javaahr navaaodya ivavalaya, maukla` pº jayaintyaa ihlsa maogaalaya WEST JAIÑTIA HILLS DISTRICT paost qadlaaiskna 793151 P.O:- THADLASKEIÑ 793151 durrrbaaya:-03652-293371 Phone No: - 03652-293371 Email:-jnvmukhla@rediffmail.com / jnvwestjaintiahills@gmail.com maanava sammmsaaqana ivakasa mam~alaya, skula isaxaa AaOr saaxarta AiBayaana Baart sarkar (Ministry of Human Resource Development, Department of Secondary & Higher Education, Govt. of India) JAWAHAR NAVODAYA VIDYALAYA: MUKHLA: The documents needed to bring on the interview day i.e on 1. Bio data form dully filled by you, signed by the head of the school & countersigned by Sub- Divisional School Education Officer (Proforma are enclosed Page -1). 2. Medical fitness certificate from the Medical Officer & Countersigned by Chief Medical Officer (Performa are enclosed page -2). 3. Xerox Copy of Blood Group Certificate 4. Socio- economic status dully filled by you which attached herewith page 3 & 4 5. Undertaking of Parents (Performa are attached page 5) 6. Rural / Urban certificate from competent authority (Performa are attached page 6) 7. An affidavit to be effect only to those child resides in rural area during his study in class V (Example are enclosed herewith page 7) 8. Provisional Certificate (Passing Certificate of Class-V) not T.C from the Head of Institution that he/she had passed class V. 9. Disability certificate from competent authority / Chief Medical Officer of the district (In case of visual handicapped candidates medical certificate from Medical Officer Counter signed by Chief Medical Officer of the district) indicating nature of Visual impairment. 10. Caste Certificate from competent authority. 11. Date of birth from the competent authority. (i.e Municipal, Hospital, C.S Office) 12. Annual income Certificate of father and mother separately from competent authority (D.C, ADM, SDO) (if Govt. servant, salary statement can be submitted) (example in page 8) 13. Residential Certificate from Headman of the locality/ from competent authority. 14. B.P.L Card (Xerox copy) (if parent fall under B.P.L) 15. Two passport size photo of your ward. 16. Two passport size photograph of father or mother or guardian. 17. Original Mark sheets of III, IV & V Class. 18. Xerox Copies of Mark sheet of III, IV & V Class. 0
BIODATA FORM 1. Name of the candidate Master/Miss 2. Sex: Boy/Girl Category: SC/ST/Gen/ OBC 3. Religion: - 4. Date of birth (in figures) Date Month Year In words 5. Are you Married Yes/No? 6. Father s Name 7. Mother s name 8. Name of Guardian (In case father is not the Guardian) 9. Present postal address 10. School(s) from where the candidate passed Class III, IV, and V Classes III IV V Month & Year of joining Month & Year of Passing Name of the School Is it a recognized school (write Yes or No) The school run by Locality / SSA Name of the village or town (in which the school is located) Name of the Block Name of the District Whether the school is located in Rural/Urban are CERTIFICATE BY THE HEAD OF THE SCHOOL Certified that the information given above is true as per school records it is also certified that Master / Miss was admitted in this school in class on (Date) and still continuing his/her study in Class VI w.e.f. (Date) Date: Signature of the Headmaster/Principal (School studying by the student in class VI) (With official stamp) Countersigned by BEO (Sub-Divisional School Education Officer) Or District School Education Officer (With official stamp) 1
MEDICAL FITNESS CERTIFICATE I certify that Km/Master D/O, S/O Shri / Mrs Who has been selected for the admission in Jawahar Navodaya Vidyalaya, Mukhla has been medically examined and he/she is not suffering from any kind of disease. He/she is suffering from the following disease. (i) (ii) 1. His/ Her Blood Group is 2. Height 3. Weight 4. Chest 5. Eye s Vision Left Vision Right 6. Ear s Left Right 7. Throat 8. Dental Hygiene 9. Skin. He / She is medically fit to get admission/not fit to get admission in Jawahar Navodaya Vidyalaya: Mukhla: West Jaiñtia Hills District, Meghalaya Sign of Candidate s Date: Signature Name & Designation of Medical Officer (With official Stamp) Countersigned of Chief Medical Officer (i.e. District Medical & Health Officer) 2
JNV-Mukhla, West Jaiñtia Hills District, Meghalaya SOCIO-ECONOMIC STATUS OF STUDENTS 1. Name of Student: 2. Cross ( ) Relevant Column Boy Girl Rural Urban ST SC OBC 3. Annual Family Income as estimated by you (Mark the relevant column) Father s Mother s Below Rs. 36,000 /- Below Rs. 36,000 /- Between Rs.36, 000 to Rs.50,000/- Between Rs.36, 000 to Rs.50,000/- Between Rs. 50,001/- to Rs. 75,000/- Between Rs. 50,001/- to Rs. 75,000/- Between Rs.75,001/- to Rs.1,00,000/- Between Rs.75,001/- to Rs.1,00,000/- Between Rs. 1,00,001/- to Rs.1,25, 000/- Between Rs. 1,00,001/- to Rs.1,25, 000/- Between Rs. 1,25,001/- to Rs.1,50,000/- Between Rs. 1,25,001/- to Rs.1,50,000/- Above Rs.1,50,000/- Above Rs.1,50,000/- 4. OCCUPATION OF THE PARENTS (Mark the relevant column and, if possible add further description of occupation. More than one column may be marked if necessary e.g. a small agriculturist also work as a laborer etc.) OCCUPATION FATHER MOTHER Agriculturist Farmer Labourer Cultivator Industrial (Organised Sector) Self Employed (Craftsman) Business (Give particulars) Teaching in Pvt School Govt. Employ Group D Clerical Teacher Technician Professional (Dr., Engg. Etc) Management Housewife Other (Specify) 6. EDUCATION OF THE PARENTS:- EDUCATION FATHER MOTHER Illiterate Literate completed a) Primary ( Under Class V) b) Primary (Passed Class V) c) Middle (Passed Class VIII) d) Under Metric e) Metric Passed f) Higher Secondary Passed g) Graduate(B.A/ B.Com/ B. Sc) h) Post-Graduate(M.A/ M.Com/ M. Sc) i ) Technical professional Diploma j) Technical/Professional Degree 3
7. FAMILY MEMBERS (INCLUDING PARENTS) 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 Name Age Relationship with candidate CERTIFICATE (BY PARENT/GUARDIAN OF THE 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 relevant certificates issued by competent authorities as and when asked for. Entries verify certified and found correct Signature of Parent/Guardian. 4
UNDER TAKING (To be signed by the father or guardian in case father is not alive in the presence of the Principal of the concerned Navodaya Vidyalaya) I Father / Mother / Guardian of who has been selected for admission to Jawahar Navodaya vidyalaya Mukhla, Jaintia Hills District, I hereby undertake that I would have no objection if my son / daughter / ward is transferred from this Jawahar Navodaya Vidyalaya, Mukhla, West Jaintia Hills - District to any other JNV linguistic state as per the provision of the Migration policy. Further, I declare that I shall abide by the condition that is my ward/son/daughter does not move to another school. He/She will not allow continuing to stay in the Navodaya Vidayalaya further and his/her studies would be discontinued. Signature of Father/Mother/Guardian Name of the Father/Mother/Guardian (In Block letters) Full Residential Address: Date: Place: Signed in my presence: Principal JNV Mukhla (West Jaintia Hills) 5
RESIDENCE CERTIFICATE (To be furnished by the parents of the qualified children at the time of admission to JNVs) As per Jawahar Navodaya Vidyalaya: MUKHLA, District: WEST JAIÑTIA HILLS, State: MEGHALAYA, letter No: - 4-2/2013/JNV-M (W. Jaiñtia Hills) / ward Master / Kumari dated my Has qualified the entrance exam for admission to Class VI at JNV: Mukhla, District: West Jaiñtia Hills, State: Meghalaya during session 2017-18. I am residing along with my ward mentioned above at following address since Village: Town : B.P.O / P.O District : State : Pin Code: Certified that the information furnished by me is true and no fact has been concealed. Place: Date: Signature of Parents Full Name Address: Fully recommended that the above information furnished is correct according to my concerned Place: - Dated: - Signature of Headman with seal. CERTIFICATE (To be filled up by the District Authorities and issued under the signature of SDM (Sub-Divisional Magistrate) / DM (District Magistrate) to the parents of the selected for admission to class VI in JNVs through JNVST-2017) This is to certify that the above information furnished by Shri / Smt Father/Mother/ Guardian of Matres/ Kumari A candidate selected for admission to Class VI in JNV District State has been verified from the records and is found to be correct. The area where residence is located falls under (Rural / Urban) area of District State Signature Full Name of SDM/ DM with Official seal 6
AFFIDAVIT (This performa is only for Example) Page - 7 (An affidavit to be furnished by parents on Rs. 10 /- Stamp paper duly attested by notary at the time of admission to Class VI in JNVs through JNVST 2017) I age Year, father / mother of Master / Kumari Resident of Village B.P.O District solemnly declare and affirm as under : a. My ward is a student (name and complete address of the Institution) which is a rural area in District in state since. He/She passed Class V from this Institution during the session b. My ward is residing with me at Vill B.P.O P.O, District, State which is located in the rural area of District,. Verified on this the day of (Date/MM/YR) 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 Date Signature (DEPONENT) Name ------------------------------------------------------------------------------------------------------------------------- (This proforma is for example only) Page No - 8 LETTER HEAD OF THE OFFICE Deputy Commissioner/ Addl Deputy Commissioner/Extra Asst Commissioner/ Sub-Divisional Officer Ref. No Dated ANNUAL INCOME CERTIFICATE This is to certify that the Annual Income of Shri and Smt parents/guardian of Mr / Miss of village from all sources is approximately Rs only and Rs only respectively. Deputy Commissioner/ Addl Deputy Commissioner/ Extra Asst Commissioner/ Sub-Divisional Officer With Office Seal 7
JAWAHAR NAVODAYA VIDYALAYA: MUKHLA: WEST JAINTIA HILLS DISTRICT, MEGHALAYA VISITOR S BIO-DATA I, Shri/Smt age (Phone Number ) Graph of Father/ Mother/ Guardian Father s/mother s/guardian of Master/Kumari of class House Junior Boys/Junior Girls do hereby authorized the following persons as a visitor to meet/ bring (out pass) my son/daughter/wards (namely.) Passport Photo Graph of Students Graph of visitor Graph of visitor 1. Signature of visitor 2. Signature of visitor Name : Name : Age : Ph. No.. Age : Ph. No. Relationship with candidate:- Relationship with candidate :- Graph of visitor Graph of visitor 3. Signature of visitor 4. Signature of visitor Name : Name : Age : Ph. No.. Age : Ph. No Relationship with candidate:- Relationship with candidate:- Signature of Father/Mother/Guardian Name: Signature of House Master/mistress Name: Principal 8