H«$. g§./S. No. gÌ / Session 2015-16

n§OrH$aU Ho$ {bE H$jm / Registration for Class..........................

~ƒo H$m \$moQ>mo(nmgnmoQ>© gmBO H$m)

Photographof the child

(Passport size)

1. {dÚmWu H$m nyam Zm_ (ñnð> eãXm| _|)Name of child in full (in Capital letters).......................................................................................................

qbJ / Sex - nwéf / Male ñÌr / Female V¥Vr` qbJ / Third Gender

2. OÝ_ {V{W (A§H$m| _|) Date of Birth (in figure) {XZ / Day _mg / Month df© / Year

eãXm| _| / in words ...............................................................................................................................

31.3.15$VH$ Am w /Age as on 31.03.2015 df© / Year _mg / Month {XZ / Day

3. ~ƒo H$m aŠV g_yh (Rh \¡$ŠQ>a g{hV)Blood Group of the child (with Rh factor)

4. ~ƒo H$s g§~pÝYV loUr / The Category to which child belonggm_mÝ` AZw0 Om{V AZw0 OZ Om{V Amo0~r0gr0 Am{W©H$ én go H$_Omoa dJ© ~r.nr.Eb. AÝ` ê$n go gj_ BH$bm¡Vr H$Ý`mGeneral SC ST OBC EWS BPL Diff. Abled S.G. Child

`{X ~ƒm Š`m AZwgy{MV Om{V/AZwgy{MV OZOm{V/Amo.~r.gr. (AÝ` {nN>‹S>o dJ©)/Am{W©H$ én go H$_Omoa / ~r.nr.Eb./{dH$bm§J/ BH$bm¡Vr H$Ý`m loUr go gå~§{YV h¡ Vmo H¥$n`m g§~pÝYV à_mU-nÌ g§b½Z H$ao &If the child belongs to SC/ST/OBC/EWS/BPL/Disabled/S.G. Category, then, Please attach relevant certificate.

n§OrH$aU g§»`m /Regd. No.

P.T.O.

H«$.g§. / S.l. No. nmd{V / ACKNOWLEDGEMENT

n§OrH$aU g§»`m / Registration No..........................

lr / lr_Vr.................................................................go CZHo$ nwÌ / nwÌr...........................................................H$m H$jm ................................_|àdoe hoVw n§OrH$aU Ho$ {bE AmdoXZ àmßV {H$`m &

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

daughter ...................................................................................... for admission to class............................

àmMm`© / Principal

{V{W / Date : Ho$ÝÐr` {dÚmb` (_moha)/Kendriya Vidyalaya (Stamp)

gÌ / Session 2015-16

Ho$ÝÐr` {dÚmb` g§JR>ZHo$ÝÐr` {dÚmb`, Y_©nwar - 636 604.

KENDRIYA VIDYALAYA SANGATHAN

KENDRIYA VIDYALAYA, DHARMAPURI - 636 704.

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5. _mVm-{nVm H$m {dVaU / Details of Mother / Father

H«$.g§. _mVm / Mother {nVm / Father

(i) Zm_ (ñnîQ> eãXm| _|) /Name (in Capital letters)

(ii) amï´>r`Vm / Nationality

(iii) ì`dgm` / Occupation(iv) H$m`m©b` H$m Zm_, nyam nVm d Xya^mf .

Name of office and Full Addressand Telephone Numbers

(v) nyU© Amdmgr` nVm d Xya^mf(à_mU g{hV)Full residential Addressand tel. no. (with proof)

(vi) {dÚmb` go Xÿar ({H$._r._|)Distance from KV (in km)*

(vii) _yb doVZ/ Basic Pay

(viii) ñWmZm§VaUm| H$s g§»`mNo. of Transfers **

(ix) _mVm {nVm H$s loUrCategory of the Parent #

x) H$_©Mmar H$moS> (`{X h¡ Vmo)Employee Code (if any)

* {dÚmb` _| Amdmg H$s Xÿar Xÿar Ho$ {bE _mVm-{nVm / A{^^mdH$ H$m gnW-nÌ _mÝ` h¡ & Amdmg à_mU - nÌ XoZm Amdí`H$ h¡ & Distance of Residence from Vidyalaya. Undertaking from parents is acceptable for distance. Proof of Residence is compulsory.

** 31.03.2015 VH$ {nN>bo gmV df© _| ñWmZm§VaUm| H$s g§»`m / No. of transfers during last 7 years as on 31.3.2015.# $ 1. Ho$ÝÐr` gaH$ma / Central Govt. 2. Ho$ÝÐr` gaH$ma Ho$ ñdm`V g§ñWmZ / Autonomous bodies of Central Govt. 3. amÁ` gaH$ma / . State Govt. 4. amÁ` gaH$ma Ho$ ñdm`V g§ñWmZ / Autonomous bodies of State Govt. 5. AÝ` / others._¢ EVX Ûmam `h à_m{UV H$aVm/H$aVr hy± {H$ Cn`w©º$ à{d{ï>`m± _oar OmZH$mar _| gË` h¢ Ÿ&I certify that the above entries are true to the best of my our knowledge

_mVm/{nVm/A{^^mdH$ Ho$ hñVmja Signature of Mother / Father / Guardian

{XZm§H$ / Date :............................ nyam Zm_ / Full Name........................................

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godm à_mU-nÌ/SERVICE CERTIFICATE(Ho$ÝÐr` gaH$ma/Central Govt.)

à_m{UV {H$`m OmVm h¡ {H$ lr / lr_Vr ........................................................., ..................... H$m`m©b` _§Ìmb` _|{Z`{_V H$_©Mmar Ho$ ê$n _| H$m ©aV h¢ Ÿ& do ajm godm / Ho$ÝÐr` [aOd© nw{bg ~b / gr_m gwajm ~b / EZ.Eg.Or. / Eg.nr.Or./gr.AmB©.Eg.Eµ\$. / Ho$ÝÐr` gaH$ma/ñdm`V g§ñWm AWdm gmd©O{ZH$ joÌ Ho$ CnH«$_ Omo nyU© `m Am§{eH$ ê$n _| H|$Ð gaH$ma go {dV-nmo{fV h¡, Ho$ {Z`{_V H$_©Mmar h¢ VWm CZH$s godm AñWmZmÝVaUr` h¡ nyU© ^maV _| H$ht ^r ñWmZmÝVaUr` h¡ Ÿ&

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 non- transferable / transferable anywhere in India.

H$m`m©b` AÜ`j Ho$ hñVmja(Zm_, nX Am¡a H$m`m©b` H$s _moha g{hV)

Signature of Head of the Office

(With Name, Designation and Office Stamp)

H$m`m©b` H$m nyU© nVm Ed§ Xÿa^mf g§»`m _________________________________________________

Complete address and Telephone No. of office _________________________________________________

godm à_mU-nÌ/SERVICE CERTIFICATE(amÁ`-gaH$ma / State Govt.)

à_m{UV {H$`m OmVm h¡ {H$ lr / lr_Vr ................................................, ............................ H$m`m©b` / _§Ìmb` _|{Z`{_V H$_©Mmar Ho$ ê$n _| H$m ©aV h¢ Ÿ& VWm CZH$s godm AñWmZmÝVaUr` h¡ nyU© amÁ` _| H$ht ^r ñWmZmÝVaUr` h¡ Ÿ&

Certified that Shri / Smt...................................................................is permenantly working in the office /

Ministry of ................................... He / She is an employee of State Govt. / Autonomous Body/ Public Sector

Undertaking fully financed by State Govt. and his/her services are non- transferable / transferable anywhere in State.

H$m`m©b` AÜ`j Ho$ hñVmja(Zm_, nX Am¡a H$m`m©b` H$s _moha g{hV)

Signature of Head of the Office

(With Name, Designation and Office Stamp)

H$m`m©b` H$m nyU© nVm Ed§ Xÿa^mf g§»`m _________________________________________________

Complete address and Telephone No. of office _________________________________________________

ñWmZ / Place ________________

{XZm§H$ / Date ________________

ñWmZ / Place ________________

{XZm§H$ / Date ________________