Scribd
Upload
192 views

Application Form OAVS

OAVS APPLICATION FORM

Uploaded by

Lalit Padhan
Copyright
© © All Rights Reserved
Available Formats
Download as PDF, TXT or read online on Scribd
192 views

Application Form OAVS

OAVS APPLICATION FORM

Uploaded by

Lalit Padhan
Copyright
© © All Rights Reserved
Available Formats
Download as PDF, TXT or read online on Scribd
You are on page 1/ 3

ODISHA ADARSHA VIDYALAYA SANGATHAN

(Application Form for OAV Entrance Test-2021-22 for Class-VI & Lateral Entry for Class VII,VIII & IX)

Paste a recent
passport size
Index No. CLASS TO
photograph here
BE ADMITED:-
and staple
another for use
in Admit card

(All information should be filled up in block letters)

1. Name of the child seeking admission:________________________

2. Name of the mother :_______________________________

3. Name of the father :________________________________

4. Class to be admitted : ______________________

5. Sex : Boy Girl

6. Caste : SC ST GEN (Put tick mark)

7. If belong to following Categories :

(a) Person with Disability: Yes/No

(b) If yes, Category of disability: (HI/VI/OH)

(c) If son/daughter of employee of OAV : (Yes/No)

(outsourced to be excluded)
(If yes attach certificate from Head of the office)

8. Nationality : ____________________

9. Date of Birth (a) In figures DD MM YYYY

(b) In words: _______________________________________

(c) Age as on 01.04.2021: ____________________


10. Mother Tongue :____________

11. i. Aadhar No. of the child: (UID/VID/EID)

ii. Aadhar No. of the Father/Guardian: (UID/VID/EID)

iii. Aadhar No. of the Mother: (UID/VID/EID)


12. Whether the child is suffering from any Chronic/ serious disease. (Yes/No)
If yes, state the nature of disease.

13. Name of the previous School where the child was/is


reading:______________

14. Whether the school is a Govt./Aided . (Yes/No).


(Please add a certificate from the DEO and clearly mention the category
of the School)
Whether recognized school and has got CoR from the Govt. of
Odisha.(Yes/No).
If yes annex a photocopy of CoR duly attested by the Principal/
Headmaster.

Signature of the
Principal/Headmaster
Office Seal
15. Contact No. of Parent (s) :___________ / Email Id._________________

16. (a) Present address with Pin Code :

(b) Permanent address with Pin Code :

17. Account Details:- i. Name of the Bank:


ii. Account No. :
iii. IFSC Code :

Signature/T.I. of the Parents/guardian.


18. Study Certificate from the Head of the Institution :
Certified that Shri/Kum.________________________________
S/D of __________________________ is a bonafied student
of Class-Vth of this institution. His/ Her date of Birth is __________
and Admission No.________________ Date._________________
as per Admission Register. The data furnished are correct to
the best of my knowledge.

Seal and Signature of Head of Institution


DECLARATION OF THE PARENT

1. We do hereby certify that the above information is correct to the


best of our knowledge and belief. If any information is found
fake/forged, the admission of our child may stand cancelled.
2. We do undertake that, our child and we shall abide by the rules and
regulations laid down by Odisha Adarsha Vidyalaya Sangathan
(OAVS), Bhubaneswar from time to time.
3. We do understand that, the decision of the empowered committee
of OAVS is final and binding on us regarding admission.
4. We certify that, we are the bonafide Parent / Guardian of the Child.

Signature of the Mother Signature of the Father


Date._____________ Date.______________

Name & Signature of the Legal Guardian with date (if parent(s)
not alive)

You might also like