-
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.
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:
____________________________________________________________________
-/ 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.
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:
____________________________________________________________________
/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).
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:
____________________________________________________________________
/ 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)