Navodaya ‘Vidyalaya Samiti NOTICE Select list of students for admission to Class IX through Lateral entry Test has been released. The parents/guardians of selected students may take the following steps for admission to Jawahar Navodaya Vidyalaya: 1. Formats for submission of details may be downloaded, 2. Filled in formats are to be submitted to the Principal of INV concerned as per schedule, 3. Certificates from the competent authority in respect of Rural, OBC, SC, ST and Disability as applicable are to be submitted to the JNV for verification of documents / eligibility to confirm admission to Class IX After verification, JNVs will confirm the admission, if the candidate is found eligible as per NVS norms. It is informed that admission will be given to the selected candidates only after due verification of the documents. Parents are advised not to take TC from the Previous school until the admission is confirmed by the JNV. Admission to INVs is done free of cost. No fee is to be paid to school authority for admission to Class- IX. The parents/students are required to approach directly the Principal of the JNV concemed. For any complaints in the process of admission, E-mail may be sent to acinvst.nvs@gov in(Tobe fil the Parent, dion of the Candidate with the hel Headmasier/Headmisiress of the Schoo! from where th Class Vill Examination) 1. Name ofthe Candidate Jaiswal Aadhar Number,_S014 420 12. 2.Sex Male_[Femare [1S = 3. 0] Category Gen [ORC [SC Sl — (b) Caste 4, Date of Birth Kolar of the -andidate passed Dale [Month [Year 23 [| 03 [200' Date of Birth in Words 5. Father's Name 6. Mother's Name. 7. Name ’of the Guardian and Tweety nine Gep. Two Thousand five axarn Singh Jeiswa Ss! su Usha Jawa) relationship with him/her. if applicable = 8. School(s) from where the candidate assed Vil. Porficulars Class VI TAI] (i) Month & Year of Joining ET (i) Month & Year of Passing Rent 2020 (8) |) Name of the Schoo! ST Mathur Teeeneag ee: Gaborn [ij sla recognized school? (YES/NO}] Wer [G| Name of the Vilage or Town in which school is located. Coleone Yravdver' (Selous) (0) | Name of the Block Bablare (6) | Name of the Distict Fanjgir chemmpa Th | Location of the School indicate: RURAL/URBAN RURAL (Separate certificate is fo be obtained if the candidate had studied class Vill in different schools)CERTIFICATE 3Y PARENT/GUARDIAN OF THE CANDIDATE CONCERNED} 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. | am ready to produce the relevant certificates issued by Competent Authorities as and when asked for. . an, Signature of PARENT/GUARDIAN Entries verified, as and found correct. Semorner Teresa Signature of figs HEADIMASTER/HEADMISTRESS Dist. Jarvaie Chamos (CG. Name:__Sravat Je! Bulbery ‘ Desgn:_Privntipal School Seal: | © a NOTE FOR THE HEAD OF THE SCHOOL: - Following Cerificate isrequired to be issued in respect of candidate selected for admission in JNV in the respective district). CERTIFICATE BY THE HEAD OF THE SCHOOL Certified that the information given above is found correct as per our school records. Its also cerfified that Master/kumar__Digamshu Jaiswal was admitted in this School in Class_NuvSe" xy on_03° 07-2009 {date} and passed Class Villon_Ppssl 2020 (date) = SiWoter Teresa Signature:ob ie Head 6 institution School G thyD} last Siudidd with SEHOSt seal Dote : 23706-2020UNDERTAKING BY THE PARENT/ GUARDIAN Certified that the information given in the application form for admission into Class IX_in Jawahar Navodaya Vidyalaya, District: Saw}qye - Champator the academic year 2020-21 for my ward is true to the best of my knowledge and belief. In case any art of the information furnished by me is found incorect, admission of my ward may be cancelled at ony time. | om ready to produce relevant certificates issued by the competent authority to your office when asked in support of entries in my original application . sg Signature of the parent/Guardian Address of parent/guardian: Name:_Dhavam Singh Jaiswal HNo:_€& : Steet__Kancq Mod Village___Cwurstela, . Mandal/Block__Da bara Pin Gode:-_U9S68B woote no, SBUDSU 2048 UNDERTAKING |_Dhasam Singh Jaiswal _(Father/ Mother/ Guardian) of Kumari/Master iganshu Jassie) who got selected:for admission into Class xX in Jawahar Navodaya Vidyalaya, CWS... District hereby give an undertaking that | am ready to pay Navodaya Vikas Nidhi (Class IX to Xil) every month as per norms of Navodaya Vidyalaya Sami eae Signature of the parent/Guardian Note: This is not applicable to SC/ST categories and all git! students and the parents whose Income is below poverty line.JAWAHAR NAVODAYA VIDYALAYA: DsTRICT._3Orm'} ge + ChAvapa MEDICAL FIINESS CERTIFICATE 01 Name of the candidate Digonshu Jaiswal 02, Father's nome _ Dharam simgh Jawad 03. Address: HNO 68. Kansa Mod churtelg cTebsil /Block - Dalbaxd , Distt: - Janjqix-Champa: C-4> YqS6ae 04. Date of birth 29:04:2005 05. Height Ft Mm inch 06. Weight 42 qe - 07. Abdomen, bE eM 08. Chest AS CM 10 Eors __NAD. 1. Throat : 12. Locomotor systems 13. State of vaccination 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. re che. ~Dabhare = Pit Lani Champa c.¢,) CIVIL SURGEON i ‘OMoer | cHc-Debhera Dist Janjgie Champa (C.G.)AL, EN’ UNDERTAKING . We, Shri. D\uscam Singh (father) &Shrimati__Usha Saisw J (mother), the parents of Master/paiss_Digam cw Jaiweal , a selected 01010102416 do hereby declare that our ward doesn’t suffer from any of the medical ailments listed below. 1, Head Injuries 2. Puo- Intermittent 3. CHD- Congenital Heart Disease 4. AA— Acute appendicitis 5, Epliepsy — Convulsions (Injury, Fever) 6. Blood Disorders (Sickle cell Anemeia, Haemophillia) 7. Communicable Diseases (I'B, Hepatitis A & B) 8, Skin Disease : We further declare that our ward Master/ MiSs. Biganshy doesn’t have any previous medical history which requited still requires prolonged or intermittent periods of medical confinement either in a hospital/ nursing home or in our house. Certified that the information furnished above is true to the best of our knowledge. Any wilful suppression o false informationon the medical antecedents revealed later, would make the admission of our ward invalid and liable for actions as deemed fit by the Vidyalaya and Navodaya Vidyalaya Samiti. cos) place: Cwurtele FATHER'S SIGN a DATE: 2-3-0202 Name, Deere Singh Jousiond momer'ssicn: NAME: Usha Jaigwal : ADDRESS: HHO» 62, KRNSR PAOD, Churtela, Babb DISH Jamie -ChAwPA OG AGS6REDISABILITY CERTIFICATE If the candidate is Divyang (differently abled), he/she shall submit the cerfificate issued by the competent authority. CATEGORY/COMMUNITY CERTIFICATE (OBC/SC/ST) 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) : iganshu Jaiswal This is to cerlify that Master/Kumari__ O1 Sous Son/daughter of Shri_Dhavan Singh Jaiswal studied class a va St. Mother tevesq English ratdium Sclool Gokva bhavtg. In ‘(Name of — the — school) — of block___Dalehava and the school is located in the village Cxdeee — which belongs to rural area of District__Jam} giv -Chawpg, Stote:_Chatis gach gn z {Signature of the ReveretgeOeE) District_Saww oy —Chauypor + Office Seal: Dated:__&%-©@ D020RESIDENCE CERTIFICATE (To be furnished by the parents of the qualified children at the time of admission to JNVs) As per Jawahar Navodaya Vidyalaya, District_Jem gir hawes State_C: Gy» letter No: dated: my ward Master/Kumari_Digaosha has qualified the: entrance exam for admission to Class IX at JNV, District_Sore)yqirr -Chsonpy State_C+6+ during the session 2020-21 Lam residing along with my ward mentioned above at the following address: District vilage:_Churtela Town: District: Sy gie - Caaw State_chwabis gael Pin Code:_HASS8% “The area of residence falls under the Rural /Uroan area of the district Certified that the information furnished by me is true and no fact has been concealed. a5 - Signature of the parent. & Fullname:_Dhavaw Singh Jaiswad Address_HeNo- 68. feamée rod Chantel sTekel = Dabkarg. Distt -Janjair Champa “Applicable for the students who seek admission through the studies in NIOS.CERTIFICATE (TO BE FILLED UP BY THE DISTRICT AUTHORITIES AND ISSUED UNDER THE SIGNATURE OF TEHSILDAR TO THE PARENTS OF THE CHILD SELECTED FOR ADMISSION TO CLASS IX IN “INVS THROUGH LATERAL ENTRY TEST) This is to cerlity that the above information furnished by shi/Smt_Dherravs Syogl _Father/Mother of Master/kumari Dicawt ly. ledstoa) candidate for admission to class IK in JNV, ‘District_emigiv-teythas been verified from the records and is found to be correct, - “The area where residence is located falls under (Rural/Urban} area of the district__Janyepy ~ Chama. sro AEE. SRT Seman" “Applicable for the students who seek admissioh through the studies in NIOS.