sa \--(( d

ffiq
gql sqgq
ftqmq ri.rrq
KE
6du frur6{ 6lddr-rs-
\ D RIYA YID YA LA} A, KATHN,IAiT* D U
!-fr"fi-iol s /neg. No. ...........................,..

an *i /

qfr-m-tvr
s.No.

d ftf oerTi negistration for Ctass

o{/vear
2021-22
1 (One) W
f+srsfr @T ERT qTq
-
Name of cnild in fr.l tin Capital lerters,) ............ Sex: , [--l .[l
Day Month Year
(Eligibility is for Children born between
2 qq frfU (erd t) oatu or s,itn
[]-l t-T-'l 01/04/2014 to 01/04/2016)
rrdi q / tnwords
qfqn sd d sr crd td frflTqt o1 erg s{ [--T-] qrs r--f-__..l tci
Age as on 31st I\,4arch of the current year. Years I I I Montns L I l uays

3. Blood Group of the chlld

cd mr {rn !r{6
4 TqTeTIsslrlrq }pfr /crf,gB-dq"tft /q{qtfr / GilfrS /e+rRf6wtoq6*q,i / ft-f,dr,r /E-6-dYft6qTt ?
qR sr dr !qrq-s-{ rioni'ot I

Do you belong to Gen./SC/ST/OBC/EWS/Disabled vu, I--l No f-l tf yes, attach retevant certificate

ffituoE+droqdsSHfr(/) o{
sq-q -*nft 3E qrh 3E un qrfr 3r)frfr srffo sq t oq-d{ q.,1 ffi{T tac|(lt a-ql
Gen. Cat SC JI oBc EWS DiSabled SG ChiId

ll tl E tt
tt
5 qrdl-fr-dT 6T d'{l / Detaits of Mother/Father fuot / rate,

(i) {Tri / Name (in Capital Letters)

(ii) tt&Tfl / Nationatity
(iil) 4clTIIq / Occupation
(iv) ffiqrds 6-T qrq, gsT qf,r E ($ils
Name of Office and full address with
telephone numbers / Mobile No.

(v) Ei 3rrqr$q qdT s gflfls

Full residential address with telephone
numbers (with proof) and email lD

(vi) fr-floq t E.fr / Distance from KV

(vii) TelI{ TfrT

/ PermanentAddress
(viii) {6 toq / sasic pay

(ix) qdqtq q{ d sr qrd 6p t-ffiFro d +{q

z qd { qenciocril of qqr
No. of transfers during 7 years as on
31st March of the current year

(x) d ft. orcn"-q t qa € xri qr{/qsc $r

qTc gs oeTr
Own brother/sister if any studying in KV Kathmandu
Name with class

t w1 il{ qS lrrFro oror g fu scg-d cfuM it \ilrrmrft t no- E r

I certify that the above entries are true to the best of my knowledge.

ITdT/frdT d fmerq / Signature of parent

ftl* / oare:
f,{ rTq / Fuil Name
 +il gqlq-g{/srnvrcE cERTt FtcATE
qrfi-q v-dpemr, ardqrlq q odsf, t t
)-11 ,.' o

EmbassyoflndiaKathmandulCentral Govt. lStateGovt. lPublicSectorlClSFlDefencelTransferablelNon-Transferable.

Full Residencial Address

teffi \rq ft{]-m' orqiiilq oTe1reT ?F"r rrq, cE ffq awlefl (ffi-qtoq frt +6T q.trd)
Station with date Sign. & Name in block letters and design. of the head of office with stamp

d fa/ytrr t dr q +sx-( q dk sc-fiT tgrqflrq e-srmTo d +{H

fuil6 o1 d ,lqr an t

Certified that Master/Km .................. is the son/daughter of late

of lndia. He/she had died in harness on the..,........ . ,,.

?T-6 fi t fu' aft/sffi

c-qFrd fuqr qrm .... .... dr
d qm/fr"ot t, qdqn
B-r-S et +1 er qrd ilfr q.rd qqt d *-iTq ermicrq gq t I gfi-fi/oTqioq" eir tS
ffi of srqB sT d-Et frn ftsr qql t, ftre..d orcnT sarFr ffi6=iT qscr t t

son/daughter ..... has/had ....... (No of positing) transfers during the preceding last seven years from
31st March of the current year. The Unit Office & the duration of such posting involving change of station are given below:-

7, ri. qq qlg TEIT;I 6E{i qt1 ef,qfu Period of stay

GiltlT {i@l
S. No. Designation Place of Posting
t From 65 To
Order No.

2.

4.

6.

7.

TerTq qti fri-rfr oTqioq seIrH al qFr, qE oltq a*are-< (ETsl-dq of m-fl sBd)
Station with date Sign. & Name in block letters and design. of the head of office with stamp

({tTIt{: Telephone No. ................

ftqufr: qeil qwdrfr t orq o-ri qa o{-qftd d flq-d t tlT qqm q-r w oqrq erffi d r*<rer{ erifko t r

Note: The service Certificate should be slgned by the authorised Officer of Embassy of lndia.