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IGNOU-UNESCO
Science Olympiad 2010
Registration Form for Tier-I Test

Registration
IG12007300593
ID :

SAURABH VIKAS TAL D.O.


Name 29/10/1994 Signature
ELE B

Residential C-101, PinC 425001


Address SHUBHAKAMANA ode
SANKUL,GANESH
COLONY,
JALGAON-425 001
Maharashtra,
India
Mobi
091-
Phone No. 91-257-2252734 le
9422278434
No.

Emai
Ge
l vvtalele@yah
Nationality India nd Male
Addr oo.com
er
ess
Current Academic Details
Currently Enrolled XI Principal's Prin A G Rao School Mooljie Jaitha
Standard / Class Name Address College,
JALGAON

Country India State Maharashtra City Jalgaon

Academic Details of Passing 10 th Standard/Class or equivalent Final Exam

Year of Passing 2010 Average Marks 93.60/A1

School Address RUSTOMJIE INTERNATIONAL, JALGAON

Details of Exam Centre as selected by Student

Nearest
Country India State Maharashtra Nasik
City/Town

Payment Details

Bank Draft No. 978379 Amount 50 Rupees Date Of Issue 30/6/2010

PUNJAB
Bank Name NATIONAL Country India
BANK

Declaration:
I hereby declare that,
• I have passed 10 th Standard / Class Exam with at least 70 % Marks / Grade from a recognised
Board of Education.
• Currently I am studying in 11 th Standard / Class.
• All the Information given above are correct and if any of the Information is found incorrect at any
stage, my canditature for Science Olympiad may be cancelled.

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