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JAWAHAR NAVODAYA VIDYALAYA SELECTION TEST - 2020
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CERTIFICATE
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Last date of submission of online application form is 15th September 2019
Affix Passport size photo of the candidate
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Certified that the information given below are correct in respect of
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(Name of Student) who is studying in Class V in
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(Name of School) and interested to apply for Jawahar Navoday Vidyalaya Selection Test 2019
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Name of candidate (IN BLOCK LETTERS)
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Father's Name (IN BLOCK LETTERS)
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Mother's Name (IN BLOCK LETTERS)
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Name of the Guardian and relationship, if any.¾
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Date of Birth In figure In Words
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DDMMYYYY
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Gender Please put (p)markBoyGirlTransgender Category
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p Gen.SCSTOBC
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p
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Nature of disability,if any. Please put (p) mark against the respective caregoryPhysically handicappedVisually impairedHearing impaired
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¾¾¾
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Identification mark
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Present Postal Address
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 Mobile NoEmail
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Nationality-Religion-
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Medium of Examination
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(Please indicate one language out of languages for the state concerned given in the prospectus)
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ParticularClass-IIIClass-IVClass-V
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Name of the school (studied-III & IV and studying V)and village/place
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School Location : Rural/Urban
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Month and Year of Joining
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Month & year of Passing
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Name of the Block
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Name of the District
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Name of the State
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I certify that the school (s) in which my studied/studying is a recognized school and fulfills all the eligibility
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criteria as per NVS requirements. I also understand that even if the candidate has studied in urban area for even a single a
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day in any of the classes III,IV &V, the student will be treated as urban candidate. If any of the information provided is
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found to be wrong, the candidature of my ward will be firfeited at any stage even after admission in JNV.
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 Signature of the candidate Signature of the Parent
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Note: In respect of NIOS students, area will be decided on the basis of residence of the candidate.
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The above details are verified from School records and found correct
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Signature of Head Master with Seal
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