Application No.

Affix a recent

passport size

photograph duly

attested by a

Gazetted Officer

VT1: Male I I

PIN

Mobile No. :

,1141 11gith;EreFdraWrff:, saWaTT:, SHRI JAGANNATH SANSKRIT VISHVAVIDYALAYA

SHRI VIHAR, PURI- 752003 ( ODISHA)

Fax No. 06752- 251073

E-mail : sanskrit.university @yahoo.com

Website : www.s'sv.nic.in

SHIKSHA SHASTRI - B.Ed. ENTRANCE TEST - 2016

jr- Trcrfi-air - 0 .?

FOR OFFICE USE ONLY Roll No.

EXAM CENTRE

TITRi31- i.ciAcilTaftzilT, (To be filled in by the applicant )

1. ill179T14

Name of the Candidate (In Capital Letters)

2. 1H Sex ( Vrt,16 kqT=Lliut V mark) 11f1I Female

3. ff: -11H

Father's Name :

4. Trig: -11H

Mother's Name :

5. ,T1-4-1R-ilg:

Date of birth : Day

Month

Year

Age

6. tARroRiv-t,

Identification Mark •

7. ,-111 .-11 .d:

Address for Communication (In English Capital

Letters Only)

8. 3TWEI9VRT

(Educational Stream) : (i) LIR 4-LiRchrl (Traditional) 7TRtiaTN1-4/3-FjR)

VR-16

(ii) (Modern) f4.7.(#Tzfft) Put mark)

Details of Demand Draft Amount : 700/- Name of the Bank :

DD No. : Date :

VR-16 kql=1)

Put mark)

VRi6 k?:11=0 Put/ mark)

Provisional

(i) Madhyama/HSC (ii) +2 (iii) Graduation (iv) Post Graduation

Mark List

9. i`ur-urr (r4 P441: 31fiqT4-ffqr Vutzil:)

Educational Qualifications

'-1)"1)41t41f1:1 Year of Passing

rVcIRKI1c1W-1/ 1:1fiTK: -IIH Name of the University/Board

-6-4TiT: Marks

Obtained

3*--di: Yid-014-1i : Courses Studied

:11:74T: Total

Marks Percentage of marks

liv-P-11/ (i)Madhyama/

H.S.C.

(ii) 6 ,RIIQ/

-11 ,1-114)/ Intermediate / +2

(iii) yiRt/

B.A.(Sans)/ +3 (Sans)

(iv)aiNFil M.A.(Sans)

(v) /

Any other

10. 3TRAinkt (Reservation Category) : SC/ST/PHC Ex-Serviceman/Sports man (National/State Level)

11. (Residential State)

12. 3.4Q-M=L:

(Studied in SJSV. Puri)

13. 31-- EF*F.RcIrcl

(Studied in Other University)

14. :

(Enclosures) A (i) Identity Card of SSET

(ii) Admit Card of SSET (iii) Self Addressed Envelopes -2

(one stamped)

(i) University Certificate (ii) Reservation Category

(SC/ST/PH/Other)

dq114:1 4-1 / DECLARATION

TFF—d-- T4 giut-T-4 zr- 31-q -q4 fq--qTut qq1,1-1) ,i #(-4-4LRFRN Tiqt

ci-ctrtic-chic

qtrvq-ru chvilT,31.-1 To7-4 (4-4Rfff I hereby certify and declare that all statements made and information given by me in

this application are true, complete and correct to the best of my knowledge and belief. In the event of any information or part of it being found false or incorrect before or after the examination/ admission action as deemed fit shall be taken against me by the authority

concerned.

Date : Place: Signature of the Applicant

/ Identity Card

SHRI JAGANNATH SANSKRIT VISHVAVIDYALAYA, SHRIVIHAR, PURI

440' SHIKSHA SHASTRI -B.Ed ENTRANCE TEST -2016

- ?0

01-05-2016 (10AM to 12 Noon)

BALASORE PURI

CUTTACK

El

07. q.)VT------- 111:1.

chice of centre : titUTF:

Controller of Examinations

CUTTACK BALASORE LI

Signature of the Applicant

PURI

St \IP 1 I 47.1WereTT * . ftrar: Affix a recent

passport size

photograph duly

attested by a

Gazetted Officer

FOR OFFICE USE ONLY Roll No.

EXAM CENTRE

1. AC / Full Name

(In Capital Letters)

2. fT: -Ira/ Father's Name :

3. TITI: .11J-1/ Mother's Name :

4. \TI-4-1R-ilg;:/Date of birth :

5. LIR•t,iirt-iv-(

Identification Mark :

6. Date of Examination:

7. t-iNTA--- zFTL

chice of centre :

Controller of Examinations Signature of the Applicant

MINI EMI =1111 MIMMI MINI MIN MI MM 111M11 I=M MIMI MIMI I■1 I■ MOM I■ MINE

IMMMI EMI NMI NINE

• , lar- aT SHRI JAGANNATH SANSKRIT VISHVAVIDYALAYA, SHRIVIHAR, PURI

SHIKSHA SHASTRI -B.Ed. ENTRANCE TEST -2016

0

34 kqqA4-i, / Admit Card

Affix a recent

passport size

photograph duly

attested by a

Gazetted Officer

FOR OFFICE USE ONLY Roll No. EXAM CENTRE

1. -111' / Full Name :

(In Capital Letters)

2. FITT -IIH/Father's Name :

3. TIM: -11 4 -I/ Mother's Name

4. ,TI-4-A-14;:/Date of birth :

5. LIRtMr-c-iV-{,

Identification Mark :

6. 1-1 ,a / Date of Examination : 01-05-2016 (10AM to 12 Noon)

N.B. : Mobile phones, pagers or any other communication devices are not allowed inside the premises where the examination is conducted.