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dsUnzh; fo|ky; laxBu
Kendriya Vidyalaya Sangathan
PART- d
FORMs and FORMATS
REG. NO.
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ØEk la0@S.No o"kZ@Year 2014
iathdj.k ds fy, d{kk /Registration for class…………………………. (Put
tick mark in appropriate box)
Ist Shift OR
IInd Shift
izFke ikyh f}rh; ikyh
1-
fo|kFkhZ dk iwjk uke
Name of child in full (in Capital letters)
…………………………………………………
Sex M F
Day Month Year
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2-
जन्म तिथि ¼vadks esa½
Date of Birth
'kCnksa esa@In words……………………………………………………….
vk;q 31-3-14 rd o"kZ ekl fnu
Age as on
31.3.14 Years Months Days |
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3. Blood Group of the child
cPps dk jDr lewg
4. The
category to which child belong
छात्र की श्रेणी
Gen. Cat SC ST OBC
EWS BPL Disabled
lkekU; Js.kh
vuq0 tkfr vuq0 tu tkfr vks0oh0lh0
vkfFkZd :i ls detksj oxZ chs ih ,y fodykax
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S.G
Child
bdyhSrh dU;k
5. D;k vki vuqlwfpr tkfr @tutkfr @ vks ch lh
ls @ 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.
6. Ekkrk&firk dk C;kSjk@ Details of Mother/ Father Ekkrk@ firk@
Mother
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) iw.kZ vkoklh; irk o nwjHkk"k
Full residential address with
Telephone numbers (with poof)…………………………..…………………………………..
(vi) fo|ky; ls nwjh@ Distance from KV*…………………………………………………………..
(vii) LFkkbZ irk@ Permanent Address ……………………………………………………………………………………..
(viii) ewy osru@ Basic Pay …………………………………………………………………………………………………
(ix) 31&3&-2014-rd lsokdky ds nkSjku 7
o"kksZa esa LFkkukUrj.kksa dh la[;k
No.of transfers during 7 years as on 31-3-2014 of the
year……………………………………
(x) Js.kh j{kk@ dsUnzh; dehZ@ Lok;r'kklh o vU;
Category to which the Parent belong to
Defence/Central Govt./Autonomous body &
others
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(xi) Employee Code:
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.
ekrk firk ds gLrk{kj @ Signature of Parent
iwjk uke @ Full Name…………………...
frfFk@ Date:
…………………
ikorh/Acknowledgement
Øe
la0 S. No
iathdj.k la[;k@
Registration No………………………
Jh@Jherh------------------------------------------------------------------------------------------------------------ls
muds iq=@
iq=h--------------------------------------------------------------------------------------dk
d{kk -----------------------------------------------------------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………………………..
izkpk;Z
dsUnzh; fo|ky; ¼eqnzkad½ @
Principal
Kendriya Vidyalaya (Stamp)
frfFk@ Date……………………
Note:
1. Proof of residence shall have
to be produced by all applicants.
2. A self-declaration from the
parent for distance may also be accepted by furnishing an undertaking to this
effect.
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