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Checkj!lg . the relevant papers and ealise the dues. ·.f-. ..........S'i$:-.,

Date...~1+~~t~ 1~

.,o,.m ~ 1llfT Admitted to Class.....f,4 .. < .....Section...... .•

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Details of amount received : · filif') /r~

~~m ;-n~iifr faflr. •
Fee Receipt No:G:i.V..Rf..~·~4t 2'1?J~ Da!ed..;).0.sii
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Admission Fee .t
. J,, ••• • l 5. ... .QY. ..-. ...... .... I
• " · · Tuttion Fee........ . .,
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Fe8···••"···.
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Pupils Fund....................... science ·
................... ·

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Total Rs.... ,1.~.~..db............... /... "7 ~ .· / .
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Name has been entered in the Class Attendan~e.· · . . ·
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 QRIGINAL
fcl©i~ll fi~l&i ' __.~:1.
ENDRIYA VIDYALAYA SANGATHAN
fa:.H3,fclitii ~ / TINSUKIA R~GION
t~ ~• /\.ft. µA 1
c:: :::rn / KENDRIYA VIDYALAYA .'... ;....~ .\.n.:~ .. - -~ -------~- ------· r •

· _ __,.., n.r r.--\ -.... t ·\- .~ · i, · '. I ·

t-Ulitldld( !JiliDl-'14
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q-~. n 1 , \ 1 i ix,.;· i" •' 1·1J, r·f.1 •. J , ; ··, , ~• · · , ;-.

TRANSFER CERTIFICAT~ g,_:_, ;;~ "'~'.-'.'. 1 :,_2-:_~i, :1· ... i

31130 ffl .i. / Admission No. 3:.g,?>. <'II. "11.11:<i. I T.C. No l$.4.0
.. .

me of pupil : .. .. J.?.i<.JS.H.T l.. . AGfl~~.A..k............. . ..,~i···........... ........ .. ... ............... ..

. , . . . A ~n .............................. ... .
/ Father's I Guardians Name . .....D.R ......B .. t.f.l........GtA~ .. AL
's Name · 'T"\.O • SU.._ '\I"- AAAf?~~\Ab ........ ...... ............. ..... .................... ...
er · · · · · · · · ···..,,l,.✓..~ ~ F-:7\ . .. .
.. .. . ..
: .........'~.~'.n.\A~............ .... ........ .. ... .. .. .. ...... ..... ...... ..... ...... .. .. ............... ........ ......................
~ <ll 31:1,efi-ld (i11'3ilfa cfil Whether the t/
to scheduled Caste or scheduled tribe? : .. ...... Nt) ........................... ................................... ..
•-cm cfft rnr~ afR ~ , :: ··\
.05.~2:-0\~ ...,.....
sion in the Vidyalaya with cla$S~ : .0.~.~ C.kA:1$.:-:-)X ............................ .
~~~~3lqil -q~-?f I '

1='.1%'b'\:...~QJ)l).~.1~.o 'tlnii~
ristian Era)'Figures : '1.~ .91.• g,(:)(l:3. .:. Words
f<rnl,jf ~ 31tl{'A WIT I ~ t(w\e_e. .
pupil l ast studi~; Figures : g ~ Words : ..s.~nJDYI..N!l l. .~ .cws .JX
· ·,... ~ 1Jtta.-11 am ~ 'tJRUT1li. ·
•,:.. ual Exc~mina~on last taken ~ith resultl.lf.., M
fm,
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s.o once/~1ce in the same class ? . : .... .. .. .. ~ .. ··;;>·~~ .... .... .. .. ..... .... ., .. . , ) ,
bJects studied. · . · · •' ..-•
l~ fy,·~ .." 1,... $ .S.1 ...... ~......... b.JG.~.~$.~ ........
2 .. 3.M.Ai~~ 4.S.~J:.............. \\l~\
·e ~- · · 1.. .' ... .·.... ...:....·... .. .. ... .. 2 .. ... .. .... ...... ........ ... ... 3 .. ... .. .~ ( ~:... .... .. .. ... 4 .... .
ijJR mt? ~ 'ITT "RT ~ cfia.-11 -?f I Whether
oti~~to higher class if so;·towhich Class : .... ...:~ ... .. :':... (VVqr~ ,:~1?~ ~ .... .... ... .... .... ........ ... ........ .
m ~·rc:1~1ci<-1
.. •
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· ...... ·. ---·~---
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l =:~;t~%0;:e~;,~;·J~~~~~tl~;;~~~m,.~ ~·· ·· · · ·
'on :t I~; of, _the ~atu: e of : t :h co:.:s~:o~: ;: i:;;.~;~~. ~
. . . . . ... . . ½>... ...
• · ·S
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·; · .. ... ·c,;,r.~
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.~ \ -, i , n~,, . \ ~ ~ ·

!ing days present : .t..5 .dowl ... ... .Q,9..~ .~ ~ ,p,~ ~ ~...- -
~ I 'l@"l't I am,1-q1ftf;1 (:;;f;f~ I 'ffi ~) t I ·, IC.--~°!,'"~,::;:;:'~~
.: ad;~oy Scout I Girl Guide (Details may b~ given) : .......... .. ~ '-'1'."'. .~ ~ ·- ······· ·· ····· ······ ········
!.-~ ~ -qrcm - fHPlltfl ~ - cfi(1fq ~ fcmt?.ff ~ fll41..lld: ,wr IB<U
· m
r- cf;T ~ -ciR) Games played or Extra-curricular activities in which
':took part (mention achieveme~level therein) · --
3eneral·Cor1duct : .. .. .... ... ......<iJ ··························.. ··.. ···········.. ··············
~~ ~ ""1 I Date ~f App;i! i~ : :~~~i~;;;;;~· : ··¢;~:·· ···;·· .... .. ......... .
;t,l ofil fuf'l t Date of issue of Certifii::ate : . ...... .. g,~.:•ri·c" ···1c· 9.,Q.\,~.··· ·········· ······ ············
~;~~I ~; :e~~~~~eaving the SChool : .8 ~ •nf~::CJ~:+o:rnti;,. ::...... .
. y . s. ·. .. .................. ....... ..... .... .. .......................... .. .... .................. .... ............ .... .. .... •; ·\~\f,,

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~✓(.,,,,'!
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~ F-!r1/t,'f{ wr~ cfwl~ ~~ I Checked by ~f ~ A tM,a .
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1(P,J{(J)<.Rfrt'}1 o/J(})ry'Jl£Jl ry'Jl
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,.,.,,, ......

a L " .2. I ·cl; ~ I ■■ Cir - ■ I I L c

flPPLICflTION FOR ADMISSION

· Sr. No.. /....L{.-.-.. ........... .. ..
q- tfo ~s-
fcmTm cfiT ~ ~ Name of Student.. ... ... .. P.R.A .Tf/Yl ....... S.fl.JK././.1.. ..................... .... ,.
~ ~ - q-~ - ~ (~-q)
Date of Birth (in figures) ...... .... ./.l.:-: ..0.&.::..2..Q.0.1:-:-:..........................·............................. ....... :·
~ (SH1.Jll~l'1 qq cfiT 1 ~ col) ~ ~ ~
Age (as on 1st April of the year) Year ...... J~ .......... Month .. ...f ............. Days ... ..J.l.. ............ .
" k fL'..,' Nat·1ona1·1ty
• •• , • •• • . .\J . t.,V.\.11,... f .. J
/11 'vi ... ... ........ . ..... . ..
,
lfRIT-Nffi cfiT G2:ITTT : lfRIT ~
Details of Parents : Mother...... .... .......... ... ....... .. ........... Father....................... ... ......... ..... .......... .. ..
(i) ~ -;;p:r Full Name ..... . kA .B.I.TIJ ..... SA.IKlA ................... HE.m.1.J.N.TA.....
$.fUKll.l
(i1) c4q fl Ill Occupation ........ /rn.w.u.,.w.;J.e.. _
.................................... ..S.v.iy/~.. ....... .. ........ .
(iii) chllllc?lll "chT ;rr:r, ~ 'qffi q ~ ~
V.fJ,!!L../3 .~~~... hf,..~?Y.--:../..
Name of office and full a~dress with Tel. No ...
(iv) ~ "11~1i'il4 'FIT ,, ~ msm c._ n ~mm, H-J on...
Full residential address with Tel. No ... -JJ··-/m,J:··· lo-Jx.ki;:.;vv:_....N~·>-J{;£-J; ..
~F!::;:;;v,
(v) ~ mR' ~ ctl5r cfiT I ~ col /J, 0- RR.L ..) JOJJ Ad.,:, ';;;;.,m,_
B~sic "pay ~son 1st April of.the year i :)../ ,g I of {~'r:..) P~ - 9 f3-!it5"31.
(vi) :srwrmt.f ~ er; 31 lIRf wfi /'~ - 9~ 3~6 C,9~1
~ 7 ~ -q sQ ~1'11;:a<orf cfiT tfo
No. of transfers during last 7 years I { c, n,e.) ~
(vii) 1:!TffT-f4ffi" ~ €tuft Category of parent ] f
~~q;r'q 'ffi(~'i t) ,-"' , ' .. .; ' .l
• _. ) ~~.. ~- . I ! . .. . \ \
Name & address of local guardian (if any) .. .. ..... .. ...... .......... ..... .. ........... .. .. ....... .... ..
~ fc:ffl1W:r ~ ~ "ITT
· Name & address oftne school last attended with class .. .f<V.>··lt. .FS... ~.~·~:3~:J. 0.~.I!-).~,
~~~ Rle.11wl m m ~ ~ 1~G1...£la1 ~ Rlti1w-1 m ~ J,, ·
Whether it was a Kendriya Vidyalaya, Recognised/U nrecognised School .N.-........i).0-..."r!.:.rP,. ,.,
wrn·
. -.
·qfu.rr
~
qfl 0 11t1 Result of lr- ,t exarninat1on .......... Y.l/L. f.'.~.~4..: ........................1( ... _.
·~ coT :,1m-tra Pe~centage of marks .. ..... .. .......... : .......... '-!,. 1" · .... ... . .... ... : ... .. .. . ...... .. . ..... .. .. . . . :.
f~-fft ~ it ffl ~ Class to which admission is sought ......... 1.X............... :........,........... ..
@if :lfR err# S4@1Rla futfll" ,
. Subje~t proposed to offer...... /4...~ •····C·8.S.E. ..... ~ma... . . ... . . . . ...................... .
- •'~.. ~l >1hH 0 t ~-"(pf
- ..
'ff'~ t ?-gi,t.:itf \
:Wh ether tl1e transfer certificate is attached ? Y e ~..... .. .... .. ....... No ... ........ ....... ..... .. ... .. ...
.;R1 t~J.f1J.G(·. ~:tTTU1'-tBf q;l" ~ q @m
' No, S/ o· a.·+·e··of·· t . t · · rt·t· t
;. ), ·. ._. \·. , , rans J467/7of
e1 ~e ·' ,ca e .......... f,IC,!,9S f
... .. ............... :.. ...................
;·:~11 11_1'~! Mother ton_gue ... ..~ ....,.. :........ .. ~
/1:/ C!. (./(. ?.. .............
,.. . .. . ..
~ Home town ... .. ..
u
JMJ. · · · ......... .
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.cat1on
, No. of Pupll/ : - 10146711 4018780
,1que ·
:r111ar card No • of the Pupil/ : -

me of the Pupil/: - PRATIM SAIKIA

ther's Name/ : - KABITA SAlKlA

lier's Name/: - HEMANTA SAIKIA

)

~ether the pupil belongs to SC/ST/OBC Category/ : - Gen

c of first admission in Vidyalaya and Class/ : -

2~- p~- ,~ ;;__ '-- ~ 0- ~ 'I\' 1,
~c of Birth of the Pupil/ : - 11/08/200 2 ,..-r

od Group/: - A+

bject/ Cl ass : - IX

~r of Admission in KV/: - 2014

'ss
I in which the pupil studied last/ : -

~ool/Board Annual Exam ination taken last with result/ : - ~ \\\

",,, -:---

{)0~~
'ether fa iled if so once/twice in the same class/ : -
.,,. ·-
'ether qualified for promotion to higher class?/: - ....... YES/NO .... ..If yes so, to which class/:
) - -l~ - {>
~I No. of working days/ : -
\10 ~7;1
al No. of Presence in working days/ : -
\~~ 'l.. ...... ,.,. ·_$.
C/ --7
"ther participated in NCC Cadet/ Boy Scout/ Girl Guide/ (Details may be given)/: -
eral Conduct/: -
~<'.> bg_ -
~ of issue of Certificate/ : V \._.k, -
\
,e;:i ~ - \ 7
son for leaving the school/ : -
-~-~~~
oth er remarks/ : - \:- , _ .L
1
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•ther admitted under RTE Act. 2009/: - NO . N--c t_~'~ 7

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