JAWAHAR NAVODAYA VIDYALAYA BHILLOWAL, POST OFFICE PREET NAGAR DISTT. AMRITSAR (PUNJAB)
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1 JAWAHAR NAVODAYA VIDYALAYA BHILLOWAL, POST OFFICE PREET NAGAR DISTT. AMRITSAR (PUNJAB) (TO BE FILLED IN CAPITAL LETTERS) NAME OF CANDIDATE: FATHER S NAME: MOTHER S NAME: DATE OF BIRTH PERMANENT ADDRESS CORRESPONDENCE ADDRESS TELEPHONE WITH CODE MOBILE NO: PARENT S SIGNATURE CERTIFICATE: We have personally checked and verified the information given by the candidate from page 1 to 9 and have found it correct. Hence, the candidate is eligible for provisional admission in JNV. VERIFICTION COMMITTEE: COUNTERSIGNED PRINCIPAL JNV AMRITSAR-II 1
2 JAWAHAR NAVODAYA VIDYALAYA BHILLOWAL, DISTT. AMRITSAR-II (PUNJAB) IDENTIFICATION SHEET NAME OF THE STUDENT : CLASS : HOUSE : CORRESPONDENCE ADDRESS : TELPHONE NUMBER WITH STD CODE MOBILE NO. : PERMANENT ADDRESS : FATHER S PHOTO MOTHER S PHOTO GUARDIAN S PHOTO NAME NAME NAME SIGN. SIGN. SIGN. LOCAL GUARDIAN S ADDRESS : TEL NO. WITH STD CODE : MOBILE NO. : 2
3 BIO-DATA (To be filled with the help of Headmaster from where the student has passed class V) 1. Name of Candidate 2. Sex (Boy/Girl) 3. Category (Gen/OBC/SC/ST) 4. Date of Birth Date Month Year 5. a) Father s Name (In Capital Letter) b) Mother s Name (In Capital Letter) 6. Name of Guardian and relation with him/her, if (Father is not a guardian) Sr.No Particulars III IV V 1 Month & Year of Admission 2 Month & Year of Passing 3 Name of the School 4 Is it recognized? Mention Yes or No 5 Name of the village or town where the school is situated 6 Name of the block 7 Name of the district 8 Is the school situated in Rural/ Urban area (Mention Rural or Urban) Signature of Headmaster with official stamp 3
4 CERTIFICATE BY PARENTS I certify that all the information given in the above format is true in my knowledge. In case any information given by me is found incorrect in any respect then the admission of my son/daughter can be cancelled. I am prepared to produce the concerned record at any time as and when required. All the entries are correct. Name & Signature of Parents/ Guardian Date: INSTRUCTION TO THE HEADMASTER Sir, The information given above is required for admission of the candidate in JawaharNavodayaVidyalaya. Kindly ensure that the entries given on the basis of school record are correct. Principal JNV Amritsar- II CERTIFICATE GIVEN BY HEADMASTER It is certified that all the entries given at page no. 01 on the basis of school records are correct. This is also certified that the admission of Master/Kumari was done in class on in this school. He/She has passed the class V on. Date:- Signature of Headmaster With Official Stamp 4
5 MEDICAL FITNESS CERTIFICATE 1. Name of Candidate : 2. Father s Name : 3. Address : 4. Date of Birth : 5. Height : 6. Weight : 7. Abdomen : 8. B.Chest : 9. Eyes : 10. Ears : 11. Throat : 12. Locomoter System : 13. State of Vaccination : 14. Skin : 15. HB : 16. Blood Group : 17. Identification Marks : Remarks of Medical Officer: admission/ Recommended/Not recommended for Recommended to C.M.O. for verification of age. Photo Attested by Medical Officer Signature of Medical Officer/CMO With official stamp Principal
6 5 JNV Bhillowal JAWAHAR NAVODAYA VIDYALAYA, BHILLOWAL, DISTT. AMRITSAR (PUNJAB) (ECONOMIC & SOCIAL STATUS OF CANDIDATE S FATHER/GUARDIAN) 1. Name of Candidate : 2. Father s Name : 3. Date of Birth : 4. Permanent Address : 5. a) Area : Rural/Urban b) Sex : Male/Female c) Category : Gen/OBC/SC/ST 6. Occupation a) Father : b) Mother : 7. Yearly income of the family : Rs. 0 to 3000/3000 to to 12000/12001 to to /24001 to to 36000/36001 to to above 8. Route of school from student s home : 9. Fare, Distance & Nature of Transport : 10. Number of family members including Mother & Father: Sr.No. Relation Age Qualification Occupation 1 Father 2 Mother 3 Brother 4 Sister Note: Full Name & Address (other than parents) of one person whom the parents may authorize to bring and meet their son/daughter. Please note that no other person will be permitted to meet the student. Photographs of parents & guardians are to be fixed in Identification sheet. Signature of the Candidate Signature of Father/Guardian 6
7 AFFIDAVIT An affidavit to be furnished by parents on Rs. 15/- Stamp Paper dully attested by Notary at the time of admission to Class 6 th in JNVs through JNVST I age years, father/mother of Master/Kumari resident of Village Tehsil Distt. solemnly declare and affirm as under: a) My Ward is a student of (Name & complete address of the institution) Located in which is a rural area in Distt. Amritsar Punjab state Since. He has passed class 5 th from this institution during the session. b) My ward is residing with me at following address which is located in the rural area of Distt.. Verified on this the day 20 at that the contents of above affidavit are true to best of my knowledge and belief based on record. Place: Date: Signature (Deponent) Name :
8 7 DECLARATION BY PARENTS/GURDIAN I, father/guardian of Master/Kumari who has been selected for admission in JawaharNavodayaVidyalaya, BhillowalDistt Amritsar (Punjab) am ready to fulfill the following terms & conditions: 1. I have read all the conditions enclosed with the application form of entrance of my Son/Daughter in JawaharNavodayaVidyalayaBhillowal, Distt. Amritsar (Punjab) which are very well clear to me. 2. I also know that under the scheme of NavodayaVidyalaya& as per National Unity formula, student will be transferred from one Vidyalaya to another Vidyalaya under Migration policies. I declare that I will follow this condition of NavodayaVidyalaya& I will not object for transfer of my son/daughter to any other area under any scheme. 3. I further declare that I abide by the above conditions fully & if my son/daughter denies for transfer to that Vidyalaya then he/she will have no right to take education from any of the NavodayaVidyalaya. 4. I also declare that if my son/daughter is found guilty of any indiscipline or he/she has damaged the property of the Vidyalaya or he/she misbehaved then the decision, in this regard of vidyalaya will be acceptable to me. 5. Besides this, if my son/daughter leaves the vidyalaya without Prior permission or intimation, then I will not make any legal action & I will not blame the Vidyalaya Management for any mishapenning. 6. I declare that my son/daughter will take part in any tour organized by the vidyalaya. During the course of tour the vidyalaya will neither be responsible for any accident nor I will take any legal action against the Vidyalaya. 7. Samiti/Vidyalaya will charge initially Rs. 200/- per student per month as token fee under corpus fund (which may gradually increase to Rs. 300/- per month) from student of Class IX and above, excluding Boys SC/ST. Girls and Students whose families are BELOW POVERTY LINE. In the last I declare that I will obey the rule & regulation made by the vidyalaya committee from time to time (Signature of Father/Guardian) Address 8
9 JAWAHARNAVODAYA VIDYALAYA,BHILLOWAL DISTRICT-AMRITSAR (PUNJAB) Agreement to be executed by the parents/ Guardian the students. (On non-judicial stamp paper) 1. This agreement is made on this day dated between Principal JawaharNavodayaVidyalaya& Father/Mother of (herein after called the Guardian or which expression shall, unless excluded by the context or the meaning thereof, demand to be include his heirs, executors administrations and legal representatives), of the one part and the NavodayaVidyalayaSamiti (herein after called the Samiti which expression shall unless excluded by the context ( or thebhillowal,distt. Amritsar Punjab on other part. 2. Whereas ( admission No. ) son/daughter of (herein after called student is son/ward of the guarantor and has at the request of the guarantor been selected for admission to JawaharNavodayaVidyalayaBhillowalDistt. Amritsar (Punjab) inters alia, on the terms and the conditions herein after appearing for the purpose of receiving education 3. Now it is hereby agreed by the parties here to follow: 4. That in consideration of the student being admitted by the Samiti to the JNV Bhillowal Amritsar (Punjab) for the purpose of the aforesaid education at the request of the guarantor, he the guarantor covenants with thesamiti that the students will attend the JNV BhillowalDistt. Amritsar (Punjab) regularly and will observe and comply with all the rules & regulations for the prescribed period i.e. up to standard XII. 5. That if after admission, any of the following viz. proof of residence, certificate of age, school leaving certificate, medical certificate supplied by the guarantor is found to be false in any way or not in order or the guarantor withdraw his ward from the said Vidyalaya before completion of this studies on ground other than genuine, medicalground due to which the student is notable to pursue his studies in the said Vidyalaya which shall be certified by the Chief Medical Officer Civil Surgeon of Govt. Hospital the guarantor shall forth with pay to Samiti the Expenditure incurred by the Samiti on the student for the period the student was at the said Vidyalaya. 6. That the Samiti will not be liable for any damage charges on account of injuries fatal of otherwise which may be sustained by the students at any time during his stay in the Vidyalaya while taking part in sports. NCC Extracurricular or any other form of activities of the Vidyalaya within or outside the Vidyalaya premises including while on migration (as per scheme of Samiti educational tours, excurse treks) undertaken through any mode of travel. All expenses may be incurred in treatment of such injuries will be borne by the parents/guardians as provide in rules of the said Vidyalaya. Contd
10 7. That the Samiti cam (in the interest of Vidyalaya) remove the student, if in the Samiti opinion, the student has failed to accept of the other students and or/if the student fails to come up to the Samiti on demand the expenditure incurred by the Samiti on the said students for the periods the students was at the said Vidyalaya. In the event of any question of dispute or difference arising under this agreement (except as to any matter the decision of which is specially provided for in this agreement) the same shall be referred to the sole arbitration of an office appointed by the Secretary, Ministry of HRD, Govt. of India, New Delhi. It will be no objection that the arbitration shall be final and binding on the parties to be contract. In the reason it shall be lawful for the Secretary to nominate another arbitrator. The arbitrator may time to time, which consent of the parties; enlarge the time for making the award. Subject as aforesaid, the arbitrator act and the rules framed there under any statuary modifications there to shall apply to the arbitration proceeding under this clause. In witness where of has set his hand and the Principal, JawaharNavodayaVidyalayaBhillowalDistt Amritsar (Punjab) by the order and direction of the board of Governors has set his hand the day the year first above written. Signed by: In the presence of See note (b) Below Signed By: for on the behalf of the JawaharNavodayaVidyalayaSamiti In presence of Note:- An agreement form is to be dully stamped. The necessary stamp paper is to be purchased by the guarantor, and witnessed by the Govt. Servant of Gazette status. The space provided for the date in 1 st para of the agreement form should not be filled in by the guarantor. This will be filled on the date on which the agreement is signed by the Principal. JNV Bhillowal, Distt. Amritsar (Punjab) 10
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