Q,R la 3 - Education Department - GCERT

Q,R la 3 Test Code aria es Otoagaa Qi2 Medium Code Name of the Student : Stu Name of the State : S'i. ;.- ... 16 211 20. °61R1c1 cli ff Rlztl Vc1104, ...

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14

Medium Code

Stu dent ID

Name of the Student : Gender 11. Boy I 2. Girl Code

S'i. ;.- te Code

Name of the State :

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Name of the District : ;

Name of the School and address :

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Sc_

trict

Code 7:- Ode \ NAF:'s, Code)

I Area r , R,qi'l ni Code i 2. i: ban 1 j___,

Location of the School :

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2. Si G JE;c: 4. Others .._ .

Social Category :

1.,,,,,,,,;,,iparee -?, her:rirg impwred 0:i nora,,,c,:fr: Impaired L____...1

Disability Category : Name of the Field Investigator :

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Name of Head Master

Signature of Head Master far slaitriA

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