Annexure

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Common Application Form for the Admission under EWS & Disadvantaged Group Category (RTE Act 2009) For the Session 2014-15 (To be filled in Block Letters)

Photo

Registration Number

A. Economically Weaker Section

(To be filled by the school)

B. Disadvantaged Group (Please Tick whichever is applicable) ~

I. Name of the School : (with address) 2. Class : Pre-School

3. Name of the Child 4. Religion

D
Male Day

Pre-Primary

Class 1

5. Sex : 6. Date of Birth 7. Age as on 31.03.2014 (In words) 8. Mother's Name 9. Father's Name 10. Guardian's Name: (If applicable) 11. Profession of Parents (a) Mother (b) Father

D DO

Female Month

D DO

Year

DO

12. Present Residential Address**: 13. Phone No. of the Parent/Guardian Mobile: Residence 14. Whether any house is owned by parents in Delhi: Yes/No. If yes, address there of 15. Total Annual Income of both the parents from all sources: I6. Proof 0 f Income *** : --;o;;---~c-=---;-o;--:c----;--------~ (Required only in case of Economically Weaker Section)

17. Ten digit No.l1.D. of lncome Certificate 18. Proof of Disadvantaged group >i<*** ; _

Declaration by the parents _________________ (Name) father/Mother of _

____ -,---c-_~,___,(Name of the Child) hereby declare that the information given above is true and correct to the best of my knowledge and belief. [have read and understood all the provisions of the notification in this regard. In case any information is found false or incorrect on verification, the admission of my ward may be cancelled. Signature of the Parent Dated: Submit
all)'

one of the following documents as proof: Birth certificate under the Birth, Death and Marriages Certification Act, 1986 . Hospital/Auxillary Nurse and Midwife (ANM) register record. Anganwadi Record. Declaration of age of the child by the parent or guardian. Ration card issued in the name of parents (mother/father having name of the child. Domicile certificate of child or his/her parents. Voter I card of any of the parents. Electricity bill/mtnl telephone bill/water bill. Unique Identity Card of mother/father/child issued by Government of India. Passport in the name of any of the parents or child.

(I) (2) (3) (4) (I) (2) (3) (4) (5) (6)

****

(I) Income certificate issed by a Revenue Officer not below the rank of Tehsildar. (2) BPL Ration card (Yellow Coloured). (3) AAY Ration Card (Pink Coloured) (I) A Certificate issued by a Revenue Officer not below the rank ofTehsildar or any other Competent Authority. (2) Caste Certificate issued by DC Office. (3) Medical Certificate from Govr. Hospital, in case of children with specialneeds/ disabilities. (4) A Certificate issued in accordance with instruction issued by the Department of Women and Child Development, GNCT of Delhi, vide order dated 11.12 12 in case of Orphan Child.

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