... Sex ( M for Male or F for Female )

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ØEk la0@s.no. Name of the K.V. where admission sought to be : iathdj.k ds fy, d{kk / Registration for class : I o"kz@year 2013/ [ / ] Date of Registration : DD / MM REG. NO.

.. Sex ( M for Male or F for Female ) Coloured Photograph of the child (Passport size) 2- जन म त थ ¼vadks esa½ Date of Birth Day Month Year 'kcnksa esa@in words vk;q 31-3-13 rd o"kz ekl fnu Age as on

1 ØEk Name of the K.V. where admission sought to be : iathdj.k ds fy, d{kk / Registration for class : I o"kz@year 2013/ [ / ] Date of Registration : DD / MM REG. NO For Office use only 1- fo kfkhz dk iwjk uke Name of child in full (in Capital letters)... Sex ( M for Male or F for Female ) Coloured Photograph of the child (Passport size) 2- जन म त थ ¼vadks esa½ Date of Birth Day Month Year 'kcnksa esa@in words vk;q rd o"kz ekl fnu Age as on Years Months Days 3. Blood Group of the child cpps dk jdr lewg Mention the Category of Special provision if any for admission other than not mention in Sl. No. 4 of this Registration Form as per KVS Admission Guidelines Part B Special Provision. A certificate in support must be enclosed. 4. The category to which child belong / छ त र क श र ण (Put tick mark in appropriate box) Gen. Cat SC ST OBC EWS BPL Disabled SG Child 5. D;k vks ch lh vkffkzd :i ls detksj@chs ih,y@fodykax@bdyhsrh du;k ;fn gka rks izek.k &i= layxu djsaa Whether the child belongs to (SC/ST/OBC/EWS/BPL/Disabled/S.G.) Category, Please attach relevant certificate. [ Write YES or NO ] ******************************* For Office use only ******************************* [ 01/04/2006 to 31/03/2008 ] DOB KV CAT No. of Transfers GEN SC ST OBC EWS BPL DSBLD SGC RTE Distance Remark(s) if any : Qualifying Occupation : M / F Occupation : Signatures with date : ************************************************************************************* Page 1 of 7 Date of issue of form with Sign. :

2 6. Ekkrk&firk dk Details of Mother/ Father : Sl. No. C;kSjk@ Details Ekkrk@ Mother firk@ Father (i) uke@ Name (in Capital letters) (ii) jk"vªh;rk@ Nationality (iii) O;olk;@ Occupation (iv) dk;kzy; dk uke] iwjk irk o nwjhkk"k Name of Office and full address with Telephone numbers (v) (vi) iw.kz vkoklh; irk o nwjhkk"k Full residential address with Telephone numbers (with proof) fo ky; ls nwjh@ Distance from KV* (vii) LFkkbZ irk@ Permanent Address म ब इल न बर /Mobile Number : (viii) (ix) (x) ewy osru@ Basic Pay 31&3&-2013-rd lsokdky ds nksjku 7 o"kksza esa FkkukUrj.kksa dh la[;k No.of transfers during 7 years as on of the year Js.kh : j{kk@ dsunzh; dehz@ Lok;r'kklh o vu; Category to which the Parent belong to : Defence / Central Govt., Autonomous Body Under Central Govt., State Govt., State Govt. Undertaking Body or Others esa,rn~ }kjk ;g izekf.kr djrk gw fd mi;qzdr izfof"v;ka esjh tkudkjh esa lr; gsaa I certify that the above entries are true to the best of my knowledge. frffk@ Date: ekrk / firk ds Signature of Parent iwjk Full Name. Page 2 of 7

3 Service Certificate for Central Govt. / Central Govt. Undertakings Employee lsok izek.k&i= / SERVICE CERTIFICATE ( Only for Central Govt. ) izekf.kr fd;k tkrk gs fd Jh@Jherh dk;kzy;@ea=ky; esa dk;zjr gsaa os j{kk lsok@dsunzh; fjtoz iqfyl cy@lhek lqj{kk ljdkj Lokf;r lalfkk@lkoztfud {ks= ds miøe ds@dh dezpkjh gsa ftudk iw.kz foùk izca/k dsunzh; LFkkukarj.kh; gsaa Certified that Shri/Smt.. is working in the Office / Ministry of. He / She is an 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 anywhere in India. स न एव द न क : Place and Date : क र लर अध र क ष क न म, प और हस क षर Signature : & Name in BLOCK letters : and designation of the head of office : with stamp: (क र लर क म हर सदह ) रभ ष : Telephone No. :.. Page 3 of 7

4 Service Certificate for State Govt. / State Govt. Undertakings Employee स व प रम ण पत र / SERVICE CERTIFICATE (State Govt.) izekf.kr fd;k tkrk gs fd Jh@Jherh dk;kzy;@ea=ky; esa dk;zjr gs aa वह र ज र म कह भ ह स रण र र ज र सरक र क एक कम च र ह Certified that Shri/Smt.. is working in the Office/Ministry of... He / She is an employee of State Government / State Government Undertaking and his / her services are transferable anywhere in the state. स न एव द न क : Place and Date : क र लर अध र क ष क न म, प और हस क षर Signature : & Name in BLOCK letters : and designation of the head of office : with stamp: (क र लर क म हर सदह ) रभ ष : Telephone No. :.. Page 4 of 7

5 Certificate for the Number of Transfers for Central / State Govt. Employees CERTIFICATE FROM PRIORITY CANDIDATES FOR ADMISSION IN CLASS I, IN KENDRIYA VIDYALAYAS I,(Smt./Shri), (Name) (rank/designation) of do hereby certify that during the past 7 years I have been transferred (unit/ship/deptt.) times from one station to another, the details of which are given as under :- (in figures & in words) Whether Period Total Formation/Unit/ Authority S.No. moved with Place Period Depot/Office From To to move family of Stay I further certify that in case the above-mentioned facts are found incorrect, my child will be disqualified for admission to Kendriya Vidyalaya. PLACE : DATE : SIGNATURE OF PARENT PLEASE REFER PRIORITIES PRESCRIBED IN ADMISSION GUIDELINES COUNTERSIGNED (Countersigned by Commanding Officer / controlling Officer of the Rank of Colonel OR Equivalent) I, Sh./Smt [ name ], , [ rank / designation ] [ unit / ship / department ] hereby certify that the particulars given above have been authenticated by the records held in the office and found to be correct. Place: Date: (SIGNATURE OF THE CO/OC UNIT/CONTROLLING OFFICER) ADDRESS / OFFICE STAMP : 1) Minimum period of posting/stay at a place should be six months. 2) Form to be signed by an officer not below the level of Colonel or equivalent in Navy/Air Force/Para-Military Forces. 3) In case the CO is below the rank of Colonel, the form to be signed by the Station Commander/Colonel/Colonel in a station. Page 5 of 7

6 Certificate for Central Govt. Employee who died in harness izekf.kr fd;k tkrk gss fd;k tkrk gs fd LoxhZ; gsa tks esa lsokjr Fks vksj mudk nsgkolku lsokydky ds nksjku fnukad dks gks x;k FkkA ;g Hkh izekf.kr fd;k tkrk gs fd tks ds ekrk&firk gsa] muds orzeku o kz dh 31 st ekpz ls lkr o"kksz a ds nksjku LFkkukarj.k gq, gsaaa,dd@dk;kzy; vksj,slh rsukfr;ksa dh vof/k dk C;kSjk uhps fn;k x;k gs] ftlds dkj.k LFkku cnyuk im+rk gsa Certified that Master/Km is the son/daughter of late Sh./Smt who was employed in the Office/Ministry/Defence service. He/she had died in harness on the It is further certified that..(particulars of son/daughter.. has/had (No. of posting) transfers during the preceding last seven years from 31 st March of the current year. The Unit Office & the duration of such postings involving change of station are given below:- क र.स. S.No प न म Designation स न Place of Posting स From ठहरन क अवथ Period of stay क To आ श स ख र Order No. LFkku,oa fnukad Station with date dk;kzy; v/;{k dk uke] in vksj glrk{kj ¼dk;kZy; dh eksgj lfgr½ Sign. & Name in block letters and design. of the head of office with stamp Address -... nwjhkk"k % Telephone No. fvii.kh % j{kk lalfkkukaas esa dke djus okys dezpkfj;kasa ds ekeys esa lsok izek.k i= ij deku vf/kdkjh ds glrk{kj visf{kr gsa Note : The service Certificate should be signed by the officer commanding in case of employees working in defence establishment. Page 6 of 7

7 ikorh / Acknowledgement Øe la0 S. No iathdj.k la[;k@ Registration No. : Jh@Jherh ls muds iq=@ iq=h d{kk १ esa izos'k gsrq iathd.k vkosnu i= izkir fd;ka Received an application from Shri/Smt for registration of her/ his son/ daughter.. for admission to class I. frffk@ Date /2013 izkpk;z@ Principal dsunzh; fo ky; ¼eqnzkad½ Kendriya Vidyalaya (Stamp) Please log in to the School website Registration List under Admission section [ ] on the next day of your registration to see your details. If any correction required, please report it immediately to the school in between 10:30 AM to 1:30 PM on all working days with Acknowledgement within the Schedule as mentioned below. Important points to be noted : 1. Before applying, please go through the Admission Guidelines available in KVS website vide 2. Following documents are to be enclosed while submitting the form duly attested by a Gazetted Officer: (i) Photocopy of Certificate of proof of age in the form of a birth certificate issued by the authority competent to register births as per KVS Admission Guidelines (ii) Proof of Residence : For Central Govt. employee s present residential address proof may be obtained from their office issued by competent authority. Others may obtain the same from the Notified Area Councillor [ if not staying in Govt. Quarters ]. (iii) A self-declaration in writing from the parent for distance of K.V. O.F. Dum Dum from his / her residence. (iv) (v) Photo copy of the Certificate that the child belongs to the Scheduled Caste/Scheduled Tribe/EWS/OBC(Non-Creamy Layer)/BPL/Disabled, wherever applicable, issued by the competent authority in concerned State Government/Union Government. The caste certificate in respect of either of the parents may be accepted initially for the purpose of admission, if this certificate is not available for the child. However, the caste certificate in respect of the child has to be submitted within a period of 3 months from the date of admission. For SG Child ( Single Girl Child ) category, the photocopy of the certificate regarding the parents having only one child and that is a girl issued by the First Class Magistrate. 3. Children of the employees of transferable and non-transferable Central Government, Central Government Undertakings, State Government or State Government Undertakings have to fill the service certificate ( Service Certificate & Transfer Certificate ) showing the number of transfers during the preceding 7 years duly signed and stamped by the head of office bearing the name, designation and other relevant particulars in block letters. If there is no transfer, please mention NIL in Transfer Certificate. 4. Eligibility for admission to class I : ( Please refer to KVS Admission Guidelines ) CLASS MINIMUM AGE ON 31/03/2013 MAXIMUM AGE ON 31/03/2013 I 5 years 7 years 5. Schedule for Class I Issue of Forms & Registration for Class I to excluding holidays 10:30 AM to 1:30 PM Notification for Lottery wherever applicable Display of total registration list for Class I. If still any correction required, please report immediately to by 11:00 AM the Vidyalaya latest by , 11:00 AM Display of final registration list for Class I after correction if any. Display of list for lottery by 1:00 PM Expected dates of lottery to Declaration of list & admission for class - I TO All information will be displayed in School Main Gate, Notice Board and School Website as per above schedule. Please do not call at Vidyalaya telephone regarding admission. Page 7 of 7

dsunzh; fo ky; laxbu

dsunzh; fo ky; laxbu Kendriya Vidyalaya Sangathan PART- D FORMS AND FORMATS Photograph of the child (Passport size) REG. NO. ØEk la0@s.no o"kz@year 2016 iathdj.k ds fy, d{kk /Registration for class. (Put