केन्द्रीय विद्यालय संगठन required for Admission in Class … ... MP and PSU employees would be needed. ... *For Single Girl Child (SGC)

Day Month Year

REG. NO. Kendriya Vidyalaya Sangathan

1, ( )

/Registration for Class

1- ( )--------------------------------------------------------- Name of Child in full (in CAPITAL LETTERS).

/Gender/ /Male /Female /Third Gender

2- ( ) Date of Birth ( )/ In words

31.03.2016 /Age as on 31.03.2016 - /Years / Months / Days

3- (Rh )/Blood Group of the Child (With Rh Factor) 4- / / / / / / / , Do you belong to Gen. / SC/ ST/ OBC/ EWS/BPL/Disabled/S.G. Child ? if Yes, Attach relevant Certificate. Y/ /N () /Tick () mark the applicable box. Gen. Cat. SC ST OBC EWS BPL Diff. abled SG Child

5. - - 6. AADHAAR Card No. - 7. - / Details of Mother-Father /Mother /Father (i) /Name (In capital Letters) (ii) /Nationality (iii) /Occupation

(iv) , /Name of Office and Full Address with Telephone Numbers

(v) /Full Residential Address with Telephone Numbers (With Proof)

(vi) ( )/Distance from KV* (In Km)

* // - - Distance of Residence from Vidyalaya. Undertaking from Parents is acceptable for distance. Proof of Residence is compulsory.

(vii) /Basic Pay

(viii)

31.03.2016 7 /No. of Transfers during 7 years as on 31.03.2016 of the year

/ S. No.

Photograph of the

Child

(Passport Size)

2016-17 / Year 2016-17

(ix) Category of the Parent **

(x) ( ) Employee Code (If any) **Category of the Parent belongs to 1.Central Govt./ 2.Autonomous bodies of Central Govt./ 3.State Govt./ 3.Autonomous bodies

of State Govt./5.Others 1. / 2. /3. / 4. / 5. I certify that the above entries are true to the best of my knowledge.

/Date: / / /Full Name /Signature of Parent

lsok izek.k&i= ( ) / SERVICE CERTIFICATE (Central Govt.) / ---------------------------------------------------

/

/ / //// - , /

Certified that Shri/Smt.is working as regular employee in the

office/Ministry of ....He/She is a regular employee of Defence

Service/CRPF/BSF/NSG/SPG/CISF/Central Govt./Autonomous Body/Public Sector Undertaking fully

financed/partially financed by Central Govt. and his/her services are transferable/non-transferable anywhere in India.

LFkku ,oa fnu Station with date dk;kZy; v/;{k gLrk{kj , dk;kZy; dh eksgj lfgr Signature of Head of the Office

(With Name, Designation and Office Stamp)

:______________________________________________________________

Complete address and telephone No. office: ____________________________________________________________________

lsok izek.k&i= ( ) / SERVICE CERTIFICATE (State Govt.) / _________________________ /

/

Certified that Shri/Smt.. is permanently working in the office/Ministry of

-------------------------------------- and his/her services are non-transferable/transferable anywhere in State.



:______________________________________________________________


-/ CERTIFICATE OF NUMBER OF TRANSFERS

__________________________ () __________________ (/) ________________________ (), / (31-03-2016 ) ________________________ ( ) - I,__________________________ (Name) ________________ (Rank/Designation) of ___________ (Office), do hereby

certify that during the past 07 years (upto 31.03.2016) I have been transferred _______________ times (in figures & in

words) from one station to another, the details of which are given as under:

S. No.

/

Office/Unit

Place

/ Rank/Designation

/Date

Period of Stay

Order No.

/From / To

1.

2.

3.

4.

5.

6.

7.

/ I know that if the above-mentioned facts are found incorrect, my child will be disqualified for admission in Kendriya Vidyalaya

/ Signature of Parent

/ Countersignature

, ______________________ () ____________ (/)__________ (), -

I, ___________________________ (Name) ___________________ (Rank/Designation) of

_____________ (Unit/department) hereby certify that the particulars given in above have been

authenticated by the records held in the office and found correct.



:______________________________________________________________


/Note: Minimum period of posting/stay at a place should be minimum 06 months.

- -/DIED IN HARNESS CERTIFICATE ( /Only for Central Govt. Employees)

/ -------------------------------------------- / ----------------------------- / ---------------------- (/) / ------------------ Certified that Master/Miss ____________________ is the son/daughter of Late Sh./Smt.

_____________________________ who was regular employee of ____________________

(Office/Department_ and he/she died in harness (while in service) on _________ (date).



:______________________________________________________________


/ Self Declaration I ------------------------------------------------------------ hereby declare that my

residence is _________________ (km) from Kendriya Vidyalaya No. --------------------

--------------.

----------------------------------------------------------------- / ---------------------------------------- ---------------------------- ()

Signature/

Kendriya Vidyalaya No. 1,Sagar Cantt. (M.P.)

. (2016-17)

Documents required for Admission in Class . (2016-17)

* , *Birth Certificate of the child issued by competent authority.

* * , / *For grandchildren of honorable MP and PSU employees, a proof of relationship of either of the childs parents with the honorable

MP and PSU employees would be needed.

* , / * For grandchildren of KVS employees a proof of relationship would be required.

* // / (- )/ /

*A certificate that the child belong to a ST/SC/EWS/OBC (Non-creamy layer)/BPL/Disabled wherever applicable issued by the

competent authority.

* /

*Admission secured on the basis of wrong certificate should be cancelled by the principal forth with and no appeal against such

action of the Principal shall be entertained.

* , *A service certificate showing the number of transfers during the preceding seven years duly signed and stamped by the head office

bearing the name, designation, and other relevant particular in block letter.

/ * A certificate of retirement for uniform defence employees.

* *A proof of residence.

* *An income certificate from the competent authority.

* , , 100/- *For Single Girl Child (SGC) an affidavit on Rs. 100/- Stamp Paper

* //- , *Self-declaration of distance by the parent.

* /, * Any other relevant certificate/document required issued by competent authority. Note: (1) Bring all the relevant documents in ORIGINAL at the time of verification and submission of completely filled form in all respect.

(2) Last date for submission is 18.04.2016

18-04-2016 ----------------------------------------------------------------------------------------------------------------------------------------------

/Acknowledgement /Session 2016-17

S. No. /Registration No.

/------------------------------------------ / ----------------------------- --------------------

--

Received an application from Shri/Smt. .. for registration of her/ his son/ daughter

. for admission to Class .

/Principal /Date: / 1, ( ) () /Kendriya Vidyalaya No. 1,Sagar Cantt. (Stamp)