Kendriya Vidyalaya No. 2, Calicut

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For Office Use Cat : Reservation : S. G. Child : Documents Submitted 1. DOB : 2. Service Certificate : 3. Transfer Details : 4. Residence Proof : 5. Caste Certificate: 6.

1 For Office Use Cat : Reservation : S. G. Child : Documents Submitted 1. DOB : 2. Service Certificate : 3. Transfer Details : 4. Residence Proof : 5. Caste Certificate: 6. Transfer Counts : E Úxp t ± x. 2, EÚ ± EÚ]ı Kendriya Vidyalaya No. 2, Calicut { V EÚÆ h C /Reg No. GÚ../ S. No. j /Year { V EÚÆ h E Ú ± B EÚI / Registration for Class t l EÚ { Æ x ( { π]ı n Â Â) Name of Child in full (In Capital letters)... SS EÚ Ú ]ı ({ { ]ı <W EÚ ) Photograph of Child (Passport size) À± M /Sex { Ø π /Male j /Female i fii À± M /Third Gender 2. V x - i l (+ EÚ Â Â)/ Date of Birth (in fingure) n x /Day /Month π «/Year n Â Â /in words i EÚ + /Age as on n x /Day /Month π «/Year 3. SS EÚ Æ HÚ Ω (Rh ËÚC]ıÆ Ω i ) Blood Group of the child (with Rh factor) 4. SS EÚ Œxv i h / The Category to which child belong x h +x V i +x V x V i + + Ãl EÚ { EÚ V Æ { B± M «EÚ± M <EÚ± Ëi EÚx Gen. Cat SC ST OBC EWS BPL Diff.abled SG Child n SS +x fi S i V i / +x S i V x V i / +... (+x { UÙb M «)/ + Ãl EÚ { EÚ V Æ /.{.B± / EÚ± M /<EÚ± Ëi EÚx h v i Ω Ë i EfiÚ{ Œxv i h -{ j ± Mx EÚÆÂ * If the child belongs to SC/ST/OBC/EWS/BPL/Disabled/S.G Category, then, please attach relevant certificate. -1-

2 5. i - { i EÚ Æ h / Details of Mother/Father GÚ.. i /Mother { i /Father (i) (ii) x ( { π]ı n Â Â) Name (in Capital letters) Æ π] ı i / Nationality (iii) (iv) / Occupation EÚ «± EÚ x, { Æ { i n Æ π Name of Office and Full Address with Telephone Numbers (v) { h «+ { i n Æ π Full residential Address with Telephone Numbers (With proof) (vi) t ± n Æ ( EÚ.. Â)/ Distance from KV(in km)* (vii) (viii) (ix) (x) ± i x / Basic Pay l x i Æ h Â EÚ J No.of transfers** i - { i EÚ h Category of the Parent # EÚ «S Æ EÚ b ( n ΩË i ) Employee Code (if any) * q ± + EÚ n Æ n Æ E Ú ± B i - { i /+ EÚ EÚ { l -{ j x ΩË * + h -{ j n x + EÚ ΩË * Distance of Residence from Vidyalaya. Undertaking from parents is acceptable for distance. Proof of Residence is Compulsory. ** i EÚ { UÙ± i π «Â l x i Æ h ƒ EÚ J /No. of transfers during last 7 years as on # 1.Æ E Úxp Æ EÚ Æ/Central Govt. ú 2. E Úxp Æ EÚ Æ E Ú i l x /Autonomous bodies of Central 3. Æ V Æ EÚ Æ /State Govt. 4. Æ V Æ EÚ Æ E Ú i l x /Autonomous bodies of State 5. +x /Others È Bi n q Æ Ω h i EÚÆ i /EÚÆ i Ω ƒ EÚ ={ «HÚ Œπ]ı ƒ Æ V x EÚ Æ Â i ΩÈ * I certifiy that the above entries are true to the best of my knowledge. i / { i /+ EÚ E Ú Ω i I Æ Signature of Mother/Father/Guardian n x EÚ/Date:... { Æ x /Full Name

3 h - { j /SERVICE CERTIFICATE (E Úxp Æ EÚ Æ /Central Govt.) h i EÚ V i ΩË EÚ / i EÚ «± / j ± Â x i EÚ «S Æ E Ú { Â EÚ «Æ i ΩÈ * Æ I / E Úxp Æ V «{ ± ± / Æ I ± / Bx.B.V./ B.{.V./.+ <«.B.BEÚ./ E Úxn Æ EÚ Æ k l +l «V x EÚ I j E Ú ={ GÚ V { h «+ EÚ { E Úxp Æ EÚ Æ i -{ π i ΩË, E Ú x i EÚ «S Æ ΩÈ i l =x EÚ + l x i Æ h ΩË / { h «Æ i Â EÚΩ l x i Æ h ΩË * 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 /State Govt./Autonomous Body/Public Sector Undertaking fully financed/partially financed by Central Govt./State Govt. and his/her services are non-transferable/transferable anywhere in India. h - { j /SERVICE CERTIFICATE (Æ V Æ EÚ Æ /State Govt.) h i EÚ V i ΩË EÚ / i EÚ «± / j ± Â x i EÚ «S Æ E Ú { Â EÚ «Æ i ΩÈ * i l =x EÚ + l x i Æ h ΩË /{ h «Æ V Â EÚΩ l x i Æ h ΩË * Certified that Shri/Smt....is permanently working in the office/ministry of.....and his/her services are non-transferable/transferable anywhere in state. -3-

4 l x i Æ h J h -{ j / CERTIFICATE OF NUMBER OF TRANSFER È, (x ) (ÆË EÚ/{ n x ) (EÚ «± ), Bi n q Æ h i EÚÆ i /EÚÆ i Ω ƒ { UÙ± i ± ( i EÚ) Â BEÚ l x n Æ l x { Æ Æ....(+ EÚ n Â Â) l x i Æ h Ω B V x EÚ Æ h x S n M ΩË * I, (Name)... (rank/designation) of....(office) do hereby certify that during the past 7 years (up to ) I have been transfered times (in figures & in words) GÚ.. S.No. EÚ «± / x ]ı Office/Unit l x Place ÆÈ EÚ/{ n x Rank/Designation /From n x EÚ/Date i EÚ/To `ˆΩ Æ x EÚ + v Period of stay + n J / Order No È V x i /V x i Ω ƒ EÚ n ={ Æ k i l M ± i { B M B i Æ SS E Úxp q ± Â E Ú ± B + M Ω V BM * I know that if the above-mentioned facts are found incorrect, my child will be disqualified for admission to Kendriya Vidyalaya. i Ω i I Æ /COUNTERSIGNED i / { i E Ú Ω i I Æ Signature of Parent È, (x ) ÆË EÚ/{ n x ) (EÚ «± ), Bi n q Æ h i EÚÆ i Ω ƒ EÚ ={ Æ HÚ Æ h EÚ EÚ «± -+ ± J Â V ƒs ± M ΩË Ω { M ΩË * 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. from one station to another, the details of which are given as under:- ]ı{ hh /Note BEÚ l x { Æ `ˆΩ Æ x EÚ + v EÚ EÚ UÙΩ Ω x S Ω B* Minimum period of posting/stay at a place should be minimum six months. -4-

5 -EÚ ± x fii h -{ j /DIED IN HARNESS CERTIFICATE (E Ú ± E Úxp Æ EÚ Æ E Ú EÚ «S Æ ƒ E Ú ± B /Only for Central Govt. Employees) h i EÚ V i ΩË EÚ E Ú Æ /E Ú Æ M «/ i E Ú { j /{ j ΩÈ V (EÚ «± / M ) Â x i Ø { Æ i l /l + ËÆ =x EÚ n Ω x EÚ± EÚ + v Â n x EÚ... EÚ Ω M l * 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). GÚ../S. No. { i /ACKNOWLEDGEMENT j /Session { V EÚÆ h J /Registration No... / i =x E Ú { j /{ j......eú EÚI Â Ω i { V EÚÆ h E Ú ± B + n x EÚ * Received an application form Shri/Smt... for Registration of her/his son/ daughter...for admission to class... i l /Date... S «/Principal E Úxp t ± ( Ω Æ )Kendriya Vidalaya (Stamp) -5-

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