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CBSE J N V RESULT SHEET FOR SELECTION TEST FOR ADMISSION IN CLASS VI SESSION 2017-2018 DATE : 23.06.2017 PAGE NO : 1
STATE : 18 ODISHA DISTRICT : 17 NABRANGPUR
SNO BLOCK CENTRE ROLL NAME SEX CATEGORY AREA D.O.B
CODE CODE NUMBER
------------------------------------------------------------------------------------------------------------------------------------
*** URBAN DISABLE SEAT ***
01 03 01 I01126 SWASTIK BEHERA BOY GEN RURAL 15/09/07
02 04 01 J01548 DHANIRAM GOUDA BOY OBC RURAL 25/05/05
03 03 01 K01201 BIJU HARIJAN BOY SC RURAL 17/07/06
NO. OF CANIDATES : 3
*** URBAN OPEN SEAT ***
04 02 01 A00404 TARINI PRASAD PATNAIK BOY GEN URBAN 01/02/06
05 02 01 B00431 RUPESH PARIDA BOY OBC URBAN 22/04/06
06 02 01 C00458 GOURAV HALDAR BOY SC URBAN 05/06/05
07 02 01 C00465 PRAMIT BAROI BOY SC URBAN 16/02/06
08 02 01 F00565 SWATAHA PRABHA SAHU GIRL OBC URBAN 08/08/06
09 02 01 H00615 PRIYA DARSANI MAJHI GIRL ST URBAN 15/07/05
10 02 01 H00618 ANJALI ZENIFER BARLA GIRL ST URBAN 11/07/06
NO. OF CANIDATES : 7
*** URBAN SC SEAT ***
11 02 01 C00455 ANIRBAN BISWAS BOY SC URBAN 20/12/05
12 01 01 G00119 PRANATI BHAKTA GIRL SC URBAN 25/07/06
13 02 01 G00577 ESHA DAS GIRL SC URBAN 08/02/06
NO. OF CANIDATES : 3
*** URBAN ST SEAT ***
14 02 01 D00501 JITENDRA MAJHI BOY ST URBAN 24/09/04
15 02 01 D00502 ROHIT KUMAR GOND BOY ST URBAN 29/11/05
16 02 01 D00504 MOHANISH KUMAR HALBA BOY ST URBAN 24/03/07
17 02 01 D00514 BIBHUTI BHUSAN MAJHI BOY ST URBAN 30/09/06
18 02 01 D00518 TULARAM BHATRA BOY ST URBAN 05/11/06
19 02 01 H00622 GEETANJALI GOND GIRL ST URBAN 27/03/06
20 02 01 H00632 TEJASWINI BHATRA GIRL ST URBAN 20/03/07
NO. OF CANIDATES : 7
*** RURAL OPEN SEAT ***
21 03 01 I01120 Y SIDDHARTH BOY GEN RURAL 09/10/06
22 05 01 I01702 KUMANDANA MEHETA BOY GEN RURAL 05/01/05
23 05 01 I01705 NITISH KUMAR THAKUR BOY GEN RURAL 09/09/06
24 10 01 I03511 OMVEER TRIPATHY BOY GEN RURAL 12/03/06
25 01 01 J00151 PITABAS BISSOYI BOY OBC RURAL 12/04/06
CBSE J N V RESULT SHEET FOR SELECTION TEST FOR ADMISSION IN CLASS VI SESSION 2017-2018 DATE : 23.06.2017 PAGE NO : 2
STATE : 18 ODISHA DISTRICT : 17 NABRANGPUR
SNO BLOCK CENTRE ROLL NAME SEX CATEGORY AREA D.O.B
CODE CODE NUMBER
------------------------------------------------------------------------------------------------------------------------------------
*** RURAL OPEN SEAT ***
26 01 01 J00152 ASUTOSH SAHU BOY OBC RURAL 16/11/06
27 05 01 J01734 SRUTIPRAJNA DAS BOY OBC RURAL 20/01/07
28 10 01 J03530 RANJEET KUMAR BISOI BOY OBC RURAL 06/07/06
29 02 01 K00710 SURAJ MANDAL BOY SC RURAL 24/11/05
30 06 01 K02055 TUSHAR RANJAN NAYAK BOY SC RURAL 20/11/06
31 07 01 K02367 SAHIL SUTAR BOY SC RURAL 12/12/06
32 09 01 K03040 KOUSIK SIKDAR BOY SC RURAL 02/04/05
33 02 01 L00756 TRIPATI MAJHI BOY ST RURAL 10/03/07
34 02 01 L00768 RAMESH BHATRA BOY ST RURAL 02/11/05
35 02 01 L00783 ANANTA MANDINGI BOY ST RURAL 07/02/06
36 04 01 L01613 NRUTYA PUJARI BOY ST RURAL 14/12/05
37 06 01 L02140 BISHAM BHATRA BOY ST RURAL 05/02/06
38 01 01 M00242 AMRITA AKANKSHYA GIRL GEN RURAL 09/03/07
39 04 01 M01629 NIBEDITA PATTANAYAK GIRL GEN RURAL 24/04/07
40 07 01 M02658 GAYATRI SUBHASMITA MOHANTY GIRL GEN RURAL 22/01/07
41 08 01 M02810 TEJASWAINI SWAIN GIRL GEN RURAL 20/03/07
42 09 01 M03242 SANDHYARANI PANDA GIRL GEN RURAL 22/08/06
43 09 01 M03244 EPSITA TRIPATHY GIRL GEN RURAL 18/09/06
44 03 01 N01102 FRANCISCA GARADA GIRL OBC RURAL 16/04/07
45 04 01 N01645 BABITA BISI GIRL OBC RURAL 23/01/07
46 06 01 N02178 PAYAL BISWAL GIRL OBC RURAL 19/10/06
47 07 01 N02523 BISWARUPA NAYAK GIRL OBC RURAL 22/06/06
48 08 01 N02829 ALVI PATRA GIRL OBC RURAL 09/06/06
49 01 01 P00281 REWA SUNDI GIRL ST RURAL 16/12/06
50 03 02 P01406 PRIYANKA MAJHI GIRL ST RURAL 20/04/06
NO. OF CANIDATES : 30
*** RURAL SC SEAT ***
51 03 02 K01419 SUMIT BEHERA BOY SC RURAL 23/08/07
52 07 01 K02369 SAJAN GAIN BOY SC RURAL 10/08/06
53 09 01 K02999 KAILASH MRUDHA BOY SC RURAL 15/06/05
54 09 01 K03035 TUFANSARDAR BOY SC RURAL 28/09/05
CBSE J N V RESULT SHEET FOR SELECTION TEST FOR ADMISSION IN CLASS VI SESSION 2017-2018 DATE : 23.06.2017 PAGE NO : 3
STATE : 18 ODISHA DISTRICT : 17 NABRANGPUR
SNO BLOCK CENTRE ROLL NAME SEX CATEGORY AREA D.O.B
CODE CODE NUMBER
------------------------------------------------------------------------------------------------------------------------------------
*** RURAL SC SEAT ***
55 09 01 K03039 DIBYENDU MONDAL BOY SC RURAL 10/01/05
56 09 01 K03041 BITTU MONDAL BOY SC RURAL 06/10/04
57 09 01 K03042 AMLAN MONDAL BOY SC RURAL 03/09/05
58 09 01 O03291 MANISA MALLICK GIRL SC RURAL 03/06/06
59 09 02 O03315 ROJEE BISWAS GIRL SC RURAL 13/06/06
NO. OF CANIDATES : 9
*** RURAL ST SEAT ***
60 02 02 L00852 SUKADEB GOND BOY ST RURAL 20/04/06
61 03 01 L01239 BIKASH HEMBRAM BOY ST RURAL 24/04/06
62 03 01 L01259 ANSUMAN NAYAK BOY ST RURAL 20/05/06
63 04 01 L01600 DALESWAR NAYAK BOY ST RURAL 12/02/06
64 06 01 L02082 KHIROD KUMAR NAYAK BOY ST RURAL 26/09/05
65 06 01 L02139 PRAHALLAD BHATRA BOY ST RURAL 02/02/06
66 07 01 L02445 BHAGATRAM BHATRA BOY ST RURAL 07/01/05
67 07 01 L02457 MAHENDRA BHATRA BOY ST RURAL 02/04/06
68 08 01 L02768 RAJENDRA BHATRA BOY ST RURAL 12/05/06
69 09 01 L03054 NALINDRA GOND BOY ST RURAL 01/03/05
70 09 01 L03062 CHANDHAN GOND BOY ST RURAL 08/04/05
71 09 01 L03065 SUSANTA GOND BOY ST RURAL 28/03/06
72 09 01 L03087 RABINDRA GOND BOY ST RURAL 22/03/06
73 09 01 L03117 KESIDHAR GOND BOY ST RURAL 18/02/06
74 09 01 L03172 ROHAN DHURUA BOY ST RURAL 23/05/05
75 09 01 L03176 MALAY RANJAN BISHI BOY ST RURAL 12/03/06
76 03 02 P01393 RASMIPRIYA BEHERA GIRL ST RURAL 13/11/06
77 05 02 P01957 MANJULA MAJHI GIRL ST RURAL 06/06/06
78 06 01 P02213 HEMADEI SANTA GIRL ST RURAL 05/11/06
79 09 02 P03344 PUNAM NETAM GIRL ST RURAL 10/08/06
80 09 02 P03409 KADAMBINI GOND GIRL ST RURAL 10/06/06
NO. OF CANIDATES : 21
1
JAWAHAR NAVODAYA VIDYALAYA AT/PO:KHATIGUDA,DIST.NABARANGPUR,ODISHA,PIN-764085
An Autonomous Organization under Ministry of Human Resource Development
Department of School Education & Literacy, Government of India Ph.No.06858-224361(Office),E-mail : [email protected] & [email protected]
Web-site : www.jnvnabarangpur.nic.in, CBSE Affl.No.1540021 & Sch.No.53017
Ref. F.No.2-1/JNV/KTG/NBPR(O)/2017-18/ Dated: 28th June, 2017
BY REGD. POST WITH ACK. DUE
To
____________________________,
____________________________,
____________________________.
Sub:- Provisional selection of candidate for admission into class-VI for the academic year 2017-18 in Jawahar
Navodaya Vidyalaya – Regarding.
Sir,
I am glad to inform you that on the basis of selection Test for admission to Jawahar Navodaya
Vidyalaya conducted by CBSE, New Delhi held on 08.01.2017, your son/daughter Master/Kumari
______________________________ Roll No.: ____________ has been provisionally selected for admission
into Class VI of JNV, Khatiguda, Dist. Nabarangpur, Odisha for the academic year, 2017-18. His/Her admission
will be finalized subject to the fulfillment of conditions and submission of documents as required by Navodaya
Vidyalaya Samiti, Noida.
Therefore, you are requested to report this Vidyalaya along with your son/daughter on
07.07.2017 (Sl.No.01 to 40 of Result Sheet)/08.07.2017(Sl.No.41 to 80 of Result Sheet) at 10.00 A.M. with the
following enclosed proformas duly filled.
Annexure – I : Bio-data form certified by Head of the School
from where class Vth
is completed
Annexure – II : Urban/Rural Area Certificate of the
school in which class Vth
is completed
Annexure – III : Medical Certificate
Annexure – IV : Residence Certificate by Parent
Annexure – V : Residence Certificate issued by Tahasildar
Annexure – VI : Affidavit by the Parent on Rs.10/- Non - Judicial stamp
paper duly attested by notary.
Besides the above, you are also required to submit the following documents for verification.
1. The caste certificate issued by the competent authority (in case of SC/ST/OBC Candidates
only).
2. The disability certificate issued by the competent authority (in case of PH/VI/HI
Candidates only)
3. Adhar Card
4. Ration Card issued by Competent Authority.
5. Govt. Recognition Certificate of the institution in case of Private School.
After verification of the above documents submitted by you, a decision will be taken regarding final
admission of your ward and the same will be intimated to you separately. Admission will be cancelled for
submission of false information, documents and records and also action shall be initiated as per the rule.
Please note that the TRANSFER CERTIFICATE of the candidate has to be submitted only after verification of the
above documents and confirmation of your ward's final admission.
Thanking you,
Yours faithfully,
PRINCIPAL
Navodaya Vidyalaya Samiti
Noida
NOTICE
Select list of students for admission to Class VI through JNVST-2017 has been
released. The following activities may be taken up by the parents/guardians
after selection of students for admission to Jawahar Navodaya Vidyalaya:
01 Select list may be downloaded from the website.
02 Formats for the submission of details may be downloaded
03 Filled in formats are to be submitted to the Principal of JNV concerned.
04 Certificates from the competent authority in respect of Rural, OBC, SC, ST
and Disability are to be submitted to the JNV for verification of
documents / eligibility to confirm admission to Class VI.
It is informed that admission will be given only to the selected candidates after
due verification of the documents. Parents are advised not to take TC from
previous school until the admission is confirmed. Admission to JNVs is done free
of cost. No fee is to be paid to school authority for admission to Class VI. The
parents/students are required to approach directly to the Principal of the
concerned JNV.
For any complaints in the process of admission, E-mail may be sent to
(To be filled in by the Parent/Guardian of the Candidate with the help of the
Headmaster/mistress of the School from where the candidate passed Class V
Examination)
1. Name of the Candidate:_______________________________
Aadhar Number:_______________________________________
2. Sex
3. (a) Category
(b) Caste : ______________________________
4. Date of Birth
In Words :_______________________________________________
5. Father’s Name : ______________________________________________
6. Mother’s Name : ______________________________________________
7. Name of the Guardian and
relationship with him/her , if applicable : ________________________________________
8. School(s) from where the candidate passed Class III,IV and V. C L A S S E S
III IV V
(A) (i) Month & Year of Joining
(ii) Month & Year of Passing
(B) (i) Name of the School
(ii) Is It a recognized school? (YES/NO)
(C) Name of the Village or Town in which t
school is located.
(D) Name of the Block
(E) Name of the District
(F) Location of the School Indicate
RURAL/URBAN
(Separate certificate is to be obtained if the candidate had studied classes III, IV & V in
different schools)
PHOTO
of student
Male Female TG
Gen OBC SC ST
Date Month Year
CERTIFICATE
(BY PARENT/GUARDIAN OF THE CONCERNED CANDIDATE)
Certified that the information given above is true to the best of my knowledge
and belief. In case, any part of the information furnished by me is found incorrect, the
admission of my child/ward may be cancelled. I am ready to produce the relevant
certificates issued by Competent Authorities as and when asked for.
_____________________________
Signature of PARENT/GUARDIAN
Entries verified, certified and found correct.
__________________________________________
Signature of the HEADMASTER/HEADMISTRESS
Name : ____________________________________
Desgn.: ____________________________________ School Seal :
NOTE FOR THE HEAD OF THE SCHOOL:
Dear Sir/Madam,
The above mentioned information is required for admission of the
candidate in the Jawahar Navodaya Vidyalaya, District -------------------. You are
therefore requested kindly to check and verify personally all the entries from the
school records and issue the certificate given below:-
Principal
JNV --------------------------
CERTIFICATE BY THE HEAD OF THE SCHOOL
Certified that the information given above is found correct as per our school
records. It is also certified that Master/Kumari _________________________________ was
admitted in this Shool in Class _____________ on ________________ (date) and passed
Class _________________ on __________________ (date).
___________________________
Signature of the Head of Institution
last studied with School Seal
Date : _____________
UNDERTAKING BY THE PARENT/ GUARDIAN
Certified that the information given in the application form for admission into Class VI in
Jawahar Navodaya Vidyalaya, District:__________ for the academic year 2017-18 for my ward is true
to the best of my knowledge and belief. In case any part of the information furnished by me is found
incorrect, admission of my ward may be cancelled at any time. I am ready to produce relevant
certificates issued by the competent authority to your office when asked in support of my original
application entries
_______________________
Signature of the parent/Guardian
Address of parent/guardian:
Name:______________________
H.No:_______________________
Street _______________________
Village_______________________
Mandal/Block_______________________
Pin Code:_____________________
STD Code:______ Phone No___________
Mobile No:__________________________
UNDERTAKING
I, _______________________(Father/ Mother/ Guardian) of Kumari/Master
___________________________ who got selected for admission into Class VI in Jawahar Navodaya
Vidyalaya, …………….District hereby give an undertaking that I am ready to pay Rs.200.00 (Rupees Two
hundred only) per month or revised amount or as charged by the Navodaya Vidyalaya Samiti, Noida
from Class IX to XII.
___________________
Signature of the parent/Guardian
Note: This is not applicable to SC/ST categories and all girl students and the parents whose
Income is below poverty line.
UNDERTAKING FOR MIGRATION
(TO BE FILLED BY PARENT IN PRESENCE OF PRINCIPAL, JNV)
I,______________________________ Father/Mother/Guardian of Kumari/Master
_________________________________ who got selected for admission in Class VI in JNV,
District_____________ hereby give an undertaking that I understand that, for promotion of National
Integration and as per the scheme at JNVs, 30% of the students of class IX from one JNV have to
migrate to another JNV from non-Hindi speaking area to Hindi speaking area and vice-versa and I
agree to abide by the rules of NVS in this regard.
_________________________________
Signature of the parent/guardian
Full name:______________________
Address:_______________________
______________________________
______________________________
Mobile No:_____________________
Land line with STD code:___________
JAWAHAR NAVODAYA VIDYALAYA: DISTRICT:_________________________
MEDICAL FITNESS CERTIFICATE
01. Name of the candidate :___________________________________
02. Father’s name :___________________________________
03. Address :___________________________________
____________________________________
____________________________________
04. Date of birth ___________________________________
05. Height ____________________________________
06. Weight ____________________________________
07. Abdomen ____________________________________
08. Chest ____________________________________
09. Vision LEFT _______ RIGHT ________
10 Ears ____________________________________
11. Throat ____________________________________
12. Locomotor system ____________________________________
13. State of vaccination ____________________________________
14. Skin ____________________________________
15 Blood Group __________
16 Dental Hygiene __________
17. Remarks of Medical Officer : Recommended/not recommended for
admission/Recommended to C.M.O for
Verification if any.
____________________________________
CIVIL SURGEON
PHOTO OF THE
STUDENT
DISABILITY CERTIFICATE
If the candidate is selected under disabled quota he/she should bring the
certificate issued by the competent authority.
COMMUNITY CERTIFICATE
Community certificate in the prescribed format from the competent authority is
to be submitted by the candidate, wherever necessary.
RURAL CERTIFICATE
(To be issued by the Revenue Officer of concerned Block)
This is to certify that Master/Kumari ___________________________
Son/daughter of Shri _________________________________ studied classes III,
IV & V In ____________________________(Name of the school) of
block________________________________ and the school is located in the
village __________ which belongs to RURAL AREA of
District;_____________,State:________________________.
(Signature of the Revenue Officer)
Block:______________________________
District._____________________________
Office Seal:
Dated:_________________________
2
ANNEXURE-II
RURAL /URBAN AREA CERTIFICATE
Certified that _______________________________ School in which Chi/Kum.
________________________________ son/daughter of ______________________
_______________________________ has studied classes from ___________
to_____________ is located in RURAL/URBAN AREA AS PER 2011 CENSUS.
Place:
TAHASILDAR NAME:
OFFICE SEAL Date: NOTE: If the student studied classes III, IV and V in different Schools, Rural/Urban Area certificates in the above proforma should be enclosed for each school separately.
3
ANNEXURE – IV
RESIDENCE CERTIFICATE
(To be furnished by the father/mother of the qualified children at the time of admission
to JNV)
As per Jawahar Navodaya Vidyalaya, Khatiguda, Dist. Nabarangpur, Odisha letter No.
___________________________, dated _________________ my ward Mast./Kum.
_________________________ has qualified the entrance examination for admission to Class –
VI at JNV, Khatiguda, Dist. Nabarangpur, State-Odisha during the session 2017-2017.
I am residing along with my son/daughter (whose name is mentioned above) at following
address since______________________ (mention years or date)
Village : _____________________
Town : _____________________
District : _____________________
State : _____________________
Pin Code : _____________________
Certified that the information furnished by me is true and no fact has been concealed.
Place: Signature of Father/Mother
Date: Full Name
Address House No.
Street Name:
Village:
Block:
District: PIN:
ANNEXURE – V CERTIFICATE
(To be filled up by the District Authorities and issued under the signature of
SDM/Tahasildar to the parents of the child selected for admission to Class – VI in JNVs
through JNVST)
This is to certify that the above information furnished by
Shri/Smt. _____________________________________________ father/mother of Master/Kum.
_________________________________ a candidate selected for admission to Class – VI in JNV,
Khatiguda, District: Nabarangpur has been verified from the records and is found correct. The
area where residence is located falls under _______________ (rural/urban) area of District.
Round Seal
Signature of SDM/Tahasildar
Name :
Official Seal :
4
ANNEXURE – VI
AFFIDAVIT (An affidavit to be furnished by parents on Rs.10/- Stamp paper duly attested by notary at the time of admission of Class – VI in JNVs through JNVST) I, _________________________________(Name of the Father/ Mother) , Age
________ Years, father/mother of Mast./ Kum. ________________________________
____________ Resident of Village _______________ Mandal___________ Dist.
_________________ solemnly declare and affirm as under:
a. My son/daughter is a student of _______________________ (name and complete
address of the Institution) located in ____________ which is a rural/urban area in
Nabarangpur District in Odisha State since __________________ (date or years).
He / She has passed Class –V from this Institution during the session
_________________(academic year)
b. My son/daughter is residing with me at following address which is located in the
urban/rural area of Nabarangpur District.
Door No. : _______________________
Village : _______________________
Post : _______________________
Block : _______________________
District : _______________________
Post : _______________________
Verified on this the _________ day ___________2018 at _________
that the contents of above affidavit are true to best of my knowledge and belief based on
record and believed by me to be true.
Place: Signature
Date: (DEPONENT)
(Father or Mother)
Name:
Sworned before me at _________ (place) on _____________ (date)
(NOTARY)
With official seal, address and Notary Registration/Renewal particulars
5
ANNEXURE-1
ADMISSION BIO-DATA FORM
JAWAHAR NAVODAYA VIDYALAYA, KHATIGUDA, DIST. NABARANGPUR, ODISHA
Admission Number :
Date :
Category :
Area :
House Allotted :
01. Name of Pupil in Full
(in block letter) :
02. Date of Birth in Christian Era
a) In figures :
b) In Words :
03. Nationality and state in which
the pupil belongs to :INDIAN-ODISHA
04. Religion :
05. Caste & Category :
06. Whether living with parent
or guardian :
07. a) Father’s Name :
b) Qualification :
c) Occupation :
d) Annual Income : Rs.
e) Full Address with phone no. :
08. a) Mother’s Name :
b) Qualification :
c) Occupation :
d) Annual Income : Rs.
09. a) Name of Guardian :
b) Qualification :
c) Occupation :
d) Annual Income : Rs.
e) Full Address :
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10. Class last studied, name of school
last attended, whether qualified
for promotion :
11. Whether Transfer Certificate/
Record Sheet enclosed :
12. Class which to admission sought : VI CLASS
13. Mother tongue of the Pupil :
14. Protection from small fox,
whether vaccinated or small for :
15. Personal Marks of Identification
1)
2)
16. Family composition(No. of
brothers, sisters) :
17. Literacy level of parents/
Brothers/Sisters :
-------------------------------------------------------------------------------
Name Age Qualification
-------------------------------------------------------------------------------
1) Father
2) Mother
3) Brothers:
1)
2)
3)
4) Sisters:
1)
2)
3)
-------------------------------------------------------------------------------
18. Particulars of brothers/sisters studying in JNV in which class
presently studying
-------------------------------------------------------------------------------
Name Relationship Class
-------------------------------------------------------------------------------
i)
ii)
iii)
-------------------------------------------------------------------------------
19. Distance from School studied in Class V to JNV, Khatiguda in K.Ms.
20. Distance from Native Place (Home Town) to JNV, Khatiguda in K.Ms.
21. Adhar Card Number of CANDIDATE:
22. Place of Birth of the candidate :
7
DECLARATION OF THE PARENT/GUARDIAN:
I declare that the above particulars are correct to the best of my knowledge and belief and that
the pupil has not attended any school besides these mentioned above.
Place: Khatiguda, Signature of Parent/Guardian
Date:
Signature of pupil as signed
in admission form (Specimen Signature)
Name and addresses of two persons other than parents (kith & kin) who may visit the Vidyalaya
to meet the student.
1) Name and address 2) Name and address
Relationship with student relationship with student
Signature of parent/ guardian
TO BE FILLED IN BY SCHOOL:
Orders of the Principal regarding admission and signature of the Principal with date.
Admitted into VI class
Principal:
Date:
8
U N D E R T A K I N G
I, Shri _____________________________________________ Father of
Master ___________________________________________ who is admitted in
JNV, Khatiguda, Dist. Nabarangpur, Odisha in Class –VI during 2017-2017 do
hereby accept to pay Rs.200/- (Rupees two hundred only) per month towards fee
(Which will be enhanced to Rs.300/- gradually) to JNV, Khatiguda from IX Class
onwards of my child as per the recommendations of the Expenditure Reforms
Commission constituted by the Ministry of Human Resource and Development,
Govt. of India and Navodaya Vidyalaya Samiti, Noida vide order No.10-
41/2001/NVS(Acad.), dated 07-05-2003 of the Joint Director(Acad.), NVS, Noida
all the students from Class-IX and above (Excluding S.C., S.T., Girls and students
whose families are below poverty line.
Place: Khatiguda signature of Parent :
Date: Name : Address :
Countersigned
PRINCIPAL
JAWAHAR NAVODAYA VIDYALAYA, KHATIGUDA, DIST. NABARANGPUR, ODISHA
9
JAWAHAR NAVODAYA VIDYALAYA, KHATIGUDA,
DIST. NABARANGPUR, ODISHA
UNDERTAKING BY THE PARENT/GUARDIAN
I, Shri ______________________________________________
father of Master/ Kumari ______________________________________
do hereby undertake that, my son/daughter/ward will not leave the
Vidyalaya campus or House without the permission of the HMs/ Principal.
If, my son/daughter/ward leaves/absconds from the Vidyalaya campus
without prior permission of the HM/Principal, the Vidyalaya administration
will not be held responsible for any lapse.
Further, I hereby declare that, my son/daughter/ward will continue
his/her study in this JNV, Khatiguda from class VI to XII and I will not
apply for T.C. in any time of his/her study period as per the rules laid down
by the Navodaya Vidyalaya Samiti, Noida.
Signature………………………………………
Name…………………………………………..
Address………………………………………..
Place……………………….
Date………………………..
10
RECOGNITION CERTIFICATE
This is to certify that (School Name)
______________________________, Vill; _________________,
Block :_______________________ Dist. Nabarangpur (Odisha)
is recognized with State Government of Odisha.
BLOCK EDUCATION OFFICER(BLOCK) NAME :____________________
DIST. NABARANGPUR (O)
11
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