IAPT SENIOR SCIENCE-2018 (NSEP / NSEC / NSEB / NSEA)

Student Registration Form

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Students (Born between 01/07/1999 and 30/06/2004) studying in classes 10 , 11 and 12 who wish to appear for the IAPT Senior
Science 2018 Examinations are to fill the below given details in BLOCK LETTERS only and Hand over the Registration Form to their
School/ Institution. Select the subject and language required by ticking.

Name of the Student : .……………….……………………………………………………………………………………...........................

(As per School records)
Gender : (Male / Female)

Class / Standard : .……………….……………………………………………………………………………………..........................

Date of Birth : D D M M Y Y Y Y
M
Language/s
Subject/s
English Hindi Gujarati Bangla
Physics
Chemistry
Biology
Astronomy
Note: Select the Subject / Language by ticking in the respective column. You can select any one of the subject- either Biology or Astronomy
STUDENT STUDYING DETAILS
School Type : KV JNV Others
School Name : .……………….……………………………………....……………………………………………….................................
School Place : .……………….…………………………................................ School Pin Code : .………...................
Is the student studying in the same state as that of center where he is enrolling: Yes No
STUDENT CORRESPONDENCE DETAILS
Residential Address : ………….…………....................................................................................................................

.............................................................. City : ............................................................

State : ............................................................... District : ............................................................

Pin Code : ............................................................... Mobile No : .........................................……………

E-Mail ID : .……………….………………………………………………………………............………………….........................
Declaration: I hereby declare that the details furnished herein are true to the best of my knowledge.
Date:
Place: (Signature of the Student)
Acknowledgement (To be handed to the Student)
Applied for IAPTNSE–2018
No. of Subject/s applied: ……..…. Received Rs: ………………/-

Centre Registration No.: .......…………..……. Institution Seal Signature of Centre In-charge.

Note: Confirm your registration status through “Check your registration status” within seven working days after
submission or else check with the respective Institution.