DETAILS OF STUDENT DURING THE TIME OF ADMISSION

( IN CAPITAL LETTER)

1. Student Name

2. Class

3. Year of admission in this KV

4. Admission No. & Date

5. Father's name

6. Mother's name

7. Permanent Address

8. Present Address

9. Section

10. Distance from KV

11. Admission Category

12. Date of birth

13. Gender

14. Physical disabled

15. Caste

16. Minority

17. Religion

18. BPL

19. Mobile No of Father

20. Mobile No of mother

21. Email ID

22. Blood Group of Student

23. Whether fee reimbursement

admissible to the parents of

student

24. Whether exemption

admissible under 'Sibbling

criterion'

25. Whether exemption

admissible under 'RTE

criterion'

26. Whether exemption under

'Single Girls Child' criterion

27. Whether exemption

admissible under 'KVS

Employee's Children'

criterion

28. Whether exemption under '

Emergency' criterion

29. Whether exemption under '

Children of armed/Para

forces//expired/disabledinwar

/operation' criterion

30. Whether exemption

admissible under' Children

of armed/Para

forces/Expired/Disabled in

Date:_____________________ Parent’s Signature

Self-Declaration Format

I ________________________________,Father/Mother of

Master/Miss______________________________________________age_____

years, resident of

_______________________________________________________________

(complete address), do hereby declare that the information given in the

Admission form for CLASS XI (2021-2022) Kendriya Vidyalaya, NEHU

SHILLONG (MEGHALAYA) is true to the best of my knowledge and belief

and nothing has been concealed therein. I am well aware of the fact that if the

information given by me is proved false / not true at any point of time, the

admission of my ward will be cancelled and I will be liable to legal actions as

per the guidelines of KVS. In such a case, any benefit accrued by me or my

ward shall be summarily cancelled.

Date:‐

Place: Signature of the Parent/Guardian