SELF DECLARATION
(Distance from School to Residence) – For Candidates Selected under RTE
I _______________________________________________ Father /Mother of
Master/Miss___________________________________________ age______
years, bearing Application submission code
_____________________________________residence address mentioned in the
registration form_________________________________________________
__________________________________________________________________
_______________
_______________________________ (Complete Address as mentioned in the
Online Registration Form), do hereby declare that the distance between Kendriya
Vidyalaya Ambassa and the above mentioned residence is _____________ km.
Date: ________________________ Signature of the Parent
Place: ____________________
Mobile No: ____________________
SELF DECLARATION
(Submission of Documents & Information)
I _______________________________________________ Father /Mother of
Master/Miss
___________________________________________ age______ years, resident of
__________________________________________________________________
_______________
__________________________________________________________________
___ (Complete Address), do hereby declare that the information given in
admission form of Kendriya Vidyalaya Ambassa and in the enclosed documents is
true to the best of my knowledge and belief and nothing has been concealed
therein. I am well aware of the fact that if the information given by me is proved
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: ____________________
Mobile No: ____________________
UNDERTAKING
(Submission of SC/ST/OBC Certificate)
I _______________________________________________ (Name of
the Parent) do hereby declare that I will submit the Caste Certificate
(SC/ST/OBC- Non-Creamy Layer) issued by the competent authority in
the name of my child ___________________________________ (Name
of the Child) within 03 (Three) months from the date of admission of my
ward in Kendriya VidyalayaAmbassa. If I fail to submit the same in the
name of my child within this period the admission of my ward will be
summarily cancelled.
Date: ________________________ Signature of the Parent
Place: ____________________
Mobile No: ____________________
SERVICE CERTIFICATE
(CENTRAL GOVERNMENT)
Certified that Sri/Smt. ____________________________________________ is
working as a regular/permanent/temporary/contractual/part time/casual employee
in the capacity of _______________________________ in this
office/Ministry/under the Ministry of _________________________________
government of India. He/She is an employee of Defense
Service/CRPF/BSF/NSG/SPG/CISF/Central Govt./Central Govt. Autonomous
body/Central govt. PSU fully financed/partially financed by the Central Govt.
His/her services are non-transferable /transferable anywhere in India.
Complete Address and telephone No. of the Office
__________________________________________________________________
_______________
__________________________________________________________________
Place: ________________________ Signature of Head of the Office
(with name, designation and seal)
Date: _________________________
CERTIFICATE OF NUMBER OF TRANSFERS
I __________________________________ (Name) ________________________________ (rank
/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
figures & in words) from one station to another. (If the distance between the form and to place is at least
20 kms and the minimum period of stay is six months then only it will be considered as a transfer). The
details of which are given as under: I know that if the above-mentioned facts are found incorrect, my
child will be disqualified for admission in Kendriya Vidyalaya Ambassa.
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
_____________________________ (Name of the Office/Unit/Department) hereby certify that the
particulars given in above have been authenticated by the records held in the office and found correct.
Place: ________________________
Date: _________________________
Signature of Head of the Office (with Name,
Designation and Office Stamp)
SERVICE CERTIFICATE
(STATE GOVERNMENT)
Certified that Sri/Smt.____________________________________________ is working as a
regular/permanent/temporary/contractual/part time/casual employee in the capacity of
_______________________________ in this office /Ministry /under the Ministry of
_________________________________ _____government of ___________________. He/She is an
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
__________________________.
Complete Address and telephone No. of the Office
_________________________________________________________________________________
_____________________________________________________________________
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
_____________________________ (Name of the Office/Unit/Department) hereby certify that the
particulars given in above have been authenticated by the records held in the office and found correct.
Place& Date: _______________ Signature of Head of the Office (with Name, Designation and
Office Stamp)
AFFIDAVIT FOR SINGLE GIRL CHILD
Rs. 100/- Stamp Paper (Class I Magistrate not less than rank of Tahsildar) Affidavit
I__________________________________________ aged ________________
years , Indian inhabitant occupation _____________________________ Resident
of_________________________________________________________________
_______
__________________________________________________________________
______ is the mother/father of ______________________________________
Date of Birth is_____________________________ submitting my undertaking to
the Head of the Institution for admission of my daughter
_________________________________________ in Class-I (One) vide KVS
Admission Guideline 2025-2026
1. I hereby declare that Miss _________________________________________
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
of Single Girl Child in the family
immediately, if and when it occurs.
2. I am also aware that in case it is detected at any time that the affidavit sworn by
me is false, appropriate action will be taken by the school authorities and KVS
against me.
Signature of Father Signature of Mother
Residential Address with Contact Number:
Solemnly affirmed at: _________________________ This _______________ (Day) of
__________ (Month) of (Year)
BEFORE ME
Explained and identified by me.
Advocate
AFFIDAVIT FOR SINGLE GIRL CHILD
(BY PARENT)
I, Father of (Single Girl Child)
______________________________________________________ &Mother of
(Single Girl Child)
_______________________________________________________ residing at
__________________________________________________________________
______
__________________________________________________________________
_______________ do solemnly declare that we have no other child except
_____________________________________ (Name of the Single Girl Child).
1. That I am citizen of India.
2. That ____________________________________________________ is my real
daughter.
3. That her date of birth is _________________________________
4. That I have a Single Daughter and no other child in my family.
5. That my above-mentioned daughter has no brother or sister.
6. That I will inform the school authority in case another son or daughter is born in
my family.
7. If any information or documents are found incorrect on verification, the
admission of my ward may be treated as canceled, I will not sustain any claim
against the decision of Principal, Kendriya Vidyalaya Ambassa.
DEPONENT