Thanks for submitting your Application

Form 61617 which can be used for all

future correspondence

Amount:
Payment Transaction No:

00000528.00
DSBI3957196163

Note : Your Application is under Scrutiny, revisit to know the further status.

Application Form

Stream Applied
Stream Name: SA

Personal Details
Application Number: 61617
Name of Applicant: DHAVAL HASMUKHBHAI SOLANKI
Date Of Birth: 02/06/1999
Category: SC
Person with disability: No
Nationality: Indian
Gender: Male

Present Address
Address Line 1: D-18/2, KAPS Township
Address Line 2: Anumala
Address Line 3: Tal-Vyara
City: Vyata

District: Tapi
State: Gujarat
Pincode: 394651
Mobile No: 9428821982
Email ID: hnsolanki1969@yahoo.com

X Standard Exam Results

Exam Board: CBSE
Aggregate % of Marks in all Science subjects
and Mathematics: 85
In the academic year 2015-16, I have joined: 29/05/2015

School/College Details
Name: ATOMIC ENERGY CENTRAL SCHOOL
Address : KAPS TOWNSHIP

ANUMALA

VYARA

City: VYARA
State: Gujarat
Pincode: 394651

Exam Preferences
Preferred Exam Language: English
Preferred Exam Mode: Comput er Based Test
City for writing the Aptitude Test: VADODARA

Declaration
I declare that the information provided above are true to the best of my knowledge and belief. I understand that if it is found that I do not meet the eligibility
norms at any point of time I may face disqualification from the KVPY program.

Candidate Signature
Version 10.00.01