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National Institute of Open Schooling

Online Admission Form 201617 (Stream 1 Block I for Apr 2017 Exam)
NIOS COPY

A0316204883

ReferenceNo
Region :

DateofRegistration:19April2016
14:6:10

Kolkata

Candidate's Name SUBHODEEPPAL

Fathers Name

SUBIRPAL

Mothers Name

KANIKAPAL

Guardians Name
Postal Address

District/State for
AI
Aadhar No

13/A
VIVEKANANDASARAINIROAD
ITALGACHA
24NORTHPARGANAS
WESTBENGALPincode:
700079

Pastehereyour
photographofsize4
x3cminthisbox
onlyhavingNameof
thelearnerandthe
dateofthe
Photographtaken
elsetheformwillbe
rejected.Donotuse
pinorstapler

YourSignature

NORTH24PARGANAS
WESTBENGAL

Subjects
English(202),DataEntryOperations(229),Mathematics(211),Painting(225),Scienceand
Offered
Technology(212)
AIs (study Centre) Selected are 1.ST. STEPHEN'S SCHOOL (220093) 2.INDIRA GANDHI
MEMORIAL SR.S. SCHOOL(220059) 3.DEVALI MEMORIAL SCHOOL (220113)
Date of Birth:20October2000

Telephone:25111841

Mobile:9007587157

Gender:Male

Category:General

Disability:Notapplicable

Course Applied For:Secondary

Medium:English

Nationality:Indian

Admission under Dual enrolment:NO

Email:subhodeep024@gmail.com

Previous Qualification:VIII

Mode of Payment:DebitCard>Admission Fee:1535.00+Late Fee:0.00+TOC Fee:0.00=Total Fee:1535.00

Bank Transaction Reference No:CTX1604190839277276642
Transfer of Credit: NO >Enrolment No:Year of Exam:0 > TOC Board:
S.No.

Subject Code of NIOS

1.

Marks Obtained
Theory

Practical

Total

2.

3.

4.

Declarationbyapplicant:IherebydeclarethatIhavereadandunderstoodtheconditionsoftheeligibility.Ihavefurnishedallthenecessarydocumentsandinformation
correctly.IunderstandthatmycandidatureisliabletobecancelledbyNIOSintheeventofanyinformationordocumentistobefoundmisleadingorincorrectatanystage.I
accepttheadmissionruleslaiddownbyNIOS.

SignatureofParent/Guardian_____________________Date:_____________SignatureofCandidate:______________

Enclosures (Please (Tick) as applicable) :

1.OnePrintedOnlinefilledinapplicationform
2. One recent colour passport size photographs pasted (NOT TO BE STAPLED) on the printed application form. The Photograph should have name of the Learner
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and the date of photograph taken else the form will be rejected
3.AttestedcopyofproofofDateofBirth
4.AttestedcopyofCertificateforSC/ST
5.TransferCertificatefromthelastschoolattended
6.SelfCertificateregardingeducationalqualifications
7.AttestedcopyofMarksheetofClassXBoardExamination
8.CertificatefromthecurrentEmployerforExServiceman
9.CertificatefromaGovernmentHospitalforahandicappedperson
10.OriginalFailure/CompartmentMarksheet(notlaminated)ofClassXorXIIforTOC
Note:IFTOCBoardmarkedwith(*Other)isselectedthentheResultshouldbeavailableontheCocernedBoardWebsiteorLearnerhastogettheTOCDataverifiedfrom
theConcernedBoardforgrantofTOCasperNIOSNorms.
11.AddressProofaspertheAnnexurementionedintheAdmissionform

To be signed by the Candidate if he/she wants to get admission on the basis of Self Certificate
Self Certificate(tobesignedbyallthosenotenclosingSchoolLeavingCertificate).CertifiedthatIhavestudiedenoughtobeableto
pursueSecondarylevelCourse
Signature of the Candidate

For Office Use only

Dated:___________________Checked&VerifiedSignature:_______________NameoftheOfficial
______________
Reference No: A0316204883

Enrolment No.:_________________________

GeneratedBy(Name):____________________Signature:_______________
CUTFROMHERENEATLY
INSTRUCTIONS TO BE FOLLOWED AND RETAINED BY THE LEARNER
1.ReadtheinstructionscarefullybeforeformisbeingdispatchedtoNIOS.
2.SendtheNIOSCopyofOnlineAdmissionForm)alongwiththerequireddocumentsandbankdraftofrequisitefees,incase,feeispaidthroughBankDraftwithin5daysto
theNIOS.
3.KeepphotocopyoftheNIOS CopyofFilledinonlineadmissionformwithyouforallfuturereference.
4.FordispatchoftheformtoNIOS,pastetheaddresssliponanenvelopekeeptheOfficeCopyofOnlineAdmissionFormalonwithenclosuressafelyintheenvelope.
a.LaminatedMarksheetwillnotbeacceptedforTOC
b.TheCBSECandidatesofyear2010onwardsmayentertheSubjectGradepointsforTOC
5.PleasenotethisReferenceNumberA0316204883 carefully for all future correspondence and monitoring the status of your candidature.
6. Kindly note the following in case of confirmation of admission:
(i) Enrolment Number will be issued through Email and on the Net through Public Comment.
(ii) ICard will be dispatched at your address.
(iii) The PCP of Stream I (II Block) will commence at your allotted AI from 1st Sunday of Nov 2016.
(iv) Submit your TMA (available on Net) at the allotted AI as per schedule.
7. The first examination for Stream I (I Block) will be held in Apr 2017.
8. Deposit Exam fees during December for Apr exam and in June for October Exam.
9. Only one Form should be send in one envelope.
10. First Exam in April for Reference No Starting with "A" and first Exam in October for Ref No Starting with 'N'
11. Contact numbers are : 0120 2404914/2404915/2404916
12. For any queries Contact Learner Support Centre at 18001809393.

13. The Study Material will be delivered to you at your address provided by you during the Registration free of cost.
Do not accept any VPP Parcel from anybody.
14. The Learners who are paying the Fee through online will get Study Material before the confirmation of the
Admission at your adreess provided by you during the Registration free of cost. The confirmation of the Admission
will be done after due verification of the Documents and as per the NIOS Norms.
ADDRESSSLIP
CUTFROMHEREANDPASTEONTHEENVELOPE

Application for On Line Admission Stream 1 Block I (201617)

Reference No: A0316204883

From:

To,
National Institute of Open Schooling
Regional Centre Kolkata
10/1/H, Diamond Harbour Road,
Kolkata 700027 (WB)

SUBHODEEP PAL,
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13/AVIVEKANANDA SARAINI ROAD

24 NORTH PARGANAS
WEST BENGAL700079

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