SELF DECLARATION SELF DECLARATION

(Submission of Documents & Information)

(Distance from School to Residence) – For Candidates Selected under RTE

I _______________________________________________ Father /Mother of

I _______________________________________________ Father /Mother of Master/Miss
Master/Miss___________________________________________ age______ ___________________________________________ age______ years, resident of
years, bearing Application submission code
_____________________________________residence address mentioned in the __________________________________________________________________
registration form_________________________________________________ _______________

__________________________________________________________________ __________________________________________________________________
_______________ ___ (Complete Address), do hereby declare that the information given in
admission form of Kendriya Vidyalaya Ambassa and in the enclosed documents is
_______________________________ (Complete Address as mentioned in the true to the best of my knowledge and belief and nothing has been concealed
Online Registration Form), do hereby declare that the distance between Kendriya therein. I am well aware of the fact that if the information given by me is proved
Vidyalaya Ambassa and the above mentioned residence is _____________ km. false/ not true at any point of time, admission has to be deemed cancelled and I will
be liable to punishment as per guidelines of KVS and the benefit accrued by me or
my ward will be summarily cancelled.
Date: ________________________ Signature of the Parent

Place: ____________________
Date: ________________________ Signature of the Parent
Mobile No: ____________________
Place: ____________________

Mobile No: ____________________

 UNDERTAKING SERVICE CERTIFICATE
(Submission of SC/ST/OBC Certificate) (CENTRAL GOVERNMENT)

I _______________________________________________ (Name of Certified that Sri/Smt. ____________________________________________ is

the Parent) do hereby declare that I will submit the Caste Certificate working as a regular/permanent/temporary/contractual/part time/casual employee
(SC/ST/OBC- Non-Creamy Layer) issued by the competent authority in in the capacity of _______________________________ in this
the name of my child ___________________________________ (Name office/Ministry/under the Ministry of _________________________________
government of India. He/She is an employee of Defense
of the Child) within 03 (Three) months from the date of admission of my
Service/CRPF/BSF/NSG/SPG/CISF/Central Govt./Central Govt. Autonomous
ward in Kendriya VidyalayaAmbassa. If I fail to submit the same in the
body/Central govt. PSU fully financed/partially financed by the Central Govt.
name of my child within this period the admission of my ward will be His/her services are non-transferable /transferable anywhere in India.
summarily cancelled.

Complete Address and telephone No. of the Office

Date: ________________________ Signature of the Parent
__________________________________________________________________
Place: ____________________ _______________
Mobile No: ____________________ __________________________________________________________________

Place: ________________________ Signature of Head of the Office

(with name, designation and seal)

Date: _________________________
 CERTIFICATE OF NUMBER OF TRANSFERS SERVICE CERTIFICATE
I __________________________________ (Name) ________________________________ (rank (STATE GOVERNMENT)
/designation) of ______________________________________ (Name of the Office), do hereby certify
that during the past 7 years (Up to 31.03.2025) I have been transferred __________________ times (In Certified that Sri/Smt.____________________________________________ is working as a
figures & in words) from one station to another. (If the distance between the form and to place is at least regular/permanent/temporary/contractual/part time/casual employee in the capacity of
20 kms and the minimum period of stay is six months then only it will be considered as a transfer). The _______________________________ in this office /Ministry /under the Ministry of
details of which are given as under: I know that if the above-mentioned facts are found incorrect, my _________________________________ _____government of ___________________. He/She is an
child will be disqualified for admission in Kendriya Vidyalaya Ambassa. employee of State Govt. / State Govt. Autonomous body/State Govt. PSU fully financed by the State
Govt./partially financed by the state Govt. His/her services are non-transferable / transferable anywhere in
Office/Unit Date of Date of Period of Transferred Distance Transfer __________________________.
and Place Joining the Release stay (in Office/Unit between the Order No.
Office/Unit from the days) and Place Two Office Complete Address and telephone No. of the Office
Office/Unit (in km) _________________________________________________________________________________
_____________________________________________________________________

Place & Date: ________________________ Signature of Head of the Office (with Name,
Designation and Office Stamp)

Office/Unit Date of Date of Period of Transferred Distance Transfer

and Place Joining the Release stay (in Office/Unit between the Order No.
Office/Unit from the days) and Place Two Office
Office/Unit (in km)

Signature of the Parent

COUNTER SIGNATURE

I , __________________________ (Name) _______________________ (Rank/Designation) of Signature of the Parent

COUNTER SIGNATURE
_____________________________ (Name of the Office/Unit/Department) hereby certify that the
I , __________________________ (Name) _______________________ (Rank/Designation) of
particulars given in above have been authenticated by the records held in the office and found correct.
_____________________________ (Name of the Office/Unit/Department) hereby certify that the
Place: ________________________
particulars given in above have been authenticated by the records held in the office and found correct.
Date: _________________________
Place& Date: _______________ Signature of Head of the Office (with Name, Designation and
Signature of Head of the Office (with Name, Office Stamp)
Designation and Office Stamp)
 AFFIDAVIT FOR SINGLE GIRL CHILD
Rs. 100/- Stamp Paper (Class I Magistrate not less than rank of Tahsildar) Affidavit
AFFIDAVIT FOR SINGLE GIRL CHILD
I__________________________________________ aged ________________ (BY PARENT)
years , Indian inhabitant occupation _____________________________ Resident
of_________________________________________________________________
_______ I, Father of (Single Girl Child)
__________________________________________________________________ ______________________________________________________ &Mother of
______ is the mother/father of ______________________________________ (Single Girl Child)
Date of Birth is_____________________________ submitting my undertaking to _______________________________________________________ residing at
the Head of the Institution for admission of my daughter __________________________________________________________________
_________________________________________ in Class-I (One) vide KVS ______
Admission Guideline 2025-2026 __________________________________________________________________
_______________ do solemnly declare that we have no other child except
1. I hereby declare that Miss _________________________________________
_____________________________________ (Name of the Single Girl Child).
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 1. That I am citizen of India.
of Single Girl Child in the family
immediately, if and when it occurs. 2. That ____________________________________________________ is my real
2. I am also aware that in case it is detected at any time that the affidavit sworn by daughter.
me is false, appropriate action will be taken by the school authorities and KVS 3. That her date of birth is _________________________________
against me.
4. That I have a Single Daughter and no other child in my family.

Signature of Father Signature of Mother 5. That my above-mentioned daughter has no brother or sister.

Residential Address with Contact Number: 6. That I will inform the school authority in case another son or daughter is born in
my family.
Solemnly affirmed at: _________________________ This _______________ (Day) of
__________ (Month) of (Year) 7. If any information or documents are found incorrect on verification, the
BEFORE ME admission of my ward may be treated as canceled, I will not sustain any claim
against the decision of Principal, Kendriya Vidyalaya Ambassa.
Explained and identified by me.

DEPONENT
Advocate