APPENDIX-I MAT OF CERTIFICATE TO BE ISSUED BY THE DISTRICT EDUC

(in ccordance with School Safety Policy, 2016 issued by the NDMC, Manuao dl

SEEKING FILIATION WITH THE CENTRALBOSTRICT EDUCATIONOFFIER IN RESPECT OF SCHOOLS

AL BOARD OF SECONDARY EDUCATION

Children in Schools developed by NCPCR and the National BuiaE Sued by the NDMC, Manual on Safety and Security of

(This part is to be filed-up by the school and to be prodd hefore the District Education Office along PART-A

With all supporting documents and certificatesin originalGENERAL INFORMATION

Name of the School: (Name should be exactly as per NOC and recognition certificate) Address of the School: U-DISE code allotted to the school:

1 K.D.B.PUBLIC SCH0OL

OLD KAVI NAGAR GHAZIABAD09090902108-01

Name and address of the Trust/Society/Company (under section-8)running the school 5 Is the Trust/Society/Company duly registered with the competentregistering authority and the registration is valid as on date?6 Proposed affiliation with CBSE for:

K.D.B.EDUCATION SOCIETY

YES

Senior SecondaryIn the municipal limits of

metropolitan city In the municipal limits of city

having population more than 15 Lakhs

7 Location of school

In the hill areas (as per

planning commission norms) In the municipal limits of

capital city of a stateIn the municipal limits of

class-X cities .On an island In the municipal limits off a

hill station In the municipal limits of city

having population less than 15 Lakhs

Outside the municipal limits of

any town/city. 8 Is the School already affiliated to any board for Class-X or XII YES

examinations? (if yes name of the Board) C.B.S.E NEW DELHI

UP TO CLASS XII From Class Nursery-to XII Class

9 Standard/level/class up to which the school is running:

(SignatureofRrincipa) KD.B. PUELIC SCHOOL Kavi Nagar, Ghaziabad (U.P.)

fT fuaAD.E.O.)

w Principal

K.D.B. PUBLIC SCHOOL ManageK.DB. PUBLIC SCHOOL

Kavi Nagar, Ghaziabad Kavi Nagar, Ghaziabad (U.P)

APPENDIx-II

ATION REGARDING NOCAND RECOGNITION CERTIFICA MFORN

YES Has a school obtained No Objection Certificate from the state

Government for Affiliation with CBSE? Number of NOC and date of issue:Has a school obtained Recogrnition Certificate from the State

Governmentfrom class-1 to 8h ? Number of Recognition Certificate from class-1, to 8th and dateo

issue:

10

2/B(9)/81 03.08.198 YES 11

12

12156/71-72,13

30.12.1971

INFORMATION REGARDING LAND DETAILS AND OWNERSHIP YES

Is the school situated on a single contiguous plot of land bounded on

all sides by a Pucca Boundary Wall? Are both the school and the Play Ground situated in a single compound

bounded by a single continuous Boundary Wall on all sidesTotal area (in square meters) in respect of 14 and 15 above on whicn

the schoolis situated: The land is in the possession of the school/Trust/society/Company

legally by way of: Name of the Owner/Lessee of the land in respect of point-16above:In case the land is in the possession of the society/school by way of

lease as per State Government norms, the period of the lease:

Is any public road, canal or thorough-fare, HT line etc. passing through

the land in respect of point-16 above?

14

YES 15

15040 SQ.M.

16

Lease Deed

17

G.D.A 18 FROM 1968 TO 2058

19 TOTAL 90 YEARSNO

20

INFORMATION REGARDING ESSENTIAL SEFETY REQUIREMENTS

YES Has the school been inspected by the Government engineer and the

school buildingbeen found structurally safe for running a school?

If yes the date of last inspection: Has the school been inspected by the officer of Government Fire

Department and the school building been declared safe for school

from the point of view of fire safety? If yes the date of last inspection:

21

04.06.2018 21(a) YES

22

26.03.18

22(a) YES

Has the school compound been checked by the public health

department and the health and sanitary conditions been founded to

be satisfactory and the water has been found safe for drinking?

23

02.08.18 23(a)If yes the date of last inspection: INFORMATION REGARDING THE STAFF

YES 24 Does the school have well defined service rules and conditions for its

employees as per prevalentnorms of appropriate Government?

(Signature pf D.£.O.) (SignaturegPEinCIpal

K.D.B. PUBLIC SCH0OL

Kavi Nagar,Ghaziabed (U.P)

Manager K.D.B. PUBLIC SCHOOL

Kavi Nagar, Ghaziabad

PrincipalK.D.B. PUBLIC SCHOOL

Kavi Naga, Ghaziabad (U.P.)

APPENDIX-I

paying salary to the teachers and other employees 3s Is the school per the norms of the appropriate Government? Is the salary to be teachers and other emploveec of the school beig paid through the bank by mode of electronic clearing? (Paymept by cheque or cash to the individuals is not allowed)

YES

26 YES

A Manager

K.DSinature with Stahi Kataf Schol anagead

incipalSienatureIthSteCPOOL

KAaÍISEhOplEHpSpaHd {UE)_

PART-B This part is to be filled-up by the District Education olirer after verifying all supporting documents and

certificates in original and visitingthe school) File No.. ************ .Date of Issuance..7.

T

his is to certity that the information above, provided by the school has been veritied on the

basis of all supporting documents & certificates and visiting the school and the information has

been found correct. Is the school recommended for extension/upgradation of affiliation

(Please ensure that the school fulfils land requirements also as per detaiis

given in Appendix-A along with point nos. 1-26)

1

2

ES/#

Senior Secondary Recommended for Middle Class Syllabus/Secondary/Senior

Secondary to CBSE?

Signature

ET td stamp of Issuing DEO) DISTRICTEDCATURNRFFICER/EQUIVALENT OFFICER

FROM EDUCATHON ADMINISTRATION A� DISTRICT LEVEL

NAME OF DISTRICT

Counter Signature

(Name, Designation and Stamp)DISTRICT cOLLECTOR/DEPUTY COMMISSIONER

(or his authorized representative*) NAME OF DISTRICT

(Not Belowthe rank of a Group-A Gazetted Officer)

(Signature of Principal) K.D.B. PUBLIC SCHOOL

Kavi Nagar, Ghaziabad (U.P)

(Signature df ö.E.O.)

ustu

Manager K.D.B. PUBLIC SCHOOL

Kavi Nagar, Ghaziabad

Principal K.D.B. PUBLIC SCHOOL

Kavi Nagar, Ghaziabad (U.P,)

APPENDIX-1

ISTRICT JCATION OFFICER SHALL PUTA TIC Name and Address of the school: K.D.B.PUBLIC SCHOOL

PART-CWHICH THE SCHOOL1 TA TICK MARK AGAINST THE COLUMN UNDER WHICH THE SCHOOLIS FULFILLING THE LAND CRITERIA

OLD KAVI NAGAR, GHAZIABAD school Total Land area in lawful possession of

SN LOCATION OF SCHOOL LAND PLEASE TICK THE

1 Any where in India REQUIREMENT CONCERNED COLUMNMinimum 6000

Square MetersIn Municipal limits of cities with a population exceeding Minimum 4000 15 Lakhs.

Square Meters In hilly areas prescribed by the Planning Commission (NITI Minimum 4000 Aayog). 4 In Municipal Limits of the State Capital Cities.

SquareMetersMinimum 4000

5 In the North Eastern States. Square Meters

Minimum 4000

6 In the state of Jammu and Kashmir Square Meters

Minimum 4000

Square Meters In Municipal Limits of Ghaziabad, Noida, Faridabad and Minimum 4000 Gurugram cities 8 | In the Municipals Limits of Panchkula and Mohali/SAS Minimum 4000 Nagar

In the Municipal Limits Class-X cities (Ahmedabad, Minimum 2000 Bangaluru, Hyderabad, Pune).

Square Meters

Square Meters 9

Square Meters Or on the Hills Stations.

For Secondary Level) 10 In the Municipal Limits Class-X cities (Ahmedabad, Minimum 3000

Bangaluru, Hyderabad, Pune). Square MetersOr on the Hills Stations.

(For Senior Secondary Level)11 In the Municipal Limits of Chennai, Delhi, Kolkata and Minimum1600

Mumbai Square Meters Or the state of Arunachal Pradesh.Or the state of Sikkim.Or the state of Islands.

For Secondary Level)12 In the Municipal Limits of Chennai, Delhi, Kolkata and| Minimum 2400

Mumbai Square Meters Or the state of Arunachal Pradesh.

Or the state of Sikkim.Or the state of Islands.

(For Senior Secondary Level)

Signature

(Name and Stamp of Issuing DEO) DISTRICT EDUCATION OFFICER/NAME QF DISTRICT

(Signatureiotipaihcipal) K.D.B. PUBLIC SCHOOL

Kavi Nagar, Ghaziabad (U.P.)

(SignatureoDE0 f fe frrir

Manager k.0.B. PUBLIC SCHoOL

Kavi Nagar, Ghaziabad

Principal K.D.B. PUBLIC SCHOOL

Kavi Nagar, Ghaziabad (U.P.)

APPENDIX-Ill RTIFICATE TO BE ISSUEDBY THE DISTRICT EDUCATION OFFIER IN RESPECT OF SCHOOLS

rOF CE

TED WITHTHEBOARD AND SEEKING EXTENSION/UPGRADATIONOFAFFILIATION WITH AFFILIATED

THE CENTRAL BOARD OF SECONDARY EDUCATION

ardance with School Safety Policy, 2016 issued by the NDMC, Manual on Safety and Security of

Children in Schoolsdeveloped by NCPCR and the National Building Code)

PART-AThis part is to be filled-up by the school and to be produced before the District Education Officer along

with all supporting documents and certificates in original) GENERAL INFORMATION

2130023Affiliation Number allotted by CBSE to the school:

Name of the School as per affiliation letter of CBSE: Address of the School:

K.D.B.PUBLIC SCHOOL

OLD KAVINAGAR

GHAZIABAD

From NUR-to XII Standard/level/class up to which the schoolis running:

Is the name and address of school in CBSE affiliation letter and State

NOC/Recognition/U-DISE same exactly the same U-DISE code allotted to the school: Name and School of the Trust/Society/Company (under section-8) | K.D. B. EDUCATION

running the school as on date Is the Trust/Society/Company duly registered with the competent

registering authority and the registration is validas on date?

Purpose of presentapplication:

Location of school

4 YES

5 09090902108-01

SOCIETY YES

Extension municipal

limits of metropolitan 9

In the

10 city

the municipal limits of city having

population more than

15 Lakhs In the hill areas (as

planning per commission norms)

the municipal limits of capital city of

a state

In

the municipal limits of class-X cities

In

On an island

the municipal limits of a hill station

In

the municipal limits of city having Population less than

In

15 Lakhs

Outside the municipal limits of

any town/city. YES

11 Government from class-1 to 8 ?

INumber of Recognition Certificate from class-1 to 8 and date of Has a school obtained Recognition

Certificate from the State

12 12156/71-72,30.12.1971

Principal Manage'

K.D.B. PUBLIC SCHOOL Kavi Nagar, Ghaziabad

K.D.B. PUBLIC SCHOOL

Kavi Nagar, Ghaziabad

(U.P.)

s the School attiliated to any other board besides CBSE for clasS-X or

xl examinations?

NO

(if yes name of the

Board) (Abo menton whether the school is

affillated for Class-X or XI)

NEOR

RMATION REGARDING LAND DETAILS AND OWNERSHIP

YES

Is the school situated on a single contiguous plot of land bounded on

all sides by a PuccaBoundary Wall?

Are both the school and the Play Ground situated in a single

compound bounded by a single continuous Boundary Wall on all

sides? Total area (in square meters) in respect of 12 and 13 above on which

the school is situated: The land is in the possession of the school/Trust/society/Company

legally by way of: Name of the Owner/Lessee of the land in respect of point-15 above:

In case the land is in the possession of the society/school by way of

lease as per State Government norms, the period of the lease

Is any public road, canal or thorough-fare, HT line etc. passing through

the land in respect of point-14 above?

YES

15

15040 SQ.M.

16 Lease deed.

1/

G.D.A | 18 FROM 1968 TO 2058

19 TOTAL 90 YEARS

NO

20

INFORMATION REGARDING ESSENTIAL SEFETY REQUIREMENTS

YES

Has the school been inspected by the Government engineer and the

school building been found structurally safe for running a schoo?

21(a)If yes the date of last inspection:

21 04.06.2018

YES

Has the school been inspected by the officer of Government Fire

Department and the school building been declared safe for school

from the point of view of fire safety?

22

26.03.2018

22(a)Ifyes the date of last inspection: Has the school compound been checked by the public health

department and the health and sanitary conditions been founded to

be satisfactory and the waterhas been found safe for drinking?

YES

23

02.08.2018 23(a)Ifyes the date of last inspection:

INFORMATION REGARDING THE STAFF

24 Does the school have well defined service rules and conditions for its YES

employees as per prevalent norms of appropriate Government?

Is the school paying salary to the teachers and other employees as per

25

YES

the norms of the appropriate Government?

Is the salary to be teachers and other employees of the school being

paid through the bank by mode of electronic clearing?

(Payment by cheque or cash to the individuals is not allowed)

Is the school paying EPF to the teachers and other employees as per

the normsof the appropriate Government?

26

YES

27 YES

ManagerK.D.B. PUBLIC SCHOOL

Signature tziabad

(of School Manager)

Kavi Negar, Gitaziabad (U.P} Signature with Stamp

(of School Principal)

Principal

Manager K.D.B. PUBLIC SCHOOL

K.D.B. PUBLIC SCHOOL

Kavi Nagar, Ghaziabad Kavi Nagar,

Ghaziabad (U.P.)

PART-B spartiIs

to be ie to be filled-up by the District Education Officer after verifying all supporting documents and certificates in original and visiting the school)

1This is to certity that the information above, provided by the school has been verified on the basis

of all supporting documents & certificates and visiting the school and the information has been

found correct. Is the school recommended for extension/upgradation of afiliation? ES/AHe

extension/upgradation

Signature (Name and Stamp of DEO)

DISTRICT EDUCATION OFFICER/NAME OF DISTRICT

FIRST/SECOND/THIRD SECRETARY (EDUCATION)/NAME OF EMBASSY

Counter Signature

(Name, Designation and Stamp) DISTRICT COLLECTOR/DEPUTY COMMISSIONER

(or his authorized representative) NAME OF DISTRICT

DEPUTY CHIEF OF MISSION/AMBASSADOR/NAME OF EMBASSY

(*Not Below the rank of a Group-A Gazetted Officer)

Principal K.D.B. PUBLIC SCH0OL Manager

K.D.B. PUBLIC SCHOOL Kavi Nagar, Ghaziabad (U.P.)Kavi Nagar, Ghaziabad