STATE COUNCIL OF EDUCATIONAL RESEARCH & TRAINING, BIHAR, MAHENDRU, PATNA
(APPLICATION FORM)
STATE LEVEL NATIONAL TALENT SEARCH EXAMINATION-2019
(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.
a. Date of Examination : 04.11.2018 (Sunday)
b. Name & Address of the Agency
for conduction NTSE. Examination : S.C.E.R.T, Bihar, Mahendru, Patna-6
c. Name of the state/UT : Bihar
(Where the candidate is studying in class X as a regular student)
For General & BC Rs. 100/- Examination Fee Paid by Cash
SC, ST & Disabled Rs. 50/- Category Amount (Cash) Date
(For District Office use Only)
District Name ---------------------------- Sl. No. --------------------------------
State Level 11 Digit Roll Number To be filled by the SCERT, Patna
State Code Year Distt. Code Centre Code Serial No Class
2 0 1 9 10
SPACE FOR PHOTOGRAPH
(To be filled in by the applicant) Paste firmly with adhesive
1 Name of the Candidate (Do not write Miss/Master) like fevicol not exceeding the
box area.
A recent photograph
2 Father's Name (Do not write Mr./Dr./Prof.) of size 35 mm x 45 mm
Attested by Principal/Gazetled Officer.
(DO NOT STAPLE)
3 Mother's Name (Do not write Mrs./Dr./Prof.)
Date Month Year Applicant's full Signature
4 Date of Birth :
5 Sex : Male 1 Female 2
Rural 1 Urban 2
6 Area to which candidate resids
Gen 1 S.C 2 S.T. 3 O.B.C 4
7 Caste Category :
7b Do you belong OBC Catergory (Please Refer details given on www.ncbc.nic.in/user_panel/centralliststateview.aspc) of Central list ?
Yes 1 NO 2 State OBC CASTE NAME
(Non Creamy Layer)
BLV 1 DH 2 LD 3 AID 4 MD 5 NONE 6
8 Disability Status of Candidate
Refer overleaf for details of codes
(please enclose a copy of the relevant certificate in support of information at Sr. No. 7 & 8
9 Postal address for correspondence (Do not write Father's or your name)
Pin Code
10 Name and address of the institution in which the applicant is studying at Class X level
Pin Code
11 Type of the institution in which studying at Class X level (See definition overleaf*) 12 Area in which the school in located
1 Govt. 2 Local Body 3 Private Aided 4 Private Unaided 1 Rural 2 Urban
11a Are you Student of Kendriya vidyalaya/ Navodaya Vidyalaya? If yes (√) 1 If No (x) 2
11b If Yes (√) for 1 Kendriya Vidyalaya 2 for Navodaya Vidyalaya
13 Medium of examination (a) at the State level (b) at the NCERT lever 14 Father's Education 15 Father's Occupation
16 Mother's education 17 Mother's Occupation 18 No. of family members living in the house
19 Number of brothers 20 Number of sisters 21 At what number is the condidate among
his/her brother and sister's
22 Parental annual income
1 2 3 4 5
Up to 2,00,000 2,00,001 to 3,00,000 300,001 to 5,00,000 5,00,001 to 10,00,000 More than 10,00,000
23 Telephone
STD Code Phone/Mobile No. E-mail Address
(Do not leave this column blank)
To be filled in by the Head of the Institution/Gazetted Officer
Certified that :
(1) Master/Miss………………………………………………………………………. Is a regular student of this 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……………………………....... mark out of.............................................. (Candidate
must fulfill the criteria announeed by S.C.E.R.T. Patna)
(2) The particulars given by Him/Her in the application form have been verified and found in order. His/Her Aadhaar no. is
(3) Master/Miss……………………………………… belongs to S.C./S.T./ O.B.C./ Disabled Category as per the records maintained in the Institution, (to be filled for
reserve category only.)
Date …………………………………………………………………………………………..
………………………………………………………. Signature of the Headmaster/Headmistress/Gazetted Officer
with Seal
Signature of the candidate
(See Indtructions overleaf)
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Important Instruction/ vko';d funsZ'k
Read Instructions carefully before filling up the Application Form
1 Use only Blue or Black Ball Point Pen. WRITE IN CAPOTAL 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 Tick (√) only one of the appropriate boxes in item nos. 5, 6, 7, 8, 11, 12 & 22
4 Please write code number in item nos. 13, 14, 15, 16 and 17 as given below.
5 It is the responsibility of the candidate and the Principal of the school to deposit the filled in form with the Distt.
Education 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 Hearmaster/Principal of his/her institution.
6 Incomplete or defective applications are liable to be rejected.
7 4% Reservation for Physically Challwnged Group of Students, with benchmark disabilities of which, one per cent each shall be reserved for
Persons with benchmark disabilities under clauses (1), (2) and (3) and one per cent for persons with benchmark disabilities under
clauses (4) and (5) namely : (Refer to Item Number -8)
1 Blindness and low vision (BLV) ;
2 Deaf and hard of hearing (DH) ;
3 Locomotor disability including cerebral palsy, leprosy, cured, dwarfism, acid attack vietims and muscular
Dystrophy (LD) :
4 Autism, intellectual disability, specific learning disability and mental illness (AID) ;
5 Multiple disabilities from amongst persons under clauses (1) to (4) including deaf-blindess in the posts identified for each disabilities' (MD) ;
6 No Disability
8 Distt. Code, Centre Code and Sl. No. will be filled in by the SCERT.
Procedure for filling up of the Application Form
Example for writing Name and Address:-
1 Candidate's Name :
S U R E N D R A K U M A R B E
If your name is "Surendra Kumar
Bedia" fill it as :
D I A
2 Father's Name :
J A L E S W A R P R A S A D B
If your Father's name is "Jaleswar
Prasad Bedia" fill it as :
E D I A
Postal Address : Do not try to write complete address in one line. Break in appropriately as shown below.
1 4 5 / 6 M O U N T R O A D
C H E N N A I PIN 6 0 0 0 1 5 Region State/UT Code
Arunachal Pradesh 11
Assam 12
Medium of Examination Education of Father of Mother Manipur 13
(Refer to item 12) (Refer to item 13 & 15 Meghalaya 14
Medium of Examination Code Education Code North East Mizoram 15
Assamese 11 No Formal education 1 Nagaland 16
Bangla 12 Up to Primary 2 sikkim 17
English 13 Upper Primary 3 Tripura 18
Gujarati 14 Secondary 4 A & N Islands 19
Hindi 15 Senior Secondary 5 Bihar 20
Kannada 16 Graduation 6 East Jharkhand 21
Marathi 17 Post Graduation 7 Odisha 22
Malayalam 18 Doctoral 8 West Bengal 23
Professional degree (Engineering.
9 Chandigarh
Oriya 19 Medicine, MCA,MBA, ETC 24
Punjabi 20 Any Other 10 Delhi 25
Tamil 21 Jammu & Kashmir 26
Telugu 22 North Haryana 27
Urdu 23 Himachal Pradesh 28
Punjab 29
FATHER'S/MOTHER'S OCCUPATION Rajasthan 30
(Refer to item NO. 14 &16 Uttar Pradesh 31
Occupation Code Uttarakhand 32
Professional, Technical and Related Worker 1 Chhattisgarh 33
Administrative, Executive and Managerial Worker 2 Daman & Diu 34
Clerical and Related Worker 3 D & N Haveli 35
Sales / Service Worker 4 West Goa 36
Farmer, Fisherman and Related Worker 5 Gujarat 37
Production and Related Worker, Transport 6 Madhya Pradesh 38
Operators and labourer Worker not classified by the above occupations 7 Maharashtra 39
Not employed 8 Andhra Pradesh 40
Karnataka 41
Kerela 42
* Type of School/Institutions (Refer to item No. 10 South Lakshadweep 43
Puducherry 44
GOVERNMENT A Government school is that which is run by the State Tamil Nadu 45
Government or Public Sector undertaking or an Autonomus Telangana 46
Organization completely financed by the Government. Abroad 47
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 Contonment 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 UNAIDED Private Unaided School is that which is managed by an
individual or a private organization and does not receive any
grant for government or local body.
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