. . . INS CHILKA
CHILKA (KHORDHA)
Ref .No. F. 150331(1)/1/KVC/1161/21-22/ Dated: 23/06/2021
NOTICE FOR ADMISSION IN CLASS-I
DOCUMENTS REQUIRED FOR ADMISSION IN CLASS-I, SESSION 2021-22
1. Hard Copy (Print Out) of the Online Application Form
2. A Color Passport size photograph of the child.
3. Birth Certificate(Photo Copy) issued by the Competent authority showing date of birth
4. Proof of Residence (Any of the proof issued by the government / government agency and in the name of
either of the parents - in case rented house a rent agreement and electricity bill of the house owner)
5. Self declaration about the distance of the residence from K.V INS, Chilka. (Format enclosed)
6. SC/ST Certificate issued by the competent authority in the name of the child. If it is in the name of the
parent an undertaking should be submitted that certificate in the name of the child will be submitted within
03 months from the date of Admission.
7. OBC (Non-Creamy Layer) Certificate issued by the competent authority in the name of the child. It
should not be older than three years i.e issued after 01.01.2018. Certificate in the name of the parent shall be
accepted only if the parent submits an undertaking that the OBC(Non-Creamy Layer)Certificate in the name
of the child shall be submitted within 06 months from the date of admission SEBC Certificate will not be
accepted in lieu of OBC Certificate.
8. EWS Certificate from the competent authority
9. BPL card (Photo Copy) (It should be issued in the name of the parent only and the name of the child
should be mentioned in that as a member of the family) – Ration Card (New) along with old BPL Card.
10. Service Certificate showing the number of transfers during the preceding 7 years issued by the competent
authority & Certificate from the DDO/Head of the Office showing the Pay particulars of the employee, the
status of employment and the nature of the establishment (Applicable only for Government employees )-
(Format enclosed)
11. For Ex-Service Man – Bonafaide Certificate & Transfer details counter signed by the Zilla/Rajya Sainik
Board or any competent authority, copy of the ID of Ex-Service Man.
12. For Single Girl Child- An affidavit form the Notary in the prescribed format (enclosed). (Affidavit should
not be elder than one year )
13. Certificate from the Employer
14. Self Declaration format (Enclosed)
15. Any other documents as required under Admission Guidelines in support of any claims made.
Please visit KVS website (https://kvsangathan.nic.in/) for further details.
Contt. Page-2
guidelines along with COVID-19 Protocols:
1. Come with the original documents as mentioned below and a self attested copy
of each of them.
2. Show the original documents and their photocopies one by one as instructed
from a distance of at least six feet.
3. Attach the original/ photocopies of the documents to the admission form as
required.
4. Put them into the box in an envelope brought by you. The box will be kept in
the Vidyalaya Main Gate.
5. Once the Challan is generated supplied to you for paying the fee.
6. Call the Help Desk No.s provided on the Vidyalaya website in case of any
doubt
Date Category Lottery Number Time
25.06.2021 &
28.06.2021
DA 1
NOTE:
1. Mere registration/ provisional selection will not confer a right to admission. Admission
secured on the basis of any wrong certificate shall be cancelled / rejected automatically
and no appeal shall be entertained.
2. The candidates from the wait list may be called by notice in case of non joining/detection of
false claims of the provisionally selected candidates. Notice will be given separately for SGC
also.
I .......................................... father/mother of .................................................
is ...............................km.
Date:................................. Signature of the parent
/ Service Certificate ( / Central Govt.)
/ .............................................................................. / / / / ... / .. / .... / , - , / Certified that Shri/Smt. ……………………………………………………………………. is working as regular employee in the Office / Ministry of …………………………………………………….. . He/She is an employee of Defence Service / CRPF / BSF / NSG / SPG / CISF / Central Govt. / Autonomous Body / Public Sector Undertaking fully financed / partially finance by the Central Govt. and his / her services are non-transferable / transferable anywhere in India.
(, )
Signature of head of the Office ( With Name, Designation and Office Stamp)
/Place………………………………….. /Date………………………………….. / Complete address and Telephone No. of office ………………………………………………………………………………….
Service Certificate ( / State Govt.)
/ .............................................................................. / /
Certified that Shri/Smt. ……………………………………………………………………. is working in the Office / Ministry of …………………………………………………….. and his / her services are non-transferable / transferable anywhere in State.
(, )
Signature of head of the Office ( With Name, Designation and Office Stamp)
/Place………………………………….. /Date………………………………….. / Complete address and Telephone No. of office ………………………………………………………………………………….
CERTIFICATE FROM THE EMPLOYER
(Regarding Status of Employment & identification of Admission Category in KVS) I Sri/Smt./Ms. _________________________________________ (Name of the Employer) ,
designation____________________________________ working in the office of
___________________________________________departmentof _____________________ , government of
__________________________________________ (Name of the Employee) whose son/daughter
____________________________________________ (Name of the Child) is seeking admission in Kendriya
Vidyalaya __________________________
01 Name of the Child for whom admission is sought (in Block Letters)
02 Class in which admission is sought
03 Full name of the employee (in Block Letters)
04 Designation of the employee
05 Employee Code / Employee Identity No.
06 Name of the office where the employee is presently posted
07 Status of Employment (Whether Permanent/ Regular/ Temporary/Contractual/
Part Time/ Adhoc/Daily Wage Basis/Casual -To be written clearly)
08
Autonomous body/PSU fully or partially financed by Govt. of India/State
Government/ Sate Government Autonomous Body/ PSU fully or partially
finance by the state govt. (To be written clearly)
09
Whether the employee is to be considered as an employee of Central
Government/Central Government Autonomous body/PSU fully or partially
financed by Govt. of India/State Government/ Sate Government Autonomous
Body/ PSU fully or partially finance by the state govt. (Any one of the above to
be written clearly)
10
Please write any one of the following which is applicable i.r.o. the child for
whom admission is sought
children of Foreign National officials, who come on deputation or
transfer to India on invitation by Govt. of India. 2. Children of transferable and non-transferable employees of
Autonomous Bodies / Public Sector Undertaking/Institute of Higher
Learning of the Government of India. 3. Children of transferable and non-transferable State Government
employees.
Autonomous Bodies/ Public Sector Undertakings/Institute of Higher
Learning of the State Governments.
5. Children from any other category
11 Recent Pay/Salary of the Employee with proper Split up
(i) Pay Level : _____________
(vii) Total :
12 Whether the employee is drawing the consolidated pay YES / NO
Place: _______________________
Date: ______________________
Complete Address of the Office:
________________________
________________________
Telephone Number: _______________________
/ CERTIFICATE OF NUMBER OF TRANSFERS
, …………………… ………………… ( / ) ................................... ( ), / .......................... ( )
I,……………………………………(Name)……………………………..(rank/designation) of …………………… (office), do
Times (in figures & in words) from one station to another, the details of which are given as under:-
/ Office /Unit and Place
/ Date of joining the Office/Unit
/ Date of release from the Office/Unit
/ Period of Stay ( in months)
/ Transferre d Office / Unit and Place
()/ Distance between the two Office (in km)
/ Transfer Order No.
/ I know that if the above mentioned facts are found incorrect, my child will be disqualified for admission in Kendriya Vidyalaya.
/ Place ……………... / / Date ……………... Signature of Parent
hereby certify that during the past 7 years (up to 31.03.2021) I have been transferred ........................................
(31/3/2021)
/ Countersignature
, …………………… ………………… ( / ) ................................... ( ), / - 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.
/ Place ……………... / Date ……………... (, )
Signature of Competent Authority (with Name, Designation and Office Stamp)
……………………………………………………………………. Complete Address and Telephone No. of Office ……………………………………………………….
/ Note :
1. Minimum period of posting / stay at a place should be minimum six months.
SINGLE GIRL CHILD
I……………………………………………….aged…………………………..years, Indian Inhabitant occupation …………………..…………………………………….Resident of ..………………………………………………………………………..… is mother/father of ………………….………………….. Date of Birth…………………………….... Submitting my undertaking to the Head of the Institution in Class I Vide KVS Admission Guidelines
1) I hereby declare that Miss………………………………………......…. is the only girl child in my family ( with no male/female sibling). I understand that it shall be my sole responsibility to inform you about any change in status of single girl child in the family immediately, if and when it occurs.
2) I am also aware that in case it is detected at any time that the affidavit sworn by me is false, appropriate action will be taken by the school authorities and KVS against me.
Signature of father Signature of mother
Residential address with Contact number:
Solemnly affirmed at ……………….. This………..day of………..20……….
BEFORE ME Explained and Identified by me,
Advocate
2021)
Self-Declaration Format I _____________________________, Father/Mother of Master/Miss __________________________
age_______ years, resident of ______________________________________________ (complete address),
do hereby declare that the information given admission form of the admission in Kendriya Vidyalaya,
______________ and in the enclosed documents 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, admission has be dimmed cancelled and will liable to punishment as per guidelines
of KVS and the benefit accrued by me or my ward shall be summarily cancelled.
Date:-