Form A

Affidavit to be furnished by the Parents of Single Girl Child

(to be engrossed on `.100 stamp paper and to be notarized by Notary Public)

AFFIDAVIT

I, Sri / Smt _______________________________, aged ________ years, S/o / D/o

Sri_______________________________________, resident of ____________________,
______________________________________________ _______________ hereby
solemnly affirm that:
I have only one child, who is a girl child, named Kum ___________________________
born on ___________________. I have no other issues, male or female.
I am making this affirmation for applying for Admission / Fee Waiver for my said only
child who is a girl child, Kum ____________________________ applying for admission
to / studying in Class ___________ Kendriya Vidyalaya No.I, JIPMER Campus,
Puducherry 605 006.
I shall intimate to the school in writing should there be a change in the single girl child
status on the birth of a sibling or my adopting another child.
If the information furnished by me above is found incorrect or any information has been
suppressed the School / KVS / CBSE authorities may take any suitable action as per their
rules and also withhold certificates.

Station:
Date :

Form B

I. Certificate & Undertaking to be furnished by the Government

Employees having Single Girl Child

1. Certified extract of the Service Records of the applicant certifying that the
applicant has only one child, who is a female child and no other children, male or
female issued by the Head of the Office, where the employee is working.

Note: (i) Form A to be submitted by the Private employees (Category VI )

(ii) Form A & B to be submitted by all Govt. Employees (Category I to V)