KENDRIYA VIDYALAYA BARGARH

DOCUMENTS REQUIRED FOR ADMISSION IN BALVATIKA-III, SESSION 2023-24

The following documents are to be submitted in original along with self attested copies by the parents whose child will be
selected and called for admission. Some of the original documents will be returned after verification.
1. Hard Coy (Print Out) of the Online Application Form: Paste the Colour Passport size photo of the child on it.
2. Birth Certificate issued by the competent authority showing date of birth (Keep the Original for verification &
attach a photocopy)
3. Proof of Residence: Electricity bill/Telephone bill/gas connection or gas delivery receipt/Aadhar
Card/bank Pass Book /Quarter Allotment order copy (if residing in govt. allotted quarter) etc. in which
the address is mentioned (This should be in the name of either of the parents). If residing in Rented
House – Rent agreement along with electricity bill of the house owner.
4. Self-declaration about Submission of documents, the distance of the residence from KV .BARGARH &
Undertaking for Caste Certificate – where applicable (The format may be downloaded from the Vidyalaya
Website).
5. Certificate of Proof of Blood Group
6. Valid SC/ST/OBC-NCL Certificate issued by the competent authority (Certificate in the name of the parent may
be accepted initially) – If it is in the name of the parent an undertaking should be submitted to submit the
certificate in the name of the child within 03 months from the date of admission.
7. OBC (Non-Creamy Layer) Certificate issued by the competent authority – should not be older than three year. It
should be issued on or after 01.04.2020.
8. Those claiming Economically Weaker Section should submit valid documents i.e. Valid “ Income &
Asset Certificate to be produced by Economically Weaker Section” issued by the competent authority
(Income Certificate will not be accepted in lieu of this) : It should be issued during the
current Financial Year i.e. on or after 01.04.2023 , Certificate issued after 01.04.2022 will be
accepted initially , however the fresh one issued after 01.04.2023 will be submitted by the
parent within 0ne month of admission.
9. Those claiming Below Poverty Line should submit the following documents:
(a) BPL Card, if available in the name of the parent of the child, but lapsed as on date, this can be
countersigned by the BDO of the locality of rural areas/Executive Officer of NAC of Municipality
areas to validate the card along with Low Income Certificate/ EWS Certificate/ Labour Card
OR
(b) PHH Ration Card (New) + Low Income Certificate/ EWS Certificate/Labour Card
OR
(c) Antodaya Anna Yojana Card + Low Income Certificate/ EWS Certificate/MGNREGP Job
Card/Labour Card
AND
An Affidavit to the effect that as on date the Parent and his family belongs to BPL Category and
Low-Income Group
10. Valid Handicapped Certificate issued by the competent authority – those claiming differently abled.
11. A Service Certificate (By Government Employees) showing the number of transfers during the preceding 7 years
issued by the competent authority- ORIGINAL (Those claimed Service Category 1/2/3/4) – Format may be
downloaded from the Vidyalaya Website
12. Certificate from the employer showing the Pay particulars of the employee, the status of employment and nature
of the establishment - ORIGINAL (Applicable only for Government employees – Those claimed Service
Category: 1/2/3/4) – should be in the prescribed format available in Vidyalaya website
13. For government employees – ID card issued by the employee/last month’s pay slip
14. For Ex-Service Man – Bonafide Certificate &Transfer details counter signed by the Zilla/Rajya Sainik Board or
any competent authority, Copy of Discharge Book, Copy of PPO.
15. Copy of Transfer Orders
16. Aadhar Card (Child, Father, Mother)
17. Any other documents as required by the admission committee as per the demand of the situation
NOTE:
a. Different Formats are available in School Website under the head “ADMISSION FORMATS” in Pdf – may
be downloaded for use.

PRINCIPAL
 CHECK LIST OF DOCUMENTS
PART-A (Details of the Child)
1. Name of the Child : ______________________________________
2. Class to which admission sought : Balvatika-3
3. Session : 2023-24
4. Application Submission Code : ___________________________
5. Selected under the category of : RTE/Cat-I/Cat-II/Cat-III/SC/ST/OBC(NCL)/DA/
6. Serial Number in the Selection List : ____________
PART-B (Documents submission by the parent)
The self-attested copy (Except cases where original is mentioned) of the following documents are submitted
by me.
Sl. Yes/
Name of the Document Remarks
No. No
1 Hard Copy (Print out) of the Online Application Form
2 Birth Certificate (Both Original & a Photocopy)
3 Residence Proof (Mention the type in Remark column)
4 Self Declaration of submission of correct information and documents, Distance
from School to Residence
5 Certificate of Proof of Blood Group
6 Caste Certificate (SC/ST/OBC-NCL) – (Specify whether in the name of the
child or parent in Remarks Column
7 Undertaking (If Caste Certificate in the name of the Parent)
8 Income & Asset Certificate for Claiming Economically Weaker Sections
9 BPL Card/ Proof of claiming BPL (Write Names of documents in Remark
Column)
10 Handicapped Certificate (Specify % of disability and type of disability in
Remarks Column)
11 Service Certificate & Certificate showing no. of transfers (ORIGINAL)
(Specify category of employee i.e. state govt./central govt. etc in Remarks
Column)
12 Certificate from the employer – in prescribed format available in Vidyalaya
Website (ORIGINAL)
13 Employee ID card/Last month’s pay slip (Specify Employee Code in Remarks
Column)
14 Transfer Orders (Specify number of transfers in preceding 7 years as on
31.03.2022 in the remarks column)
15 For Ex-Service Man ID proof/Discharge Book (Specify the date of discharge
in Remarks Column)
16 For Ex-Service Man Certificate of transfers counter signed by the Authority
(ORIGINAL) - (Specify no. of transfers in Remarks Column)
17 Aadhar Card (Child, Father, Mother)
18 Any Other

Signature of the Parent with Date

PART-C (For the Verifying Officers)
All the documents mentioned above are submitted by the parent and verified by us from the original and found
with the following Remarks. (Specify whether admission is approved or rejected in Remarks Column)
Verifying Officer -1 Verifying Officer-2

Remarks:

Signature:
Name & design. :
I/C Admission Counter Signed by the Principal
 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 the admission in
Kendriya Vidyalaya Bargarh 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 : ____________________

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 as
mentioned in the Registration Form __________________________________________________
_________________________________________________________________________________
_______________________________ (Complete Address as mentioned in the Online Registration
Form) , do hereby declare that the distance between Kendriya Vidyalaya Bargarh and the above
mentioned residence is _____________ km .

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 Vidyalaya Bargarh
Bhubaneswar. 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 Defence
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

Date: _________________________ (with Name, Designation and Office Stamp)

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 31.03.2023) 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.

Distance
Date of Date of Period
between
Office/Unit Joining Release of stay Transferred Transfer Order
the Two
and Place the Office/ from the (in Office/Unit and Place No.
Office (in
Unit Office/Unit days)
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: ________________________ Signature of Head of the Office

Date: _________________________ (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: ________________________ Signature of Head of the Office

Date: _________________________ (with Name, Designation and Office Stamp)

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 31.03.2023) 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:
Distance
Date of Date of Period
between
Office/Unit Joining Release of Transferred Transfer Order
the Two
and Place the Office/ from the stay(in Office/Unit and Place No.
Office (in
Unit Office/ Unit days)
km)

I know that if the above mentioned facts are found incorrect, my child will be disqualified for
admission in Kendriya Vidyalaya.

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: ________________________ Signature of Head of the Office

Date: _________________________ (with Name, Designation and Office Stamp)
 CERTIFICATE FROM THE EMPLOYER
(Regarding Status of Employment & identification of Admission Category in KVS)
I Sri/Smt./Ms. _________________________________________ (Name of the Employer) ,
designation____________________________________ working in the office of
___________________________________________department of _____________________ , government of
___________________________ do hereby certify the following in respect of Sri/Smt./Ms.
__________________________________________ (Name of the Employee) whose son/daughter
____________________________________________ (Name of the Child) is seeking admission in Kendriya Vidyalaya
Bargarh.
01 Name of the Child for whom admission is sought (in Block Letters)

02 Class in which admission is sought

03 Full name of the employee (in Block Letters)

04 Designation of the employee

05 Employee Code / Employee Identity No.

06 Name of the office where the employee is presently posted

Status of Employment (Whether Permanent/ Regular/ Temporary/Contractual/

07
Part Time/ Adhoc/Daily Wage Basis/Casual -To be written clearly)
This office/organization is Central Government/Central Government
Autonomous body/PSU fully or partially financed by Govt. of India/State
08
Government/ Sate Government Autonomous Body/ PSU fully or partially
finance by the state govt. (To be written clearly)
Whether the employee is to be considered as an employee of Central
Government/Central Government Autonomous body/PSU fully or partially
09 financed by Govt. of India/State Government/ Sate Government Autonomous
Body/ PSU fully or partially finance by the state govt. (Any one of the above to
be written clearly)
Please write any one of the following which is applicable i.r.o. the child for
whom admission is sought
1. Children of transferable and non-transferable Central government
employees and children of ex- servicemen. This will also include
children of Foreign National officials, who come on deputation or
transfer to India on invitation by Govt. of India.
2. Children of transferable and non-transferable employees of
10 Autonomous Bodies / Public Sector Undertaking/Institute of Higher
Learning of the Government of India.
3. Children of transferable and non-transferable State Government
employees.
4. Children of transferable and non-transferable employees of
Autonomous Bodies/ Public Sector Undertakings/Institute of Higher
Learning of the State Governments.
5. Children from any other category
(i) Pay Level : _____________
(ii) Pay : ________
(iii) DA : _______________
11 Recent Pay/Salary of the Employee with proper Split up (iv) HRA : ___________________
(v) Any Other ______________
(vi) Any Other : ____________
(vii) Total :

12 Whether the employee is drawing the consolidated pay YES / NO

Place: _______________________
Date: ______________________
Signature of the Certifying Authority with Seal

Complete Address of the Office:

________________________
________________________
Telephone Number: _______________________