Appendix - B
Instructions for filling up the Application Form for Admission
GENERAL INSTRUCTIONS
1. Apply for admission only on the forms available in the Prospectus (or downloaded from the NIOS website).
2. Forms are provided in duplicate. Fill in both the forms giving same particulars. In case of any variation, particulars
filled in the original Form will be treated as final.
3. Ensure your eligibility before filling up the form. You will not get admission in case any of the eligibility criteria is
not fulfilled and fee will be forfeited without any intimation.
4. Fill in the form legibly in CAPITAL letters English or Hindi only. Avoid overwriting.
5. Leave one box blank between parts of Name, Father’s Name, etc. Do not write Mr., Mrs., Shri, Kum., etc.
before any name.
6. Incomplete admission form without supporting documents will be summarily rejected and fee forfeited.
Submit your Application Form and deposit fee only in the AVI/SAIED
where you wish to seek admission, and obtain proper receipt.
SPECIFIC INSTRUCTIONS
PART A of the Form
You need to affix your two recent passport size photographs on each application form. Photograph pasted on left side
of the forms has to be attested by anyone of the following persons:
• Coordinator of NIOS AVI/SAIED
• Principal of a recognized school / college or institution
• District Magistrate
• Gazetted Officer
• Pradhan, Gram Panchayat / Chairman, Panchayat Samiti / Chairman, Zilla Parishad
• Sarpanch of a Village/ Tehsildar
The photograph on the right side shall not have any mark as it will be scanned for record. It shall also fit in the Box
provided for it.
Sign in the box provide below this place. Don’t sign outside the box.
1.
Name of the Candidate : Mention your name as already recorded in your previous school certificate.
V I
2&3.
S H A L
H A N D E N
S O D H I
Father’s and Mother’s Name: Write your father’s and mother’s names in block letters, in English
as per specimen given below. Do not write Shri, Smt., Mr. or Mrs. before the name.
N I H H A
4a.
C
L
C H A N D E N
S O D H I
Your Father's and Mother's name should tally with your previous records. This will be recorded in your
Certificate. No change will be permitted later on.
Postal Address : Provide your complete address with House No., Father’s Name
(if required), Ward No., Village and Post Office, Tehsil, District, State and Pin Code. NIOS will not be
responsible for non-delivery of items/letters/materials if any, to the candidate, due to incomplete
address.
165
Prospectus 2012 Vocational Education Courses
National Institute of Open Schooling
4b.
Permanent Address : Provide your complete address with House No., Father’s Name (if required),
Ward No., Village and Post Office, Tehsil, District, State and Pin Code. NIOS will not be responsible
for non-delivery of items/letters/materials if any, to the candidate, due to incomplete address.
5.
Date of Birth : Mention your date of birth correctly in figures only e.g. 05.08.1967 instead of 5th August
1967. Attested copy of certificate as proof of date of birth should be attached with the admission
form.
1
9
DATE
0 6
1 9 8 4
MONTH
YEAR
6.
Gender: Write 1 for Male and 2 for Female in the box provided.
7.
Category: Write 1 for General, 2 for SC, 3 for ST, 4 for Ex-Servicemen and 5 for Handicapped, 6 for OBCs (Others
Backward Classes) in the box provided.
8.
Disability: Write 1 for Locomotor Disability, 2 for Visually Impaired, 3 for Hearing Impaired, 4 for Leprosy Cured,
5 for Mentally Retardation, 6 for Mental Illness, 7 for Multiple Disabilities, 8 for Spestic/Cerebral Palsy, 9 for Learning
Disabilities and 10 for Not Applicable, in the box provided.
9.
Disadvantaged Group: Write 1 for Street Children, 2 for Working Children, 3 for Rural Women, 4 for Slum Dwellers and
5 for Not applicable, in the box provided.
10.
Category of Course Applied for : Provide (a) category of the course. Please tick (P) in the appropriate
box. (b) name of the course and (c) subject code no(s). Refer to Table I on page 4 onwards.
11.
Medium of Study: Write 1 for Hindi Medium and 2 for English Medium in the box provided.
12.
Nationality: Write 1 for Indian and 2 for any other, in the box provided.
13.
Religion : Write 1 for Hindu, 2 for Muslim, 3 for Christian, 4 for Sikh, 5 for Jain, 6 for Budhist, 7 for Parsi, 8 for Jews.
14.
Your Previous Qualification, : Please tick (P) in the appropriate box. Attach attested copy of marks
sheet as proof of educational qualifications.
15.
Year of Passing X & XII Exam. : Write the name of the Board from where you have passed
Examination.
16.
Amount of Admission Fee Paid : Fill in details of fee remitted. Amount of fee to be remitted is given in
Table I on Pages 12 onwards. Do not pay any extra amount over and above what has been prescribed
by NIOS.
your
PART B of the Form
17.
Fill in this section which will help us develop appropriate strategies for you.
18.
Signatures of the Candidate and Counter Signatures of Parent/Guardian (if required) with date be clearly
put at the appropriate place.
National Institute of Open Schooling
166
Appendix - C
ewy izfr
ORIGINAL
QkeZ la-@FORM NO.
;gka QksVks fpidk,¡ tks fd leUo;d@
ç/kku@ljiap@ç/kkukpk;Z ;k
jktif=kr
vf/kdkjh }kjk lR;kfir gksA
PASTE PHOTOGRAPH HERE OF THIS
BOX SIZE DULY ATTESTED BY
COORDINATOR/PRINCIPAL/
PRADHAN/SARPANCH OR
GAZETTED OFFICER
jk"Vª h ; eq D r fo|ky;h f'k{kk la L Fkku] uks , Mk ¼m-ç-½
National Institute of Open Schooling, NOIDA (U.P.)
ckWDl ds vkdkj dk QksVks ;gk¡
fpidk,¡
O;kolkf;d ikB~ ; Øeks a es a ços ' k ds fy, vkos n u i=k-2012
tks lR;kfir u gksA
Application Form for Admission to Vocational Courses-2012
QkWeZ fganh ;k vaxzst+h ds cM+s o.kks± esa HkjsaA dsoy uhys ;k dkys ckWy IokbaV isu dk gh ç;ksx djsaA ,d [kkus esa dsoy
,d o.kZ fy[ksaA [kkuksa ls ckgj dgha Hkh dqN u fy[ksaA bl QkeZ dh QksVks dkWih dk iz;ksx u djsaA dsoy vjch
vadksa dk iz;ksx djsa tSls 1, 2, 3... Write in Hindi or English (CAPITALS). Use only Blue/ Black Ball Point Pen.
PASTE HERE
PHOTOGRAPH OF
THE STUDENT OF THE
SIZE OF THIS BOX ONLY
Write one letter in one Box. Do not write outside the boxes. DO NOT USE PHOTOCOPY OF THIS FORM . Use Arabic Numericals only
DO NOT ATTEST
egÙoiw.kZ % QkWeZ f'k{kkFkhZ }kjk nks izfr;ksa esa Hkjk tk,A 'kqYd rFkk çek.ki=ksa dh lR;kfir QksVks dkWih ds lkFk iwjk QkWeZ Hkjdj vafre frfFk ;k mlls igys ekU;rk çkIr laLFkk esa
tek djsaA QkWeZ v/kwjk Hkjs tkus ij f'k{kkFkhZ dks lwfpr fd, fcuk mls jí dj fn;k tk,xk rFkk 'kqYd Hkh ugha ykSVk;k tk,xkA
IMPORTANT: To be filled by the Candidate in DUPLICATE. Completed forms with attested photo copies of certificate and fees should be deposited with Accredited Vocational
Institution on or before the last date. Incomplete admission forms will be summarily rejected and fee forfeited without any intimation to the candidates.
f'k{kkFkhZ ds gLrk{kj Signature of the Student
ukekadu la[;k ¼,ohvkbZ@,l,vkbZbZMh }kjk nh tk,xhA½ / Enrolment Number (to be given by AVI /SAIED)
Hkkx&d@ PART-A
uke@Name of Candidate in full in CAPITAL Letters
1.
f'k{kkFkhZ dk iwjk
2.
firk ;k vfHkHkkod dk iwjk uke@Father's or Guardian's Name in CAPITAL Letters
3.
ekrk ;k fgrS"kh ekrk dk iwjk uke@Mother's or Mentor Mother's Name in CAPITAL Letters
4a- i=&O;ogkj ds fy, irk@Postal Address in CAPITAL Letters
irk@Address
ftyk@District
jkT;@State
bZ&esy@E-mail
fiudksM@Pincode
,lVhMh dksM@STD Code
4b- LFkk;h irk@ Permanent Address
irk@Address
nwjHkk"k@eksckby@Telephone/Mobile
ftyk@District
jkT;@State
5. tUefrfFk@Date of birth
ekg Month
frfFk Date
fiudksM@Pincode
6. fyax@ Gender
7.
o"kZ year
Js.kh@Category
10 a. ftl ikB~;Øe ds fy, vkosnu fd;k gS ml [kkus esa þ fpg~u yxk,¡a
Category of the Course Applied for (Mark ü):
iSdst
Ng ekg
Package
Six-Month
11.
14.
,d lky
nks lky
thou le`f)
i`Fkd :i okys
One year
Two year
Life Enrichment
Stand Alone
9.
vkidh iwoZ ;ksX;rk
oafpr oxZ@Disadvantaged Group
ikB~;Øe dk uke@Name of the Course
c.
fo"k; dksM la[;k@Subject Code No.
12. jk"Vªh;rk@Nationality
15.
lgh [kkus esa þ djsAa
Put
fodykaxrk@ Disability
b.
v/;;u dk ek/;e@Medium of Study
Your Previous Qualification
16.
"
8.
þ inside the Appropriate Box.
V
VI
VII
VIII
IX
X
XI
XII rFkk
mlls Åij
13. /keZ@Religion
nloha vkSj ckjgoha cksMZ ijh{kk mÙkh.kZ djus dk o"kZ
nloha
ckjgoha
Year of Passing X and XII Class Examination
X
XII
¼Ñi;k vko';drkuqlkj lacfa /kr [email protected]= vo'; layXu djs½a
(Please enclose the relevent papers/certificates
positively as necessary)
cksMZ dk uke@Name of the Board%
i) nloha d{kk ds fy,@For Class X
ii) ckjgoha d{kk ds fy, For Class XII
nh xbZ izos'k 'kqYd dh jkf'k@Amount of Admission Fee paid : Rs.
P.T.O
"
(f'k{kkFkhZ dks nh tkus okyh jlhn@ Receipt to be given to the candidate)
Received application form with Bank Draft No. ................ dt. ................ /Cash Rs. .................. from Mr./Ms. ......................................................... for
............................ Course(s)/Code(s) .....................
leUo;d ds gLrk{kj eqgj lfgr
Signature of Coordinator with Stamp
Hkkx ([k) (i`"BHkwfe lwpuk) PART B (BACKGROUND INFORMATION)
17.
ü) fpg~u yxk,¡A
uhps nh xbZ lwpuk,a lgh&lgh HkjsaA lgh ckDl esa (ü
Please fill in the following information correctly. Put tick mark (ü
ü) in appropriate box.
1.
2.
ifjokj esa lnL;ksa dh la[;k@ Number of members in your family : _________________
ifjokj dh okf"kZd vk; @Total family income per year :
1. 12,000 #- rd
1. Upto Rs. 12,000
3.
2. 24,000 #- rd
2. Upto Rs. 24,000
5.
6.
8.
9.
3. vkBoha rd
3. Upto Middle
4. nloha rd
4. Upto Secondary
5. dkWyt
s rdA
5. Upto College
3. vkBoha rd
3. Upto Middle
2. xzke
2. Rural
4. nloha rd
4. Upto Secondary
5. dkWyst rdA
5. Upto College
ekrk dh 'kSf{kd ;ksX;rk
Mother’s educational qualification :
1. vui<+
2. izkbejh rd
1. No Education
2. Upto Primary
vki dgk¡ jgrs gSa\
1. 'kgj
Where do you live?
1. Urban
vkids ?kj esa dejksa dh la[;k
Number of rooms in your residence:
1. ,d
2. nks
1. One
2. Two
7.
4. 36,000 #- ls vf/kdA
4. Above Rs. 36,000
firk dh 'kSf{kd ;ksX;rk
Father’s Educational qualification :
1. vui<+
2. izkbejh rd
1. No Education
2. Upto Primary
4.
3. 36,000 #- rd
3. Upto Rs. 36,000
3. rhu
3. Three
4. rhu ls vf/kd
4. More than three
vkids ?kj esa buesa ls dkSu&dkSu lh phtsa gSa\
Which of the following do you have at home?
1. fctyh
2. ia[kk
3. jsfM;ks/Vªkfa tLVj
4. Vhoh
1. Electricity
2. Fan
3. Radio/Transistor
4. TV
6. lkbfdy
7. LdwVj
8. dkj
9. jlksbZ xSl
10. ohlhvkj@ohlhih
6. Cycle
7. Scooter
8. Car
9. Cooking Gas
10. VCR/VCP
12. eYVhehfM;k daI;wVj
13. VsyhQksu
14. daI;wVj
12. Multimedia Computer
13. Telephone
14. Computer
vki dke djrs gSa ;k csjkstxkj gSa\
1. dke djrs gSa
2. viuk jkstxkj
Are you employed or unemployed?
1. Employed
2. Self-employed
5. dSlsV/lhMh Iys;j
5. Cassette/CD Player
11. tujsVj@buojVj
11. Generator/ Invertor
15. dscy
15. Cable Connection
3. csjkstxkj gSa
3. Unemployed
?kks"k.kk Declaration
eSa izekf.kr djrk gw¡ fd@Certified that:d½ esjs ikl ikB~;Øe ds fy, vko';d U;wure 'kSf{kd ;ksX;rk gS@eSaus ,uvkbZvks,l ds vkBoha d{kk ikl rd dh ;ksX;rk okys ikB~;Øe ds fy, v/;;u
djds i;kZIr ;ksX;rk izkIr dj yh gSA a) I possess the minimum educational qualification for the course / I have studied enough to pursue NIOS
[k½
x½
?k½
³½
Vocational Education Courses where entry level qualification is upto class VIII pass.
eSaus foojf.kdk esa nh xbZ ;ksX;rk 'krs± i<+dj le> yh gSaA eSa blds ;ksX; gw¡A b) I have read and understood the eligibility conditions as laid down
in the Prospectus. I fulfil these criteria.
eSaus lkjh t:jh lwpuk,a vkSj nLrkost lgh&lgh ns fn, gSaA eSa tkurk gw¡ fd ;fn ;s lwpuk,a xyr ;k Hkze esa Mkyus okyh gksaxh] rks ,uvkbZvks,l }kjk
esjh mEehnokjh lekIr dj nh tk,xhA c) I have furnished the necessary information/documents correctly. I understand that my candidature
is liable to be cancelled by NIOS if this information is found incorrect or misleading.
eSa ,uvkbZvks,l ds lHkh fu;eksa dk ikyu d:¡xk vkSj , oh vkbZ @,l,vkbZbZMh ds vuq'kklu vkSj e;kZnk dks cuk, j[kw¡xk@j[kw¡xhA d) I shall abide by
all the rules and regulations of NIOS and shall maintain discipline and decorum at the AVI/SAIED.
eSaus fdlh ,ohvkbZ@,l,vkbZbZMh esa fdlh vU; ,uvkbZvks,l O;kolkf;d ikB~;Øe esa nkf[kyk ugha fy;k gSA e) I have not taken
admission in any other NIOS Vocational Education Course at any AVI/SAIED.
___________________________________
___________________
18.
ekrk firk@vfHkHkkod ds izfrgLrk{kj ¼frfFk lfgr½
f'k{kkFkhZ ds gLrk{kj
Countersignatures of Parent/Guardian Date.............
Signature of Candidate
irk@ Address __________________________________________________
___________________________________________________
ü) fpg~u yxk,¡A
layXudksa dh tk¡p lwph lgh ckDl esa (ü
Date ................
fiu PIN _____________
ü)
CHECKLIST OF ENCLOSURES Please tick (ü
izo's k QkWeZ dh nwljh izfr Duplicate copy of the admission form
'kSf{kd ;ksX;rk lac/a kh izek.k i= Certificate of Educational qualification
vPNh rjg
ls fpidkbZ xbZ QksVks Photograph duly pasted
vuqHko izek.ki= ¼;fn ykxw gks½ Experience Certificate, if applicable
tUefrfFk izek.ki= Certificate of
Date of Birth
frfFk@Dated : ....................
______________________________________________
Full Signature with seal of Co-ordinator of the AVI/SAIED
, oh vkbZ@,l,vkbZbZMh ds leUo;d ds iw.kZ gLrk{kj eqgj lfgr
Appendix - C
nwljh izfr
DUPLICATE
QkeZ la-@FORM NO.
;gka QksVks fpidk,¡ tks fd leUo;d@
ç/kku@ljiap@ç/kkukpk;Z ;k
jktif=kr
vf/kdkjh }kjk lR;kfir gksA
PASTE PHOTOGRAPH HERE OF THIS
BOX SIZE DULY ATTESTED BY
COORDINATOR/PRINCIPAL/
PRADHAN/SARPANCH OR
GAZETTED OFFICER
jk"Vª h ; eq D r fo|ky;h f'k{kk la L Fkku] uks , Mk ¼m-ç-½
National Institute of Open Schooling, NOIDA (U.P.)
ckWDl ds vkdkj dk QksVks ;gk¡
fpidk,¡
O;kolkf;d ikB~ ; Øeks a es a ços ' k ds fy, vkos n u i=k-2012
tks lR;kfir u gksA
Application Form for Admission to Vocational Courses-2012
QkWeZ fganh ;k vaxzst+h ds cM+s o.kks± esa HkjsaA dsoy uhys ;k dkys ckWy IokbaV isu dk gh ç;ksx djsaA ,d [kkus esa dsoy
,d o.kZ fy[ksaA [kkuksa ls ckgj dgha Hkh dqN u fy[ksaA bl QkeZ dh QksVks dkWih dk iz;ksx u djsaA dsoy vjch
vadksa dk iz;ksx djsa tSls 1, 2, 3... Write in Hindi or English (CAPITALS). Use only Blue/ Black Ball Point Pen.
PASTE HERE
PHOTOGRAPH OF
THE STUDENT OF THE
SIZE OF THIS BOX ONLY
Write one letter in one Box. Do not write outside the boxes. DO NOT USE PHOTOCOPY OF THIS FORM . Use Arabic Numericals only
DO NOT ATTEST
egÙoiw.kZ % QkWeZ f'k{kkFkhZ }kjk nks izfr;ksa esa Hkjk tk,A 'kqYd rFkk çek.ki=ksa dh lR;kfir QksVks dkWih ds lkFk iwjk QkWeZ Hkjdj vafre frfFk ;k mlls igys ekU;rk çkIr laLFkk esa
tek djsaA QkWeZ v/kwjk Hkjs tkus ij f'k{kkFkhZ dks lwfpr fd, fcuk mls jí dj fn;k tk,xk rFkk 'kqYd Hkh ugha ykSVk;k tk,xkA
IMPORTANT: To be filled by the Candidate in DUPLICATE. Completed forms with attested photo copies of certificate and fees should be deposited with Accredited Vocational
Institution on or before the last date. Incomplete admission forms will be summarily rejected and fee forfeited without any intimation to the candidates.
f'k{kkFkhZ ds gLrk{kj Signature of the Student
ukekadu la[;k ¼,ohvkbZ@,l,vkbZbZMh }kjk nh tk,xhA½ / Enrolment Number (to be given by AVI /SAIED)
Hkkx&d@ PART-A
uke@Name of Candidate in full in CAPITAL Letters
1.
f'k{kkFkhZ dk iwjk
2.
firk ;k vfHkHkkod dk iwjk uke@Father's or Guardian's Name in CAPITAL Letters
3.
ekrk ;k fgrS"kh ekrk dk iwjk uke@Mother's or Mentor Mother's Name in CAPITAL Letters
4a- i=&O;ogkj ds fy, irk@Postal Address in CAPITAL Letters
irk@Address
ftyk@District
jkT;@State
bZ&esy@E-mail
fiudksM@Pincode
,lVhMh dksM@STD Code
4b- LFkk;h irk@ Permanent Address
irk@Address
nwjHkk"k@eksckby@Telephone/Mobile
ftyk@District
jkT;@State
5. tUefrfFk@Date of birth
ekg Month
frfFk Date
fiudksM@Pincode
6. fyax@ Gender
7.
o"kZ year
Js.kh@Category
10 a. ftl ikB~;Øe ds fy, vkosnu fd;k gS ml [kkus esa þ fpg~u yxk,¡a
Category of the Course Applied for (Mark ü):
iSdst
Ng ekg
Package
Six-Month
11.
14.
,d lky
nks lky
thou le`f)
i`Fkd :i okys
One year
Two year
Life Enrichment
Stand Alone
9.
vkidh iwoZ ;ksX;rk
oafpr oxZ@Disadvantaged Group
ikB~;Øe dk uke@Name of the Course
c.
fo"k; dksM la[;k@Subject Code No.
12. jk"Vªh;rk@Nationality
15.
lgh [kkus esa þ djsAa
Put
fodykaxrk@ Disability
b.
v/;;u dk ek/;e@Medium of Study
Your Previous Qualification
16.
"
8.
þ inside the Appropriate Box.
V
VI
VII
VIII
IX
X
XI
XII rFkk
mlls Åij
13. /keZ@Religion
nloha vkSj ckjgoha cksMZ ijh{kk mÙkh.kZ djus dk o"kZ
nloha
ckjgoha
Year of Passing X and XII Class Examination
X
XII
¼Ñi;k vko';drkuqlkj lacfa /kr [email protected]= vo'; layXu djs½a
(Please enclose the relevent papers/certificates
positively as necessary)
cksMZ dk uke@Name of the Board%
i) nloha d{kk ds fy,@For Class X
ii) ckjgoha d{kk ds fy, For Class XII
nh xbZ izos'k 'kqYd dh jkf'k@Amount of Admission Fee paid : Rs.
P.T.O
"
(f'k{kkFkhZ dks nh tkus okyh jlhn@ Receipt to be given to the candidate)
Received application form with Bank Draft No. ................ dt. ................ /Cash Rs. .................. from Mr./Ms. ......................................................... for
............................ Course(s)/Code(s) .....................
leUo;d ds gLrk{kj eqgj lfgr
Signature of Coordinator with Stamp
Hkkx ([k) (i`"BHkwfe lwpuk) PART B (BACKGROUND INFORMATION)
17.
ü) fpg~u yxk,¡A
uhps nh xbZ lwpuk,a lgh&lgh HkjsaA lgh ckDl esa (ü
Please fill in the following information correctly. Put tick mark (ü
ü) in appropriate box.
1.
2.
ifjokj esa lnL;ksa dh la[;k@ Number of members in your family : _________________
ifjokj dh okf"kZd vk; @Total family income per year :
1. 12,000 #- rd
1. Upto Rs. 12,000
3.
2. 24,000 #- rd
2. Upto Rs. 24,000
5.
6.
8.
9.
3. vkBoha rd
3. Upto Middle
4. nloha rd
4. Upto Secondary
5. dkWyt
s rdA
5. Upto College
3. vkBoha rd
3. Upto Middle
2. xzke
2. Rural
4. nloha rd
4. Upto Secondary
5. dkWyst rdA
5. Upto College
ekrk dh 'kSf{kd ;ksX;rk
Mother’s educational qualification :
1. vui<+
2. izkbejh rd
1. No Education
2. Upto Primary
vki dgk¡ jgrs gSa\
1. 'kgj
Where do you live?
1. Urban
vkids ?kj esa dejksa dh la[;k
Number of rooms in your residence:
1. ,d
2. nks
1. One
2. Two
7.
4. 36,000 #- ls vf/kdA
4. Above Rs. 36,000
firk dh 'kSf{kd ;ksX;rk
Father’s Educational qualification :
1. vui<+
2. izkbejh rd
1. No Education
2. Upto Primary
4.
3. 36,000 #- rd
3. Upto Rs. 36,000
3. rhu
3. Three
4. rhu ls vf/kd
4. More than three
vkids ?kj esa buesa ls dkSu&dkSu lh phtsa gSa\
Which of the following do you have at home?
1. fctyh
2. ia[kk
3. jsfM;ks/Vªkfa tLVj
4. Vhoh
1. Electricity
2. Fan
3. Radio/Transistor
4. TV
6. lkbfdy
7. LdwVj
8. dkj
9. jlksbZ xSl
10. ohlhvkj@ohlhih
6. Cycle
7. Scooter
8. Car
9. Cooking Gas
10. VCR/VCP
12. eYVhehfM;k daI;wVj
13. VsyhQksu
14. daI;wVj
12. Multimedia Computer
13. Telephone
14. Computer
vki dke djrs gSa ;k csjkstxkj gSa\
1. dke djrs gSa
2. viuk jkstxkj
Are you employed or unemployed?
1. Employed
2. Self-employed
5. dSlsV/lhMh Iys;j
5. Cassette/CD Player
11. tujsVj@buojVj
11. Generator/ Invertor
15. dscy
15. Cable Connection
3. csjkstxkj gSa
3. Unemployed
?kks"k.kk Declaration
eSa izekf.kr djrk gw¡ fd@Certified that:d½ esjs ikl ikB~;Øe ds fy, vko';d U;wure 'kSf{kd ;ksX;rk gS@eSaus ,uvkbZvks,l ds vkBoha d{kk ikl rd dh ;ksX;rk okys ikB~;Øe ds fy, v/;;u
djds i;kZIr ;ksX;rk izkIr dj yh gSA a) I possess the minimum educational qualification for the course / I have studied enough to pursue NIOS
[k½
x½
?k½
³½
Vocational Education Courses where entry level qualification is upto class VIII pass.
eSaus foojf.kdk esa nh xbZ ;ksX;rk 'krs± i<+dj le> yh gSaA eSa blds ;ksX; gw¡A b) I have read and understood the eligibility conditions as laid down
in the Prospectus. I fulfil these criteria.
eSaus lkjh t:jh lwpuk,a vkSj nLrkost lgh&lgh ns fn, gSaA eSa tkurk gw¡ fd ;fn ;s lwpuk,a xyr ;k Hkze esa Mkyus okyh gksaxh] rks ,uvkbZvks,l }kjk
esjh mEehnokjh lekIr dj nh tk,xhA c) I have furnished the necessary information/documents correctly. I understand that my candidature
is liable to be cancelled by NIOS if this information is found incorrect or misleading.
eSa ,uvkbZvks,l ds lHkh fu;eksa dk ikyu d:¡xk vkSj , oh vkbZ @,l,vkbZbZMh ds vuq'kklu vkSj e;kZnk dks cuk, j[kw¡xk@j[kw¡xhA d) I shall abide by
all the rules and regulations of NIOS and shall maintain discipline and decorum at the AVI/SAIED.
eSaus fdlh ,ohvkbZ@,l,vkbZbZMh esa fdlh vU; ,uvkbZvks,l O;kolkf;d ikB~;Øe esa nkf[kyk ugha fy;k gSA e) I have not taken
admission in any other NIOS Vocational Education Course at any AVI/SAIED.
___________________________________
___________________
18.
ekrk firk@vfHkHkkod ds izfrgLrk{kj ¼frfFk lfgr½
f'k{kkFkhZ ds gLrk{kj
Countersignatures of Parent/Guardian Date.............
Signature of Candidate
irk@ Address __________________________________________________
___________________________________________________
ü) fpg~u yxk,¡A
layXudksa dh tk¡p lwph lgh ckDl esa (ü
Date ................
fiu PIN _____________
ü)
CHECKLIST OF ENCLOSURES Please tick (ü
izo's k QkWeZ dh nwljh izfr Duplicate copy of the admission form
'kSf{kd ;ksX;rk lac/a kh izek.k i= Certificate of Educational qualification
vPNh rjg
ls fpidkbZ xbZ QksVks Photograph duly pasted
vuqHko izek.ki= ¼;fn ykxw gks½ Experience Certificate, if applicable
tUefrfFk izek.ki= Certificate of
Date of Birth
frfFk@Dated : ....................
______________________________________________
Full Signature with seal of Co-ordinator of the AVI/SAIED
, oh vkbZ@,l,vkbZbZMh ds leUo;d ds iw.kZ gLrk{kj eqgj lfgr
Appendix - D
jk"Vªh; eqDr fo|ky;h f'k{kk laLFkku
National Institute of Open Schooling
@NOIDA
uks,Mk@
,uvkbZvks,l dh O;kolkf;d ijh{kk esa cSBus ds fy, vkosnu QkWeZ
¼foojf.kdk ds vuqPNsn 5-5 i`"B 16 ij vafdr 'kqYd ds lkFk v/;;u dsaæ ij tek djsaA½
Form for appearing in Vocational Examination of NIOS
(to be submitted in the Study Centre alongwith the requisite fees as mentioned in the para 5.5 of page 16 mentioned
in Prospectus)
dsoy uxn vkSj jk"VªhÑr cSd
a ksa ds cSd
a Mªk¶V gh Lohdkj fd, tkrs gSAa Ñi;k os fo"k; Hkjsa ftudh ijh{kk esa vki cSBuk pkgrs gSaA
Please fill correctly the subjects in which you desire to appear in the
pSd@/kukns'k Lohdkj ugha fd, tk,¡xsA
Only Cash/Bank Drafts from Nationalised Banks are acceptable. Examination.
dksM ua/Code
Cheques/Indian postal Orders are not acceptable.
1.
ukekadu la[;k@Enrolment No.
No.
fo"k;/Subject
1.
.......................................
2.
.......................................
3.
.......................................
4.
.......................................
5.
.......................................
6.
.......................................
2. iwjk uke@Name in full (Block Letters)
3.
irk /Address ....................................
.................................................
.................................................
Exam. fee Rs. 150/- per subject.
fiu dksM/PIN CODE
(Signature of the Candidate)
+
,sls f'k{kkFkhZ ftuds ,ohvkbZ jn~n dj fn, x, ;k dk;Z ugha dj jgs gSa] os vius {ks=h; dsaæ ij ijh{kk QkWeZ ^lfpo* ,uvkbZvks,l* ds i{k esa rFkk lacaf/kr
{ks=h; dsaæ ij ns; Mªk¶V ds lkFk ijh{kk QkWeZ tek dj ldrs gSaA
+
Candidate whose AVIs stand cancelled or not functioning can deposit his/her examination fees at the respective Regional Centre (RC)
by submitting examination form alongwith Bank Draft drawn in favour of "Secretary", National Institute of Open Schooling, payable
at the respective Regional Centres.
*
f'k{kkFkhZ vius ijh{kk dsaæ ds ckjs esa tkudkjh çkIr djus ds fy, vius ,ohvkbZ@,l,vkbZbZMh@{ks=h; dsæ ls laidZ djsaA ;fn dksbZ fo|kFkhZ fu/kkZfjr ijh{kk
dsaæ ds vfrfjDr fdlh nwljs ijh{kk dsaæ ls ijh{kk esa cSBrk gS rks mldk ijh{kkQy ?kksf"kr ugha fd;k tk,xkA
*
Application form will not be accepted after the prescribed date.
Student may contact his/her AVI/RC or NIOS for information regarding his/her examination centre. If a candidate appears from an
exam. centre other than the one allotted to him on his own, his result will be withheld.
fVIi.kh@NOTE: i) viw.kZ@xyr lwpuk okys ijh{kk QkWeZ dks vLohdkj dj fn;k tk,xkA Examination form with incomplete/wrong information
shall be rejected.
ii) tks ykxw u gks mls dkV nsaA Strike off whichever is not applicable.
iii) fo"k; dksM ds fy, foojf.kdk dk v/;k; 5 rkfydk&2 ns[ksaA Please see table 2 of Chapter 5 of the Prospectus for the Subject Code(s).
--------------------------------------------------------------------------------------------------------------------------------------jlhn ¼f'k{kkFkhZ dks nh tk,½@RECEIPT (TO BE ISSUED TO THE STUDENT)
fuEufyf[kr fo"k; dksMksa ds fy, jk"Vªh; eqDr fo|ky;h f'k{kk laLFkku dh O;kolkf;d ijh{kk ds fy, -----------------------------------------------------------------ls ukekadu la- -------------------------------- ijh{kk QkeZ ds lkFk --------------------------------------- #- 'kqYd çkIr fd,A
Received examination form alongwith fee of Rs. ................................ from ............................... Enrolment No. ............................
for the ..................... Vocational Examination of National Institute of Open Schooling in the following subject Codes :
fnukad@Date:............
gLrk{kj@Signature
leUo;d@Coordinator
,ohvkbZ la-@AVI No.
jk"Vªh; eqDr fo|ky;h f'k{kk laLFkku
Appendix - E
National Institute of Open Schooling
,&24@25] baLVhV~;w'kuy ,fj;k] lsDVj&62] uks,Mk&201309@A-24/25, Institutional Area, Sector-62, NOIDA-201309
vadrkfydk vkSj ewy izek.ki= dh nwljh izfr izkIr djus gsrq vkosnu QkWeZ
Application Form for Obtaining Duplicate Certificate/Marks Statements etc.
123-
vuqØekad@Enrolment No.
f'k{kkFkhZ dk uke ¼lkQ v{kjksa esa½
................................................................................................................
Name of the student (in CAPITAL letters)
................................................................................................................
firk@ekrk dk uke
Father's/Mother's Name
4-
ml izek.ki= dk uke tks pkfg,
Name of Certificate Required
5-
................................................................................................................
ijh{kk dk uke vkSj o"kZ
Name and Year of Exam
67-
................................................................................................................
................................................................................................................
ijh{kk ifj.kke/Result
................................................................................................................
'kqYd dk Lo:i % udn@cSad MªkÝV
................................................................................................................
cSad Mªk¶V la[;k ------------------------------------ jde ---------------------------------------------- fnukad --------------------------cSad dk uke ---------------------------Mode of Payment : Cash/Bank Draft
B.D. No. ------------------------------------ Amount --------------------------------------------- Date --------------------------Bank -------------------------------------------------
¼funsZ'k% cSad Mªk¶V lfpo] jk"Vªh; eqDr fo|ky;h f'k{kk laLFkku] uks,Mk ds i{k esa rFkk uks,Mk esa ns; gksuk pkfg,A½
(N.B.: Bank Draft Must be drawn in favour of Secretary, NIOS, NOIDA, payable at NOIDA.)
8-
irk@Address (in CAPITAL letters) .............................................................................................................................................
................................................................................................................ fiu
LFkku@Place :
fnukad@Date: ...................................................................
dksM (PIN Code) ....................................................
..................................................................
f'k{kkFkhZ ds gLrk{kj@Signature of the Student
dsoy dk;kZy; iz;ksx ds fy,
FOR OFFICE USE ONLY
vuqØekad@Enrolment No .......................................................................................................................................................................
fo|kFkhZ dk uke@Name of the Student ....................................................................................................................................................
izkIrkad fooj.k@Marks Obtained ............................................................................................................................................................
fo"k; dksM
fl)kar
iz;ksx
vkarfjd
;ksx
1.
2.
3.
4.
5.
6.
Subject Code
TH
PR
INT
Total
......................................................................................................................................................................................................
......................................................................................................................................................................................................
......................................................................................................................................................................................................
......................................................................................................................................................................................................
......................................................................................................................................................................................................
......................................................................................................................................................................................................
ifj.kke@RESULT : .................................................................................................................................................................................
dk;kZy; lgk;d ds gLrk{kj@Signature of D.A.
vko';d funsZ'k/Important Notes
vkosnu QkWeZ dks Hkjus ls igys funsZ'kksa dks lko/kkuh ls i<+s% / Read the Instructions carefully before filling the form
1-
çR;sd çek.ki= ds fy, vyx&vyx QkeZ dk ç;ksx djsaA Use seperate form for each certificate.
2-
çek.ki= dh nwljh izfr ds fy, vkosnu QkWeZ uhps fn, x, funsZ'kkuqlkj çFke Js.kh eftLVsªV }kjk lR;kfir 'kiFk i= ds lkFk çLrqr djsaA The
application for duplicate passing certificate must be accompanied with an affidavit executed in front of a Ist class Magistrate in the
format given below.
3-
ewy çek.ki= dh r`rh; çfrfyfi rc rd tkjh ugha dh tk,xh] tc rd funs'kd] ewY;kadu çek.k i= dh f}rh; çfrfyfi ds okLro esa [kksus@u"V
gksus dh iqf"V ls iw.kZr% larq"V u gksA Triplicate copy of the passing certificate shall not be issued unless the Director (Eva.) is satisfied
that duplicate copy has been actually lost/destroyed.
4-
lk/kkj.kr% iw.kZ vkSj Bhd rjg ls Hkjs x, vkosnu QkWeZ ds vk/kkj ij ek¡xs x, çek.ki= nks g¶rksa ds ckn tkjh fd, tk,¡xsA The documents applied
for will ordinarily be issued after two weeks (excluding holidays) from the date of receipt of the application form and fee, provided the
application is found complete in all respects.
5-
;fn vkosnd 'kqYd tek djus ds ckn rhu eghus ds Hkhrj Hkh çek.ki= çkIr ugha djrk gS] rks mls fn, x, irs ij lk/kkj.k Mkd ls Hkst fn;k
tk,xkA vkosnu QkWeZ esa irk u fy[kus dh fLFkfr esa çek.ki= fujLr dj fn;k tk,xk vkSj f'k{kkFkhZ dks mlds fy, iqu% vkosnu djuk gksxkA In
case the documents is not collected by the applicant within three months from the date of depositing the fee it will be sent by-ordinary
post at the address given. In case the address is not given the documents will be cancelled and the student will have to apply afresh.
lHkh çek.ki= fdlh Hkh dk;Z&fnol esa vijkg~u 3 cts ls 5 cts rd 'kqYd dh jlhn ,oa vuqØekad dks fn[kkus ds ckn tkjh fd, tk,¡xsA 'kqYd
lHkh dk;Z&fnolksa esa çkr% 10 cts ls vijkg~u 4 cts rd tek fd;k tk ldrk gSA All Certificates will be delivered on the production of
receipt of payment with Enrolment No. between 3.00 P.M. to 5.00 P.M. on working days. The fee can be deposited between 10.00 A.M.
to 4.00 P.M. on all working days.
çek.ki=ksa ds fy, fu/kkZfjr 'kqYd fuEu çdkj gSa% / Fees prescribed for various certificates are as follows :
123-
çek.ki= dh nwljh çfr/Duplicate copy of Certificate
:
vadrkfydk dh nwljh çfr/Duplicate copy of the Statement of Marks
:
Mkd 'kqYd ¼;fn çek.ki= iathÑr Mkd }kjk pkfg,½/Postal Charges (if the documents is required by Regd. post) :
Rs. 100.00
Rs. 100.00
Rs. 40.00
fVIi.kh
%
vadrkfydk dh nwljh çfr rqjUr çkIr djus dk 'kqYd 200 #- gS rFkk ;g nLrkost+ vkosnu çkIr gksus ls 48 ?kaVs ds vanj miyCèk djk
fn;k tkrk gSA
Note
:
Prescribed fee for the issue of urgent Duplicate Marksheet is Rs. 200/- and these documents will be issued within
48 hours from the date of receipt of application.
'kiFk i= 2-00 #i, ds LVkEi isij ij çFke Js.kh eftLVªsV }kjk lR;kfir gksuk pkfg,A ¼dsoy mu fo|kfFkZ;ksa ds fy, ftUgsa ewy çek.ki= dh nwljh
çfr ds fy, vkosnu djuk gS½ vksFk dfe'uj@uksVjh }kjk gLrk{kfjr@lR;kfir 'kiFk&i= Lohdkj ugha fd;k tk,xkA Form of Affidavit to be executed
on Non-judicial Stamp Paper of Rs. 2.00 (For Candidate applying for duplicate copy of qualifying certificate) The affidavit attested by oath
Commissioner/Notary is not acceptable.
eSa ------------------------------------------------------ iq=@iq=h ------------------------------------------------------ 'kiFkiwoZd ?kks"k.kk djrk gwa fd esjk jk"Vªh; eqDr fo|ky; f'k{kk laLFkku
¼blls iwoZ jk"Vªh; eqDr fo|ky;½ fnYyh dh ijh{kk ------------------------------------ ebZ@uoEcj ------------------------------------ dk ewy çek.k&i= u"V gks x;k@[kks
x;k gSA mi;qZDr fn, x, lHkh rF; esjh tkudkjh esa iw.kZr% lgh gSaA
I .......................................... Son/Daughter of .......................................... declare on oath that my certificate of having passed the
................................................... Exam. of May/Nov. ...................................... from National Institute of Open Schooling, (Formerly National
Open School) Delhi, has been lost/destroyed certified that the fact stated above is true to the best of my knowledge and belief.
vuqØekad/Roll No. .................................................
f'k{kkFkhZ ds gLrk{kj/Signature of the Student. .............................................
fnukad/Date .................................................
irk/Address. ........................................................................................
LFkku/Place .................................................
..............................................................................................
U;k;ky; dh eksgj % çFke Js.kh eftLVªsV/Court Seal : Sworn before me Ist Class Magistrate.