SPORTS AUTHORITY OF INDIA NETAJI SUBHAS SOUTHERN CENTRE, BANGALORE-560056 SELECTION FOR THE YEAR ____________ NAME OF THE CENTRE ____________ ( Please tick ? the appropriate option ) REGULAR DAY BOARDER Name (In Capital Letters )______________________________________ Game ___________________ Event / Playing Position : ______________ Date of Birth ( Attach attested certificate copy ) Sex : Male Female Parent Name: _________________________________ Permanent Residential Address : Present Residential Address : ________________________________ _______________________________ ________________________________ _______________________________ ________________________________ _______________________________ Tel No: Tel No: Email Id: ( Attach certified documentary proof of above - DL/Ration Card/Passport ) Belong to : Rural or Urban Height : ___________ (in CM) Weight_________ Belong to : OBC SC ST GEN EDUCATION QUALIFICATIONS : Sl. No Class School / College / University Board Year of Passing School / College Address Medium of Instruction Whether undergone training in any of the SAI scheme : Yes No If Yes, Details of Scheme & Year __________________________________________ Are you In receipt of any Scholarship from SAI / State : Yes No If Yes, Furnish Details of Scholorship & Year _________________________________ Contd. Latest Photo DETAILS OF PERFORMANCE / ACHIEVEMENTS ( PREVIOUS THREE YEARS ) Sl. No Competition Name Date & Venue Age Group Event Position Time / Distance ( Attach attested certified copy of each competition ) The above information is true to the best of my knowledge and will be liable for disqualification from the scheme , if found wrong at any later date. SIGNATURE OF PARENT SIGNATURE OF TRAINEE PLACE: DATE: INSTRUCTIONS : 1. Please tick the appropriate option in the box provided. 2. All attestations on the certificates ( Residence , Competitions etc ) must be from a Gazetted Officer only. 3. Date of birth proof must be only Birth Certificate from Panchayat / Municipality / 10th Class Marks Card. 4. Fitness certificate only from a Qualified Medical Practioner. 5. All original documents to be produced for verification at time of selections. CHECK LIST OF DOCUMENTS TO BE SUBMITTED :- 1. Residential Proof 2. Date of Birth Proof 3. Achievements Certificates 4. Medical Fitness Certificate 5. Latest Passport size Photograph
