Application Form

National Talent Search Examination, 2015-16

For the Students Studying in Class X)

Read the instruction carefully given on the next page before filling the application form. You may take
the help from your teacher/parent for filling up the application form. Space for the Photograph
- Date of Examination: (Passport size)

- Name & address of the State Agency The Photograph should

for conducting first level NTS Examination:
be endorsed by the
- Name of the State/UT Head of the Institution/
(where the candidate is studying in class X as a regular student):
Gazetted Officer
- Name of the examination centre*
(where candidate studying in Class X or likely to appear in Exam ):
- Application fee, if any (write NIL if there is no fee):
Amount DD Number Date of DD Name of Bank Application No, if any

State Level 11 digit Roll Number

State Code Year Centre Code Serial No. (Office to fill) Class Date of birth
3 8 1 6 10

Date Month year

1. Name of the candidate (Do not write Miss/Master)

2.

3.

4. Sex 5.Area in which candidates resides 6. Category of candidate 7. Disability status

1 2 1 2 3
1 2 1 2 3 4
Male Female Rural Urban General SC ST
Orthopaedic Hearing Visually None
Impaired Impaired
(Please enclose a copy of the relevant reservation certificate in support of information at Sr.No.6 &7)
8. Postal address of the candidates for

Pin Code
9. Name and address of the School/Institution in which studying at Class X level

Pin Code
,

10. Type of the institution in which studying at Class X (see definition overleaf*) 11. Area in which the school is located

11 Govt 2 Local Body 3 Private aided 4 Private Unaided 1 Rural 2 Urban

12. Medium of examination (a) at the state Level (b) at the NCERT Level Occupation

iving in the house

18. No. of brothers 19.No. of sisters 20.At what no. is the candidate among his/her brothers and sisters
21. Parental annual income in Rs.
1 2 3 4 5

Upto 50,000 50001 to 1,00,000 1,00,001 to 2,00,000 2,00,001 to 5,00,000 More than 5,00,000
,

22. Telephone
STD Code Phone 23. E-mail address

24. Mobile
(Do not leave this column blank)

To be filled by the Head of the Institution/Gazetted Officer

Certified that:
(1) Master/Miss....................................................................................... is a regular student of School/Institution and
he/she has secured % marks in the class IX annual examination, i. e., when He/She was promoted from class IX to Class X. He/She has

secured ................... marks out of.............................

(2) The particulars given by him/her in the application form have been verified and found in order.

(3) Master/Miss................................................................................ belongs to Scheduled Caste/Scheduled Tribe category as per the records maintained in
the Institution.(to be filled for SC/ST candidates only)

Signature of the Headmaster/ Headmistress/Gazetted Officer

Date With seal

(See Instructions Overleaf)

Signature of the candidate
 To be filled in by Sankul Principal
Certified that:

(1) Master/Miss............................................................................................. is a regular student of School/Institution and

he/she has secured % Marks in the class IX annual examination, ie., when He/ She was promoted from class IX to Class X. He/ She has secured

................... marks out of............................... (Candidate must fulfil the criteria announced by the State/UT)

(2) The particulars given by him/her in the application form have been verified and found in order.

(3) Master/Miss................................................................................ belongs to Scheduled Caste/Scheduled Tribe category as per the records maintained in the
Institution.(to be filled for SC/ST candidates only).

category and his/her

disability % is 40 % and above.(to be filled for PH candidates only)
Orthopaedic Hearing Visually
Impaired Impaired

Signature of the Sankul Principal

Date With seal
 Coding Plan
Read instruction carefully before filling up the Application Form.
1. Use only Blue or Black Ball Point pen. WRITE IN CAPITAL LETTERS. Do not mark or write outside the boxes.
2. Leave one box blank between two words. Limit your name and/or address within the space provided for it. Please see example as given below.
3. Cross(x) only one of the appropriate boxes in items nos. 4,5,6,7,10,11 and 21.
4. Please write code number in items nos 12, 13,14, 15 and 16 as given overleaf.
5. It is the responsibility of the candidate and the principal of the school to deposit the filled in form with the state concerned Officer before the last
date. No request for condoning delay in submission will be entertained whether it is due to the fault of the Candidate or the Headmaster/Principal
of his/her institution.
6. Incomplete or defective applications are liable to be rejected.

Example for writing Name and Address.

Postal Address: do not try to write complete address in one line. Break it appropriately as shown below:

Region State/UT Code

North East Arunachal 11

Pradesh
Assam 12

Manipur 13

Meghalaya 14

Mizoram 15

Nagaland 16

Sikkim 17

Tripura 18

East A& N island 19

Bihar 20

Jharkhand 21

Orissa 22

West Bengal 23

North Chandigarh 24

Delhi 25

Jammu & 26
Kashmir
Haryana 27

Himachal 28
Pradesh
Punjab 29

Rajasthan 30

31
Uttar Pradesh
Uttarakhand 32

West Chhatisgarh 33

Daman & Diu 34

D&N Haveli 35

Goa 36

Gujarat 37

Madhya Pradesh 38

Maharashtra 39

South Andhra Pradesh 40

Karnataka 41

Kerela 42

Lakshadweep 43

Pondicherry 44

Tamil Nadu 45

Telangana 46
 1 4 5 / 6 M O U N T R O A D Abroad 47

C H E N N A I PIN
Medium of Examination Education of Father or Mother
(Refer to item 12) (Refer to item Nos 13 & 15)
Medium of Examination Code Education Code

Assamese 11 No Formal Education 1

Bangla 12 Up to primary 2

English 13 Upper primary 3

Gujarati 14 Secondary 4

Hindi 15 Senior secondary 5

Kannada 16 Graduation 6

Marathi 17 Post graduation 7

Malayalam 18 Doctoral 8

Oriya 19 Professional degree(Engineering, 9

Law,Medicaine, MCA, MBA,etc)
Punjabi 20

Tamil 21

Telugu 22

Urdu 23

(refer to item Nos 14 & 16)

Occupation Code

Professsional 1

Executive and Managerial 2

Clerical 3

Business 4

Agriculture , fishery 5

Production and Transport 6 *Type of School/Institutions (refer to item No.10)

GOVERNMENT A Government school is that which is run by the
Operators and labourers 7
State Government or Public Sector undertaking
Not employed 8 or an Autonomous Organization completely
financed by the Government
LOCAL BODY A Local Body School is that which is run by
Panchayati Raj and local body institutions such
as Zila Parichad, municipal Corporation,
Municipal Committee, Notified Area
Committee and Cantonment Board
PRIVATE AIDED A private aided school is that which is run by an
individual or a private organization and receives
grant from government or local body.
PRIVATE Private Unaided School is that which is
UNAIDED managed by an individual or a private
organization and does not receive any grant
from government or local body.