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Kendriya Vidyalaya
rEEErffi
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tdtrtum{il
d*qt{q d@T/ Regd. No.
sT/session - 2015-16
m. €./S. No.
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Photo,graph
fi frg irtr /Registration
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child
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fr)
tull (in Capital letters)
Name of child in
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ofthe
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rfizFemale
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)/ Date of Birth (in
6dro 61q1*rd Gender
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31.03.2015 ntF. sirgl Age as on
3
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1.03.201 5
fiRT./Month
frazDay
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Blood Croup ofthe child (with Rh factor)
4.
ild
6r fiEBrd MIzthe categoryto which chitd belong
General
SC
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OBC
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Diff. Abled
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lf the child betongs to SC/ST/OBC/EWSEPUDisab|ed/S.G. Category, then, please attach relevant certificate.
t
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5. e{fdt-Fa
6I fuaflrr/petails of Mother/ Farher -
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Enfr (€qg er<t
g,; urn*,,n
ftFII/ Mother
ftfrt/Father
Capital letters)
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(iii)
zrrqgF Occupation
(iv)
orqtilq tnr ;rrfi,
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of Office and full
addrcss and Telephone
Name
number.
(v)
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(qa{Iur
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sfra)
{tfiN
Full residential address and
Tel. no. (with poof)
(vi)
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Distance from
(vii)
(viii)
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(in
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ttra/Basic pay
Fqrdil{d Ar Ti@T
(i*)
No. of Transfers **
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Category of the Parent #
6ts (cfE
t
ril)employce Code (if any)
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Distance of Rcsidence from vidy-alry. a, undertaking
ffi
from parenh is accept^uble for distance. proof of Residence
is comoulsor
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state Govt.
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I certifr that the above entries are true to the best of my knowledge.
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Signature of MotherFather,zGuardian
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pa1";
WI dlallFull Name
,.
g./s. No.
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T;t,/Session
uffi74.l.rr,nledgement
tr.
Received an application
daughter,.....
from
l6
for registration of her/ his son/
Shri/Smt
""""'foradmissiontoclass'
qEr{z
Date...
201 5-
Registrati on No-
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PrinciPal
frffq Ffirrfiq (rilFr) Kendriva
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Vidyalaya (stamp)
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tEr rffsr-q=u SERvICE cERTIFICATE
(Affiq s{irrt/c entral G ovt.)
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Er6T/*rrr g{cn {6T/eEr.w.fr,/(rs.fi.fr,/S.,sG.rrg.w'.zidm Frfirq Fnqtr itrTr 3rqEr
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ire$ srfi trEr:renaiilsfrq tzqut 8Trfi fr EF€t $ rqrflialrsffq tt
Certified that
Shri/Smt,.....
office&Iinistry of
.....,........is working as regular employee in the
He/She is a regular employee of Defence
Service,/CRPF/BSFiNSG/SPG/CtSF/Central Govt./Autonomous Body/Public
financed/partially finanoed by Central Govt. and hiVher services
arre
Sector Undertaking tully
non-tfirnsferable/trarrsferable anywhere in
India.
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fudicr/Date
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of
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Complete address and Telephone No. of office
to
rqpr-q*zsnRvlcn cERTIFICATE
({rfl -S{-lF,It/
State Govt.)
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Complete address and Telephone No. of office
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rapr.$yCERTIF.ICATE Or. NUMBER
(arfi)-(to'zurrars)
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-.. -(Name)
OF. TRANSFERS
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(rank/ designation) of
ftfi
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t(office), do
hereby certiff that during the past 7 years (up to 31.03.2015) I have been transferred
times (in figures & in words) from one station to another, the details of which are given as under
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I know that
if
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the above-mentioned facts are found incorrect, my child
will
be disqualified
for
admission in Kendriya Vidyalaya.
EriTr/Rfrr
S'rsrrqil
Signature ofParent
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(unit/departnent) hereby certify that the particulars given in above have been authenticated by the records held in
the office and found correct.
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Signarure of Flearl tlf the Oifiae
ffifmtDate
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fi
(With Name. Designation and Offlc:e Starnp)
qot qflI !?i ({Srq dEqT
Complete address and Telephone No. of office
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66r* fiI 3rqfr qq fi o-a Er6 IfliH drfr qfrwt
Minimum period of posting/stay at a place should be minimum six months.
6
t{I-$rdrfi {q ge{rur-q:r,/ DIED IN rrAR}r,ss
.ERTTFICATE
&rd fuilfq unrrt fi ffi
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Certifi ed that Master/Jvliss
is the son/daughter of Late
Sh./Smt.
who was regular employee
(office/Department) and helshe
died in harness (whire in service)
q'rstmr 3rsaeT
ft, 6tfrtrr
q{ 3ik
uEr$.?rq
ft atft sfraf
olH*ui of the Otfice
(With Nanre. Designation
and Ofiice Stnmp)
Signature
EaiE'/nate
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*:
(aEr,
{{r;r,zPlace
of
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Complete address and Telephone
No. of office
6