Annexure III

COJllJllUII Application FOI'III fOI' the Admission untler[cOIlOlllicnitv Wenkei' Section (f.WS) & Dis:1dv:1nlagl'dGroup C:lIcgon' (DG) (under RT'E Art 2009) for the Session 2017-18 .

Photo

Registration Number

(To be filled by the school)

I. Name of tile School'(With address)

2. Class: Nursery/Pre-School o KG/Pre-Primary 0 Class! 03. Name of the Child:

4. Catcgorv under \\ hich Applied: (a) Economically Weaker Section (EWS) D(Please Tick whichever is applicable) (hi Disadvantaged Group (DG) D5. Category if Disadvantaged Group (DG):

[Please Tick \I hichev er is applicable)SC CJST CJOBC(Non Creamy Layer) DOrphan ~Transgender ~ .Child With Special Needs/Disabled CJChild With Special Needs!Disabled (Mentally CJwllenged)D

6. Gender: Ma1eO Feillale

7. Dale of Birth": Day DO Month

o Transgender 0DOvea,DO

8. Age as on 31.03.2017 (In words):

9. Mother's Name:

10. Father's Name:

11. Guardian's Name (If applicable):

12. Profession of Parents/Guardian:((I) Mother

(b) Father

(c) Guardian.

13. Present Residential Address**:

14. Mobile No. ofthe Parents/Guardian

15. Email address. if any:

16 Aadhar No. of'the Child, ifany: I I17. Aadhar No. of the Mother, if any: I I18. Aadhar No. of the Father, if any: I I19. Aadhar No. ofthe Guardian, if any: I I20. Total AnnualIncome of both the parents from all sources:

2 I. Proof or!ncome for E.W .S. Only** *:.~---~c--"CO-----,,---------------(Income Certificate not required for Disadvantaged Group Category)

22. Income Certificate NoIifissued)' Rcccipt lvo.tif applied but not issued): _

23. Income Cenificnte Dale (if issued)! Date of Receipt (if applied but not issued): _

24. Proof of Disadvantaged Group****: _

25. Disadvantaged Group Certificate No. (if issued)! Receipt No (if applied but nOI issued) .

26. Disadvantaged Group Certificate Date (if issued)/ Date of Receipt (if applied but 110t issued):

,

Dcda.-atiOIl bv the Pnrenrs/Cuardtan

-----------cc-;---=;-=-c-c-;- (Name) Mot her/F iIIIH:!r/Gnard ian 0 f _-;-_~ _____ -r-r-r __ co-{Nameof theell lid)11CI-8bydeclare that IIte information given above is true andCOITeCI to the best of Illy knowledge and belief I have read and understood all the provisions of thenotification in this regard. III case flily iufonnruion is found false or incorrect on verification, theadmission of Illy ward may be cancelled and I will be liable for the action to be taken against me as per'law.

Signature or tile Parents/GuardianDntcd:-

Submit nuy one of the following documents as proof:·Pr(lnf (If [);Ill' of IJirlh:-

(I) Birth certificate under the Birth, Death and Marriage Certificate Act. 1986.(2) Hospital/Auxiliary Nurseand Midv ifL" (ANM) register record.(3) Angnnwadi Record.(4) Declaration of age of the child by the parents or guardian.

•••* Proof of Presell! H.eshlrn [iill Address:-

(I) Ration card in the name of Parents ha, tng name ofthe Child in Ration card,(2) Domicile certificate of child or his/her parents.(3) Voter I card of any of the parents.(4) Electricity Bill/MTNL telephone bill/Water bill.(5) Unique Identity Card (Aadhar) otMorher/Father/Child issued by Go\'1. of India.(6) Passport in the name of any ofthe parents or child .

•••••••••I'roofof Eronomir:llh "e:lkel' Seclion (E\\ ") :-

(I) Income certificate issued by a Revenue Officer not below the rank of Tehsildar.(2) BPL Ration Card (Yellow coloured)(3) AA Y Ration Card (Pink coloured)(4) Food Security card issued by Food 8: supply Dept.(GNCT of Delhi).

*"'**l'roo!ofD{;:-

(I) Caste Certificate issued by Revenue Dept. GNCT Deihl (DC Office) ill respect orSC/ST/Ol3C (NOll Creamy Layer) ofChild/Parents.

(2) Medical Certificate issued by Covr. Hospital in respect of child with SpecialNeeds/Disabled.

(l) Documentary evidence forOrphan.(4) Doc umentary ev ide nee for Transgender .

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