ENROLMENT LIST

FOR OFFICE USE ONLY

Centre No. Receipt No. PHY CHEM BIO NSEA NSEJS Total Amount (Rs)
ENG.

After filling the following form completely TAKE TWO XEROX COPIES. Despatch this original form with D.D. to the examination in-charge Prof. M. L. Ogalapurkar, on 16-9-2010 and
retain the xerox copies with you. Do not forget to write PIN Code number on the mailing address. In column "Subject offered" write 'YES' for subject offered and put a dash if not offered.

INDIAN ASSOCIATION OF PHYSICS TEACHERS

NSEP, NSEC, NSEB, NSEA,
& NSEJS 2010 - 2011
Centre Number : _________________________ ( Do not enter in case of a new centre.) Date : ______________________
Name of Centre In-Charge : ______________________________________________________________________________________________________________________________
Name & address of Centre (All Exam ____________________________________________________________________________________________________________________
Material will be sent to this address) } _______________________________________________________________________________________ PIN :
Telephone No. (with STD code) ( )________________________ e-mail : ______________________________________________ Fax : ____________________________
Number of Candidates Enrolled :
NSEP : English _________, Hindi / Bangla / Gujrati _________, Total (For NSEP) _________
NSEC _________, NSEB _________, NSEA _________, NSEJS _________
(NOTE : Subjects other than Physics are in English only.)
Only one combined DD must be sent for NSEP / NSEC / NSEB / NSEA / NSEJS.
Details of draft sent (DD in favour of Indian Association of Physics Teachers payable at Pune) : Bank ______________________________________ Date : ______________________
D.D. No. ________________________ Amount In figures Rs. ________________________ (In words) : _________________________________________________________________

LIST OF CANDIDATES
(At a centre, no two students can have the same Roll number) FOR NSEJS ONLY
Roll Complete Name of Candidate Language Date of Birth
NSEP for NSEP NSEC NSEB NSEA NSEJS Class
No. (First name, Middle name, Surname) only. Date - Month - Year

001
002
003
004
005
006
007
008
009
010
011
012
013
014
015
016
017
018
019
020
021
022
023
024
P.T.O.
 FOR NSEJS ONLY
Language Date of Birth
Roll Complete Name of Candidate
NSEP for NSEP NSEC NSEB NSEA NSEJS Class
No. (First name, Middle name, Surname) only. Date - Month - Year

025

TOTAL
(FOR MORE NUMBER OF STUDENTS PREPARE
SIMILAR ADDITIONAL LIST)

Signature of Centre In-charge. ..............................................

SEAL
OF THE
SCHOOL /COLLEGE
FOR NSEJS ONLY
Certified that the birth dates given in the last column are correct to the best of my information.

Signature of Centre In-charge. ..............................................