by notary at the time of admission of Class VI in JNVs through JNVST) I, (Name of the Father/ Mother), Age Years, father/mother of Mast./ Kum. Resident of Village Mandal Dist. solemnly declare and affirm as under: a. My son/daughter is a student of (name and complete address of the Institution) located in which is a rural/urban area in Nabarangpur District in Odisha State since (date or years). He / She has passed Class V from this Institution during the session (academic year) b. My son/daughter is residing with me at following address which is located in the urban/rural area of Nabarangpur District. Door No. : Village Post Block District Post : : : : : Verified on this the day 2018 at that the contents of above affidavit are true to best of my knowledge and belief based on record and believed by me to be true. Place: Signature Date: (DEPONENT) (Father or Mother) Name: Sworned before me at (place) on (date) (NOTARY) With official seal, address and Notary Registration/Renewal particulars 4

15 ADMISSION BIO-DATA FORM JAWAHAR NAVODAYA VIDYALAYA, KHATIGUDA, DIST. NABARANGPUR, ODISHA ANNEXURE-1 Admission Number : 01. Name of Pupil in Full (in block letter) : Date : Category : Area : House Allotted : 02. Date of Birth in Christian Era 03. Nationality and state in which the pupil belongs to a) In figures : b) In Words : 04. Religion : 05. Caste & Category : 06. Whether living with parent or guardian : 07. a) Father s Name : b) Qualification : c) Occupation : :INDIAN-ODISHA d) Annual Income : Rs. e) Full Address with phone no. : 08. a) Mother s Name : b) Qualification : c) Occupation : d) Annual Income : Rs. 09. a) Name of Guardian : b) Qualification : c) Occupation : d) Annual Income : Rs. e) Full Address : 5

16 10. Class last studied, name of school last attended, whether qualified for promotion : 11. Whether Transfer Certificate/ Record Sheet enclosed : 12. Class which to admission sought : VI CLASS 13. Mother tongue of the Pupil : 14. Protection from small fox, whether vaccinated or small for : 15. Personal Marks of Identification 1) 2) 16. Family composition(no. of brothers, sisters) : 17. Literacy level of parents/ Brothers/Sisters : Name Age Qualification ) Father 2) Mother 3) Brothers: 1) 2) 3) 4) Sisters: 1) 2) 3) Particulars of brothers/sisters studying in JNV in which class presently studying Name Relationship Class i) ii) iii) Distance from School studied in Class V to JNV, Khatiguda in K.Ms. 20. Distance from Native Place (Home Town) to JNV, Khatiguda in K.Ms. 21. Adhar Card Number of CANDIDATE: 22. Place of Birth of the candidate : 6

17 DECLARATION OF THE PARENT/GUARDIAN: I declare that the above particulars are correct to the best of my knowledge and belief and that the pupil has not attended any school besides these mentioned above. Place: Khatiguda, Signature of Parent/Guardian Date: Signature of pupil as signed in admission form (Specimen Signature) Name and addresses of two persons other than parents (kith & kin) who may visit the Vidyalaya to meet the student. 1) Name and address 2) Name and address Relationship with student relationship with student TO BE FILLED IN BY SCHOOL: Signature of parent/ guardian Orders of the Principal regarding admission and signature of the Principal with date. Admitted into VI class Principal: Date: 7

18 U N D E R T A K I N G I, Shri Father of Master who is admitted in JNV, Khatiguda, Dist. Nabarangpur, Odisha in Class VI during do hereby accept to pay Rs.200/- (Rupees two hundred only) per month towards fee (Which will be enhanced to Rs.300/- gradually) to JNV, Khatiguda from IX Class onwards of my child as per the recommendations of the Expenditure Reforms Commission constituted by the Ministry of Human Resource and Development, Govt. of India and Navodaya Vidyalaya Samiti, Noida vide order No.10-41/2001/NVS(Acad.), dated of the Joint Director(Acad.), NVS, Noida all the students from Class-IX and above (Excluding S.C., S.T., Girls and students whose families are below poverty line. Place: Khatiguda signature of Parent : Date: Name : Address : Countersigned PRINCIPAL JAWAHAR NAVODAYA VIDYALAYA, KHATIGUDA, DIST. NABARANGPUR, ODISHA 8

19 JAWAHAR NAVODAYA VIDYALAYA, KHATIGUDA, DIST. NABARANGPUR, ODISHA UNDERTAKING BY THE PARENT/GUARDIAN I, Shri father of Master/ Kumari do hereby undertake that, my son/daughter/ward will not leave the Vidyalaya campus or House without the permission of the HMs/ Principal. If, my son/daughter/ward leaves/absconds from the Vidyalaya campus without prior permission of the HM/Principal, the Vidyalaya administration will not be held responsible for any lapse. Further, I hereby declare that, my son/daughter/ward will continue his/her study in this JNV, Khatiguda from class VI to XII and I will not apply for T.C. in any time of his/her study period as per the rules laid down by the Navodaya Vidyalaya Samiti, Noida. Signature Name.. Address.. Place. Date.. 9

20 RECOGNITION CERTIFICATE This is to certify that (School Name), Vill;, Block : Dist. Nabarangpur (Odisha) is recognized with State Government of Odisha. BLOCK EDUCATION OFFICER (BLOCK) NAME : DIST. NABARANGPUR (O) 10

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