Tobe ed aaa JScHoLARsHiP AWARDS Application Form amiga ua (Ason3istian2011) tra Sea (steed 2cr1 88) ctsion (Bonetsignonphote) ScHooL seine st (ate se eeeare nt it) Pleas filth aplication form in English language ony Perel Raber de FathersfGuarian’s Name Reyes A RT od Conespondence Address 20 cry is sue = m Ret oe Prone Nobie s ee ate ot ath se mL] conte oe ema 0 ea Bam Cente Code {Refer bet fo cere code emes eee on Fact ont for las 1158 1208) oo commerce Science Math Scence logy vias (eee sate 1245) = ue facie Berean xamiationFees 4.300 (Wassrst9sihy a. A00/ (Cass6entoath) R500 (cass seco 120) erg S300/- (eerie) was0/- (eroded) 5.800/- (amoaa res) Payment Mode Cask \/) cain op ‘perro Ree (wee Berta) = ore Bank Draft Detals, Aout a Rupes) In favour a0. Carp. Lined (3) Payable tinder Segre Rec (8) 20.8 ae (gy CH Be are of the Bank DD Number Date of ue unm pean coon ae Date ee face / 2 Signature of Candidate Signature of FaheriGurdan Place/ eet RH ET ‘n/ Hee ree soe ae nee ACKNOWLEDGMENT. Fermete dts visit: wowhasargenus011 am centre Code Rectipt Ne, pae________| pane tatestcoour cas School os. oo net ign on phot Name ofthe Candidate sna nen (oa sceeewe 0 Father Name ‘uthorsedSeala Sign EXAM CENTRE CODES (MP & C6): INDORE-01, JAIN -02, RATLAM- 03, KHANDWA-04,DHAR 05, SHOPAL 6, JAGAR-07, HOSHANGABAD -8, ETUL 08, CHATTARPUR- 10, GWALIOR.-11, (GUNA~12,JABALPUR=13,REWA-16,SATNA-15,CHINDWARA 16 RAIPUR 17, HILA- 18, KORBA. 18, BILASPUR-20. cere sreucmeatie fetta tet e ~ Ghia areas Netlink —memsravouc ra | steer Sips “gation als