JOINING BOOK 2021-22

CBSE Affiliation No.: 830488

KITTUR RANI CHANNAMMA RESIDENTIALSAINIK SCHOOL FOR GIRLS - KITTUR-591 115Dist: Belagavi Karnataka State, INDIA

2021-22

KITTUR RANI CHANNAMMA RESIDENTIAL

SAINIK SCHOOL FOR GIRLS, KITTUR

DI SG TN INIV CE TI IOHC N

A

JOINING INSTRUCTIONS2021-22

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st st1. Academic Session will be from 1 June to 31 March.

2. The School will observe the same rules and regulations as imposed by the Government regarding cancellation of classes or sending back students home etc.

3. Major medical treatment of students will be sole responsibility of parents, and if necessary students can be sent back home for further treatment

4. It is mandatory for Parents/Guardinas to be in possession of school Identity Card while coming to the school to pick-up / meet / drop their wards. No other form of identification is acceptable.

5. While going out or returning to school, all students will be in the prescribed uniform with School Identity Card.

SPECIAL INSTRUCTIONS TOPARENTS / GUARDIANS

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Resident Medical Officer

INSTRUCTIONS FOR FOLLOW UP

1. Students should have recent valid reports in original of Covid 19 test such as

Covid RTPCR / RAPID ANTIGEN / ANTIBODY TESTS from a Government Hospital.

2. Antibody quantitative titre should be done for driver/whoever drops and picks up

the student.

3. Students should bring Hot Water in a flask with a tumbler.

4. Students should wear clean clothes with fully covered face mask & hand gloves.

These should be changed everyday.

5. Students should maintain safe distance of 6 feet (182cm) in the classroom.

6. Students with any kind of sickness such as cold, dry cough, sore throat, fever

should inform immediately to school Doctor.

7. Students should regularly interact with School Doctor about her Health condition.

8. Student should use Hexa Savlon anti- virus soap.

9. Students should not sit close to other student nor touch the student.

10. Driver should and must provide all the reports of tests done to this Office for

record.

11. Students to Interact with Teachers and maintain physical distance at 6 feet (182

cm) all time.

12. Students should carry Sanitizer Bottle in their school bag to clean their hands

frequently.

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DOCUMENTS COMPULSORILY TO BE PRODUCED

1. PROFORMA ACKNOWLEDGEMENT OF RECEIPT OF JOINING INSTRUCTIONS

[Appendix -A]

2. UNDERTAKING BY PARENT / GUARDIAN [Appendix-B]

3. INDEMNITY BOND [Appendix - C]

4. RISK CERTIFICATE [Appendix - D]

5. CERTIFICATE OF INCOME [AFFIDAVIT] [Appendix- E]

6. CERTIFICATE OF INCOME [Ex-Serviceman] [Appendix F-1 and Para 5b of Section II]

7. CERTIFICATE [Non receipt of any of the financial assistance in respect of

Ex-Serviceman] [Appendix - F]

8. DECLARATION BY PARENT REGARDING ENTRIES IN APPLICATION FORM

[Appendix - G]

9. DECLARATION BY PARENT [Appendix - H] - PROPERTY & EMPLOYMENT

10. ADDRESS PARTICULARS [Appendix - I]

11. STUDY DETAILS [Appendix - J]

12. IDENTITY CERTIFICATE OF PARENT / GUARDIAN Appendix- K & L] in 2 Copies

13. TRANSLATION CERTIFICATE [Appendix - M]

14. BOND OF UNDERTAKING [On Stamp of Rs.100=00 non judicial] [Appendix - N]

15. LANGUAGE PREFERENCE [Appendix - O]

16. MEDICAL FITNESS CERTIFICATE [Appendix - P]

17. CBSE REGISTRATION FORM [Appendix - Q]

18. IDENTITY CARD OF PARENT / GUARDIAN [Appendix-R] in 2 Copies

19. REQUEST LETTER FOR TRANSFER CERTIFICATE [Appendix - S]

21. UNDERTAKING BY THE STUDENT [ CONDUCT AND ANTI-RAGGING]

[Appendix -T]

22. UNDERTAKING BY PARENT / GUARDIAN [ CONDUCT AND ANTI-RAGGING]

[Appendix - U]

22. TRANSFER CERTIFICATE FORMAT [On a Stamp of Rs.20=00 non judicial ]

[Appedix - V]

23. UNDERTAKING BILINGUAL - TAKING THE WARD TO

HOME ON LEAVE-[Appedix - W1 & W2]

24. AUTHORITY LETTER [Appendix - X & X1]

25. APPLICATION FOR THE ISSUING OF TRANSFER CERTIFICATE [Appendix X2 & X3]

26. FORM OF CASTE CERTIFICATE OF SC / ST [Appendix - Y]

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DOCUMENTS COMPULSORILY TO BE PRODUCED

1. PROFORMA ACKNOWLEDGEMENT OF RECEIPT OF JOINING INSTRUCTIONS

[Appendix -A]

2. UNDERTAKING BY PARENT / GUARDIAN [Appendix-B]

3. INDEMNITY BOND [Appendix - C]

4. RISK CERTIFICATE [Appendix - D]

5. CERTIFICATE OF INCOME [AFFIDAVIT] [Appendix- E]

6. CERTIFICATE OF INCOME [Ex-Serviceman] [Appendix F-1 and Para 5b of Section II]

7. CERTIFICATE [Non receipt of any of the financial assistance in respect of

Ex-Serviceman] [Appendix - F]

8. DECLARATION BY PARENT REGARDING ENTRIES IN APPLICATION FORM

[Appendix - G]

9. DECLARATION BY PARENT [Appendix - H] - PROPERTY & EMPLOYMENT

10. ADDRESS PARTICULARS [Appendix - I]

11. STUDY DETAILS [Appendix - J]

12. IDENTITY CERTIFICATE OF PARENT / GUARDIAN Appendix- K & L] in 2 Copies

13. TRANSLATION CERTIFICATE [Appendix - M]

14. BOND OF UNDERTAKING [On Stamp of Rs.100=00 non judicial] [Appendix - N]

15. LANGUAGE PREFERENCE [Appendix - O]

16. MEDICAL FITNESS CERTIFICATE [Appendix - P]

17. CBSE REGISTRATION FORM [Appendix - Q]

18. IDENTITY CARD OF PARENT / GUARDIAN [Appendix-R] in 2 Copies

19. REQUEST LETTER FOR TRANSFER CERTIFICATE [Appendix - S]

21. UNDERTAKING BY THE STUDENT [ CONDUCT AND ANTI-RAGGING]

[Appendix -T]

22. UNDERTAKING BY PARENT / GUARDIAN [ CONDUCT AND ANTI-RAGGING]

[Appendix - U]

22. TRANSFER CERTIFICATE FORMAT [On a Stamp of Rs.20=00 non judicial ]

[Appedix - V]

23. UNDERTAKING BILINGUAL - TAKING THE WARD TO

HOME ON LEAVE-[Appedix - W1 & W2]

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Please Note : Some of the document formats are available at the end of this Booklet

24. AUTHORITY LETTER [Appendix - X & X1]

25. APPLICATION FOR THE ISSUING OF TRANSFER CERTIFICATE [Appendix X2 &

X3]

26. FORM OF CASTE CERTIFICATE OF SC / ST [Appendix - Y]

28. OBC CERTIFICATE FORMAT [Appendix - Z]

29. NATIVITY CERTIFICATE ISSUED BY TALUKA / MANDAL REVENUE OFFICER.

30. INCOME CERTIFICATE ISSUED BY TALUKA / MANDAL REVENUE OFFICER.

31. INCOME CERTIFICATE ISSUED BY THE EMPLOYER FOR SALARIED PERSONS

ONLY.

32. 06 NOS OF LATEST PASSPORT SIZE PHOTOS AND STAMP SIZE PHOTO OF THE

GIRL, FATHER, MOTHER & LEGAL GUARDIAN.

33. ADOPTION DEED (IF APPLICABLE).

34. CERTIFICATE OF BLOOD GROUP OF THE GIRL ISSUED BY ANY DIAGNOSTIC

CENTRE.

35. COMBINED FAMILY PHOTO AND SINGLE PHOTOGRAPHS OF THE FATHER,

MOTHER, AND GUARDIAN AS APPLICABLE IN RESPECT OF THE GIRL WHO IS

BEING ADMITTED.

36. DEMAND DRAFT DRAWN IN FAVOUR OF THE PRINCIPAL KRCR SAINIK SCHOOL

FOR GIRLS, KITTUR.

37. AFFIDAVIT AND CERTIFICATE OF INCOME DULY SIGNED BY THE PARENT.

38. CERTIFICATE FROM DEFENCE PERSONNEL REGARDING NON RECEIPT OF ANY

SCHOLARSHIP.

39. TRANSFER CERTIFICATE FROM PREVIOUS SCHOOL COUNTER SIGNED BY B.E.O.

OR D.DP.I.

40. MARKS CARD FROM PREVIOUS SCHOOL WITH DISE CODE (DISTRICT

INFORMATION SYSTEM FOR EDUCATIONAL CODE).

41. ATTESTED COPIES OF AADHAAR CARD, VOTER ID & PAN CARD (WHEREVER

APPLICABLE) OF FATHER, MOTHER & CANDIDATE [AADHAAR CARD OF

CANDIDATE IS COMPULSORY].

42. CANDIDATE’S BIRTH CERTIFICATE ISSUIED BY CHIEF REGISTRAR OF BIRTHS

AND DEATHS(ATTESTED PHOTO COPY).

43. LATEST SALARY CERTIFICATE OF FATHER, MOTHER (BASIC+DA) FOR JOB

HOLDERS ONLY.

44. CANDIDATES BELONGING TO SC/ST CATEGORIES SHOULD PRODUCE THE

LATEST PASS BOOK PERTAINING TO THEIR S.B. ACCOUNT OPENED IN A

NATIONALISED BANK, ORIGINAL CASTE CERTIFICATE AND INCOME

CERTIFICATE OF THE PARENTS / GUARDIANS ALONG WITH 3 SETS OF PHOTO

COPIES DULY ATTESTED FOR THE PURPOSE OF AVAILING SCHOLARSHIP.

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SECTION - I

SCHOOL FEES STRUCTURE FOR THE ACADEMIC YEAR 2021-22

Sl.No. School Fees Merit Full Fee Payment

To be paid to School A/c

1. Tuition fees 71,300 = 00 71,300 = 00

2. Other School Fees 61,500 = 00 61,500 = 00

3. Technology Aided Teaching /

Development fees 6,000 = 00 6,000 = 00

4. Uniform 5,900 = 00 5,900 = 00

5. Health Insurance 1,400 = 00 1,400 = 00

6. Event Fees 300 = 00 300 = 00

7. Extra Curricular Activities Fees 1,000 = 00 1,000 = 00

8. One Time Fees

Admission 9,500 = 00 9,500 = 00

Golden Jubilee Fees 2,200 = 00 2,200 = 00

PTA Contribution 2,100 = 00 2,100 = 00

Caution Money 4,200 = 00 4,200 = 00

Co-operative Society Deposit 1,100 = 00 1,100 = 00

Alumni Association Subscription 2,500 = 00 2,500 = 00

9. Pocket Money 5,000 = 00 5,000 = 00

Total Rs. 1,74,000 = 00 Rs. 1,74,000 = 00

Less Merit / Merit cum Mean Scholarship from -NIL- Govt of Karnataka

Less Uniform Charges from Govt of Karnataka -NIL-

Total Fees to be paid Rs. _________ Rs. 1,74,000 = 00

[Pocket Money and other kit & clothing items will be charged extra]* [ School Fees may be revised at any time by the BoG, KRCMC ]

Note:-

1. (a) All seeking admission under Merit Scholarship Category will pay the total parents/guardians

fees in the form of Demand Draft for Rs. _____________in favour of Principal, KRCRSSG,

Kittur, payable at Kittur Branches of State Bank of India, Canara Bank only ( IFSC Code -

SBI Bank : BIN0013140, Canara Bank : CNRB0010514 ). OR You may make the payment for S

above amount through ‘SBI online Collect’ System by visiting our School Website :

www.kittursainikschool.in

(b) Once the student is admitted to Class VI under the Merit Scholarship Scheme, and if the

Parent / Guardian wishes to withdraw his / her daughter / ward for seeking admission to any

other school, or for any other reason, the entire amount of the scholarship already deducted

from the total fees shall be paid back to the institution by the Parent / Guardian in the form of

Demand Draft, failing which the Transfer Certificate will not be issued by the school.

(c) The complete fees will be paid in one installment only.

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2. All Parents / Guardians seeking admission under Full Fee Payment Category will pay the total fees in the form of Demand Draft for in favour of Principal, Rs. 1,74,000/-KRCRSSG, Kittur, Payable at State Bank of India, Canara Bank at Kittur Branch.

3. Payment of fees should be made by Bank Demand Drafts Only. No Cash or cheques will be accepted.

4. The Statement of Account will be sent to the parent during April of each year indicating the exact amount of fees for the next academic year.

5. Taking into consideration factors such as inflation, increase in cost of living and such other reason the school fees may be revised at any time by the Board of Governors and the Parents / Guardians / Guardians will have to abide by the decision. An undertaking to this effect (as given at Appendix ‘B’) is to be signed and submitted by the parent at the time of admission.

6. Parents/Guardians are expected to furnish correct details with regard to income and availing of any scholarship from any agencies. In case if it is found incorrect during verification by the school through Vigilance/Police, their daughter/ward will be removed from the rolls of the School. Additionally, parents/guardians will be liable to refund all financial benefits enjoyed by their daughter/ward during her stay in the school.

7. Parents / Guardians are requested to pay fees as and when due, failing which the fees will be recovered with penal interest as per bank rate interest. If the fee is not paid by the end of academic year, the results in respect of such cadets will be with- held and shall only be declared after the payment of the fees. If the fees for the previous academic year is still not paid, in such cases the name of the student will be struck off from the school’s roll for the following academic year at the parent’s/guardian’s own risk. School will not be held responsible for the same under any circumstances.

8. FEES ONCE PAID/ REMITTED WILL NOT BE REFUNDED UNDER ANY CIRCUMSTANCES.

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SECTION - II

DOCUMENTATION

1. Please ensure that before you report to the School for admission, the undermentioned documents are to be duly completed and submitted. The formats where applicable, are given in the appendices at the end of the Section-V. These documents to be executed by you are important and must be presented in original at the time of admission, failing which admission will not be entertained.

(a) Indemnity Bond/ Risk Certificate as per pro-forma at Appendix ‘C’ & ‘D’.

(b) Certificate of Nativity issued by the Mandal Revenue Officer / Tahashildar.

(c) Demand Drafts in favour of the Principal, KRCRSSG, Kittur, Branches of State Bank of India, Canara Bank only S ( IFSC Code-SBI Bank : BIN0013140, Canara Bank : CNRB0010514 )

as per details given at Note 1 (a) and Note 2 to Section I, towards annual fees in respect of your daughter/ward.

(d) As proof of date of birth, the Parents / Guardians shall produce one of the following documents as applicable to them.

(i) Girls who have previously at any time attended a recognized school, Transfer Certificate duly countersigned by the District Education Officer/BEO/DDPI of the District concerned.

(ii) Girls who have not attended a recognized School: Extract from the Register of Births issued by the Registrar of births and deaths (Applicable only in case of admission to class VI)

(iii) Girls whose Parents / Guardians are serving in armed forces or Ex-service personnel: A certificate from the Commanding Officer/ Records/ Service Headquarters furnishing the Date of Birth of the girl as entered in the service records, of the parent. If the date is not recorded in the Service Record a certificate from the Record office/Service Records that the birth is not recorded, will also be submitted. The above certificate is required in addition to the certificate mentioned at (i) or (ii) above.

2. Ex-service men will produce original discharge certificate from the Forces along with Photo copy duly attested.

3. Certificate for salary (Basic + DA) issued by the Tahasildar / Drawing and Income Disbursement Officer of concerned department only. Income certificate from any other authority will not be accepted.

4. Appendix ‘E’Affidavit of Income duly signed by the Parent at

5. Documents to be produced by service personnel will also include evidence of their bonafide, a Certificate from Commanding Officer stating service details. The original Discharge Certificate will be returned after perusal. In addition, following documents are also required to be submitted.

(a) In respect of Serving Personnel of Defence Services

(i) A photo copy of your latest pay slip.

(ii) A Certificate showing name of the present post held, Scale of Pay, Basic pay, DA and

(iii) Certificate to the effect that you are not in receipt of any other financial assistance

as per Pro-forma given at Appendix ‘F’.

(b) In respect of Ex-servicemen

(I) Income Certificate by Income Tax / Revenue Officer not below the rank of MRO / Tahashildhar with Office Seal as per Pro-forma given at Appendix ‘E’.

(ii) A copy of the latest Pension Certificate showing the Basic Pension, DA on the Pension, Medical Allowance and other Allowance issued by the concerned Unit or Authority from where you are drawing your Pension etc.

(iii) A Certificate from District Sainik Welfare Officer stating that you are eligible to apply for candidature of your daughter under the Ex Serviceman Quota.

(iv) Certificate to the effect that you are not in receipt of any other financial assistance as per the Pro-forma given at Appendix ‘F’.

6. Adoption Deed : In case of adopted children, the original Adoption Deed along with an attested copy should be submitted to the school along with the other documents for record. The original Adoption Deed will be returned after verification. Please note that acceptance or otherwise of the adoption rests with the school authorities as already mentioned in the School Prospectus.

7. SC/ST Certificate : Latest Certificate duly verified and certified by the authority prescribed on or after 01 Jan 2016 is to be produced without fail. If Father/Guardian is an employee, a Certificate from his employer is to be submitted in addition to the Certificate issued by the respective authority Refer Appendix -Y

8. Ten latest passport Size Photos: The Parent / Guardian has to submit ten (10) Passport Size photos of his / her daughter/ward at the time of admission. In addition, the Parent / Guardian has to submit one group/family photo with the girl, with 03 copies of indivisual passport size photos of the Father, Mother, and a legal Guardian.

9. Latest Certificate issued by the prescribed authority is to be submitted for BC or OBC Candidates for School record as per praforma at Appendix-Z.

10. A certificate from a recognised and approved Diagnostics Laboratory indicating the Blood Group of the girl is also to be submitted at the time of admission.

11. Signatures on the Documents : All the documents submitted to the School must be signed by the Father of the Girl. If Father of the Girl is not alive, documents shall be signed by the Girl’s Mother and if both the Parents / Guardians are not alive, the same will be signed by the Legal Guardian. In case of adoption, the documents must be signed by the adopting Father/Mother. Every Parent/Guardian will sign the declaration(s) at Appendix ‘G’ and Appendix ‘H’ and submit to the school along with other documents.

12. Address Particulars : All Parents / Guardians will submit address particulars along with other details as per praforma at Appendix ‘I’

13. The Particulars of the Schools of Study from Standards 1st to 5th will be submitted (Please see Appendix - J)

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14. Study Details : Parents /Guardians will submit Identity and Income Details as per Proforma

at Appendix ‘K’ & ‘L’ in duplicate.

15. Parents/Guardians will submit Translated Equivalent to English of the Transfer certificate as per format given at Appendix ‘M’

16. Agreement needs to be executed on a non judicial stamp of Rs. 100/-. Stamp paper shall be purchased with either of the Parents / Guardians or legal guardian as the first party and the Principal KRCRSSG as the second party. (The text of the Agreement is appearing at Appendix N -both in Kannada and English versions. It for your is reference only.)

PROCEDURE TO BE FOLLOWED DURING PURCHASE OF E-STAMP

n Two e-stamps should be purchased, one for Rs.100/- and another one for Rs.20/-

n E-stamp should be purchased in the name of Cadets Father/Mother or Guardian (in case of death of Cadets parents)

n First party name for purchase of e-stamp : Cadets Father/Mother or Guardian (in case of death of Cadets parents) and it should contain First-Middle-Last name of the first party.

n Second party name for purchase of e-stamp : The Principal KRCRSSG Kittur

n Purpose : Admission (Enrollment in School)

n Description : Agreement

n The parents are instructed to bring blank e-stamp to the office costing to Rs.100/-, the agreement matter will be printed in the office on said e-stamp.

n And they are also instructed to bring e-stamp of Rs.20/- with agreement matter printed. Please refer the agreement matter printed in joining instruction booklet page number 89 of Appendix-V. The information's furnished in the agreement should be followed previous school records

17. Language Preference for classes VI to VIII : Parents / Guardians are requested to submit Language preference in respect of their Daughter / Ward as per format given at Appendix ‘O’

18. Medical Fitness Certificate : For details please refer to Section V and Appendix ‘P’.

19. CBSE Registration Form Appendix ’Q’.

20. Identity Card of natural Parent / Guardian Appendix’R’ in 2 copies

21. Request Letter for Transfer Certificate of Previous School Appendix - ‘S’

22. Cadet and Parent / Guardian shall submit Anti-Ragging undertaking as per Appendix ‘T’ and ‘U’ respectively.

23. Transfer Certificate Format on Rs. 20/- non judicial Stamp shown in Appendix ‘V’

24. Authority Letter to be filled by Father/Mother/Legal Guardian as per Appendix ‘X’ & ‘X1’ and submit it during unavailability of Father/Mother/Legal Guardian to escort during leave / vacations.

25. Request of Transfer Certificate (English & Kannada format) Appendix ‘X2’ & ‘X3’

26. Backward Communities Certificate issued by Competent authority as per - Appendix - Z

27. SC/ ST Certificate - Appendix - Y

28. Understanding in respect of restriction on Demand of Leave - Appendix - W1 & W2 (bilingual - English / Kannada)

SECTION-III

ARTICLES OF CLOTHING AND OTHER NECESSITIES

1. Maintaining high standards of discipline and conduct at all times is the foundation on which any educational institution would like to function. It should be the endeavour of every girl child admitted to the school to observe all rules and regulations as a matter of habit rather than as fear of punishment. Hence it is imperative to follow the right dress code and be neatly and smartly dressed at all times.

2. To maintain uniformity amongst all cadets the required school uniforms, Kit / Clothing and other items as per list given below, will be issued to the girl cadets at the time of admission from the chool o perative ociety. Necessary payment for items will be S C -O Scollected from the Parents / Guardians at the time of admission.

(A) Details of school uniform to be issued by School at the time of admission.

S.No Particulars of Qty. Being Approximate Total School Uniform Items Issued Rate Cost

Uniform

1 Olive Green Uniform 2 Pair 1050.00 2100.00

2 Bottle Green Uniform 1 Pair 850.00 850.00

3 Beret 1 0.00 0.0020 20

4 Beret Badge 1 50.00 50.00

5 Flag Badge 1 100.00 100.00

.00 0.006 Green Belt 1 200 20

7 Green Belt buckle 1 170.00 170.00

8 Lanyard 1 5 5 0.00 0.00

9 Name plate 2 50.00 100.00

1 00.00 300.0010 School Tie 3

11 Shoulder flash (cloth) 1 35.00 35.00

12 Shoulder Titles (brass) 1 85.00 85.00

13 Jersey (Full sleeve sweater ) 1 400.00 400.00

14 Sweater (Half sleeve) 1 350.00 350.00

15 Swimming costume 1 910.00 910.00

Total Amount 5,900.00

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S.No Particulars Qty. Selling Price Total Price

(B) s Details of School Kit / Clothing item to be purcha ed by Parent on Payment at the time of Admission

KIT FOR CLASS VI TO IX

List -1 : Cloth and Games Items

1. Air Bag 1 500.00 500.00 2. White Cloth (for embroidery work) 1 100.00 100.00 3. Bed Rubber Sheet (1.mtr) 1 150.00 150.00 4. Bed Sheet (Regular) 2 500.00 1000.00 5. Bed Sheet (School) 2 500.00 1000.00 6. Wool Blanket 1 350.00 350.00 7. Carpet 1 250.00 250.00 8. Cotton Blanket (Chaddar) 1 500.00 500.00 9. Iron Sheet Trunk 1 1000.00 1000.00 10. Mattress with pillow 1 4000.00 4000.00 11. Mosquito Net White 1 350.00 350.00 12. School bag 1 1000.00 1000.00 13. Roller Skates 1 850.00 850.00 14. Head Scarves (School) 2 250.00 500.00 15. Bath Towel Regular 1 100.00 100.00 16. Bath Towel (Terry) 1 300.00 300.00 17. Bathroom Slippers 1 100.00 100.00 18. Games Shorts 2 200.00 400.00 19. Games T-Shirt 2 350.00 700.00 20 Track Suit 2 750.00 1500.00 21. Black Shoe 1 700.00 700.00 22. Green Socks 5 50.00 250.00 23. Sports Shoe 1 659.00 659.00 24. White Socks 2 50.00 100.00 25. Note books 29 1491.00 1491.00

List -2 : General and Stationery Items

26. Dark Pencil (set of 10) 1 70.00 70.00 27. Ball Point Pen (Set of 5) 1 30.00 30.00 28. Bath Bucket 1 310.00 310.00 29. Bath Mug 1 80.00 80.00 30. Bathing Soap(Set) 1 220.00 220.00 31. Bi Colour Pencil (set of 10) 1 100.00 100.00 32. Book Cover (roll of 10.mtrs) 1 49.00 49.00

33. Buttons Packet 3 5.00 15.00

34. Clip Board (Omega Exam Pad) 1 280.00 280.00

35. Cloth clip 1 50.00 50.00

36. Coconut Hair Oil (200.ml) 1 85.00 85.00

37. Comb (Lice comb) 1 15.00 15.00

38. Comb(regular comb) 1 15.00 15.00

39. Dictionary Oxford (Eng-Eng-Kan) 1 360.00 360.00

40. Dictionary Oxford (Eng-Hindi) 1 299.00 299.00

41. Dictionary Oxford Adv' learners 1 795.00 795.00

42. Ear buds 1 25.00 25.00

43. Embroidery Ring 1 30.00 30.00

44. Multi compartment plastic box 1 50.00 50.00

45. Feviquick( Fixwell 12gr) 1 35.00 35.00

46. Geometry Box 1 150.00 150.00

47. Glue (White glue) 1 20.00 20.00

48. Hair Band (Stretch Band) 2 15.00 30.00

49. Hair Clip 1 10.00 10.00

50. Hairnet (Blunt) 12 10.00 120.00

51. Hand Kerchief (1 set of 12nos) 12 15.00 180.00

52. Cloth Hangars 12 15.00 180.00

53. Highlighter 1 20.00 20.00

54. Hook Buttons 1 10.00 10.00

55. Key Chain 1 50.00 50.00

56. Lock & Key (Medium - 40mm) 1 55.00 55.00

57. Lock & Key Small 1 30.00 30.00

58. Nail Cutter 1 80.00 80.00

59. Napkin (Terry napkin) 2 35.00 70.00

60. Needles Box (Multi sized) 1 40.00 40.00

61. Oxford School Atlas Book 1 400.00 400.00

62. Paint Marker (Yellow) 1 55.00 55.00

63. Painting Bowl 1 15.00 15.00

64. Painting Brush set (set of 4) 1 70.00 70.00

65. Painting Dish 1 5.00 5.00

66. Pen Glitter shining (set of 10) 1 100.00 100.00

67. Pen Pick pens (set of 10) 1 100.00 100.00

68. Pencil Pouch 1 65.00 65.00

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S.No Particulars Qty Selling Price Total Price

S.No Particulars Qty Selling Price Total Price

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Note :

1. A cadet is welcome to bring any musical instrument, the item will be cared for and she will have ample opportunity to use it. It is our experience that cadets lose their keys. Therefore, good quality combination locks which need no keys are preferred.

2. Class XI cadets will get separate KIT

For further information regarding Kit Items please contact Mr. B K Kotagi (Manager), Cell : 9972936540

69. Press buttons 1 15.00 15.00

70. Ball point pen(Red) 1 10.00 10.00

71. Rough book 2 30.00 60.00

72. Safety pins 1 15.00 15.00

73. Scale big plastic 12” 1 12.00 12.00

74. Scale small plastic 6” 1 5.00 5.00

75. Scissor small (Regular) 1 50.00 50.00

76. Shampoo Bottle Medikar 1 50.00 50.00

77. Shampoo (80-100 ml) 1 50.00 50.00

78. Shoe Polish Brush 1 50.00 50.00

79. Shoe Polish Tin (Wax, 15.gm, Black) 1 27.00 27.00

80. Shoe Shiner (Black) 1 65.00 65.00

81. Six layer thread (R,P,B,G&B) 25 3.00 75.00

82. Sketch Pen Packet (set of 10) 1 55.00 55.00

83. Soap Case 2 30.00 60.00

84. Stapler 1 54.00 54.00

85. Stapler pin 1 9.00 9.00

86. Talcum Powder (100.gr) 1 55.00 55.00

87. Thread (white,green,black) 3 5.00 15.00

88. Tixo Tape (Cello tape small) 1 15.00 15.00

89. Tooth Brush 1 20.00 20.00

90. Tooth Paste (80gm) 1 45.00 45.00

91. Torch Small (Eveready) 1 110.00 110.00

92. Umbrella 1 400.00 400.00

93. Vicks Inhaler (0.5.ml) 1 50.00 50.00

94. Vicks Vaporub (10.ml) 1 32.00 32.00

95. Washing Brush 1 25.00 25.00

96. Washing Soap 1 10.00 10.00

97. Flask (Milton 500ml) 1 775.00 775.00

98. Whitener 1 30.00 30.00

99. Swimming headgear 1 164.00 164.00

Kit Total Amount 25,000.00

S.No Particulars Qty. Selling Total Price

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C) Admission Kit Materials List for Academic Year 2021-22

KIT FOR CLASS - XI

1. Air Bag 1 500.00 500.00

2. Bath Bucket 1 310.00 310.00

3. Bath Mug 1 80.00 80.00

4. Bath Towel (Regular) 1 100.00 100.00

5. Bath Towel (Terry) 1 300.00 300.00

6. Bed Sheet (Regular) 1 500.00 500.00

7. Bed Sheet (School) 1 500.00 500.00

8. Book Cover (roll of 10.mtrs) 1 49.00 49.00

9. Carpet 1 250.00 250.00

10. Clip Board (Omega Exam Pad) 1 280.00 280.00

11. Dictionary Oxford Adv' learners 1 795.00 795.00

12. Dissection Instruments Box 1 240.00 240.00

13. Games T-Shirt 2 350.00 700.00

14. Head Scarf (School) 1 250.00 250.00

15. Iron Sheet Trunk 1 1,000.00 1,000.00

16. Lock & Key (Medium - 40mm) 1 55.00 55.00

17. Mattress with pillow 1 4,000.00 4,000.00

18. Mosquito Net White 1 350.00 350.00

19. Napkin (Terry napkin) 2 35.00 70.00

20. Note books 11 1,491.00 1,491.00

21. Paint Marker (Yellow) 1 55.00 55.00

22. School bag 1 1,000.00 1,000.00

23. Track Suit 2 750.00 1,500.00

24. Water Bottle 1 775.00 775.00

25. Wool Blanket 1 350.00 350.00

Grand Total : 15,500.00

17

SECTION - IV

Rules and Regulations

Part -I GENERAL INSTRUCTIONS FOR PARENTS / GUARDIANS

1. The following instructions are issued for information to parents/guardians.

(a) All girls in the School are required to wear School Uniform on all days except on Sundays & Holidays.

(b) Parents / Guardians should advise their daughter/ward to abide by the rules and regulations of the School and should not leave the School premises without the prior permission of the Principal. They should also refrain from going to ‘ ’ areas.Out of Bounds

(c) All communications are to be addressed to the Principal, Kittur Rani Channamma Residential Sainik School for Girls, Kittur-591115 Tq: Bailhongal DT: Belagavi Karnataka State .Telephone No. : 08288-234608 / 234605, Mobile No. : 9483501100

(d) All Scholarship holders other than SC/ST are to obtain 65% in each subject and 70% aggregate in the Annual Examinations for the renewal of the same as per promotion rules, failing which, the Scholarship will be withdrawn.

(e) Progress reports for the periodical examinations including the Annual Examination will be forwarded to the Parents / Guardians. Parents / Guardians of the girls whose performance is not satisfactory should exhort their children to study well. While observing the procedure, the Principal will have full powers to carry out withdrawal of the girls on poor academic performance.

(f) If a student is withdrawn at the instance of the Parent during the term, apart from being liable to refund the amount of scholarship till then enjoyed by the girl, she will also be liable to pay School fees for the full academic year. She would further forfeit the Security Deposit if clear TWO months notice for withdrawal before the commencement of the following term is not given by the Parent / Guardian.

(g) Girls are encouraged to write letters to their Parents / Guardians every week. Parents / Guardians are advised to reply to their children regularly and promptly.

(h) Change of address whenever necessary should be communicated to the Principal by the Parents / Guardians immediately.

(i) The School office will be closed on all Sundays & on all Public Holidays.

(j) Annual Day will be celebrated in the month of December / January. Exact date will be intimated to the Parents / Guardians in advance and they will be invited to attend the same. Entry to the School will be for those with School Identity Cards.

(k) All remittances to the school should be made in favour of the Principal, Kittur Rani Channamma Residential Sainik School for Girls, Kittur. Payment through Bank is accepted only in the form of Bank Drafts drawn on Kittur Rani Channamma Residential Sainik School for Girls. If a bank Draft is drawn on other than Canara Bank, SBI, collection charges as well as charges for postage has to be borne by the Parents / Guardians. The school has a Consumer Co-operative Society where all types of items are available. Parents / Guardians may advise their ward to purchase items from Society.

18

Part -II CODE OF CONDUCT FOR CADETS

INTRODUCTION

1. Discipline is the foundation on which an educational institution functions. As future citizens of the country who are also trained to serve the mother land it is incumbent on cadets to develop self-discipline to the highest degree. It should be the endeavor of every student to observe all rules and regulations as a matter of habit rather than for fear of punishment.

2. To ensure that all cadets are made aware of the various nuances of discipline, its effect on one’s personality and character, there is a need to lay down certain guidelines and procedures for the cadets in the form of Code of Conduct that needs to be followed by all for developing self-discipline of the highest degree .

CONDUCT RULES

3. The cadets of the School shall obey the following conduct rules:-

(a) Set highest standards of courtesy, personal conduct and discipline.

(b) Be properly turned out at all times, according to the dress regulations prescribed by the

School.

(c) Be punctual on all occasions and for all parades / periods / meals etc.

(d) Mix well socially, be courteous and respectful to all, and establish good human relations

based on tolerance, sensitivity and goodwill.

(e) Maintain good order and discipline and show obedience to rules and regulations,

orders and instructions passed by the Principal or on his behalf or with his concurrence

by his immediate Junior Officer.

(f) Take notice of and check or report instantly any act of dishonesty, fraud, negligence,

infringement of orders, or impropriety of conduct, committed by other student or a

group of cadets.

(g) Be dignified, polite and temperate in speech, and behaviour.

(h) Pay compliments to seniors and meticulously return compliments paid to you by your

juniors.

(j) Make every effort to prevent theft and report the same immediately.

(k) Be sympathetic and patient to weak cadets.

(l) Remain physically fit to play all games.

(m) Every Cadet must have regard, respect and love for her motherland, the weak and the

down trodden people including universal brotherhood.

(l) Students are expected to return from leave / vacation in time. They are supposed to be in the prescribed dress and should have the school identity card. Similarly parents / guardians are permitted to enter only with school identity cards. In case of late arrival/ improper dress/ parents not in possession of school identity card a fine of Rs. 1000/-, or as decided from time to time, will be imposed.

(m) Application for Transfer Certificate must be submitted at least 10 (ten) days in advance as per format attached (page No. 97 & 99 : English & Kannada ) No TC will be given by hand on the spot.

19

HONOUR CODE FOR CADETS

n I shall not lie, steal or cheat or tolerate those who do so.

n I shall not do anything selfish or mean including letting down my fellow School mates for self interest.

n I shall not, by any action to commission or omission bring the name of this School into disrepute.

n I shall not oppress the weak, rather respect them and care for.

n I shall accept voluntarily my responsibility for infringement of this Code.

7. All cadets will follow the above conduct rules towards smooth administration of the School. All Parents / Guardians and House Teachers will educate the cadets and make them aware of these conduct rules towards developing self-discipline to the highest degree amongst the cadets.

Part -III CODE OF CONDUCT FOR PARENTS / GUARDIANS

1. All Parents / Guardians / legal guardians as per our school records only are permitted to visit the school on all occasions. To maintain high standards of discipline and conduct of the Parents / Guardians visiting the school, following minimum duties / responsibilities are expected on part of the Parents / Guardians:-

(a) Leave : Girl Cadets are not granted any sort of leave during the School session / term. However, Girl Cadets may be permitted to go on leave only in case of medical treatment / extreme emergencies / or other such requirements, hence Parents / Guardians are expected not to frequently apply / request for leave for their daughter. Parents / Guardians seeking medical leave will bring all medical report / documents stating the specific need for such absence from the school. The medical report should clearly indicate the nature of illness, treatment given, period of absence, details of medication required to be continued at the school, and fitness of the child to attend the school. For leave on medical grounds a letter from the Parents / Guardians should be received by the Principal well in time duly communicating all details. For other details refer to Instructions for grant of leave (Part IV).

(b) Second Sundays : Parents / Guardians are permitted to visit the KRCRSSG campus only between 09.00 am to 04.00 pm on Second Sundays. However, firm dates will be intimated to all Parents / Guardians well in advance and Parents / Guardians are requested to visit the school only on permitted days to avoid embarrassment at all levels. Though the visit is intended for the Parents / Guardians to spend quality time with their wards, Parents / Guardians are expected to meet Class Teacher, Subject Teachers, Warden, House Teacher, HM and the Principal to discuss the academic performance and general conduct of their daughter. Parents / Guardians shall take due care to maintain cleanliness of the Campus and any waste materials like paper, plastic bag, disposable food etcetera shall be placed in the waste drums / baskets kept at various places in the campus. Your co-operation in this regard will be highly appreciated. Parents / Guardians are requested not to visit the school on any other day.

(c) Guests \ Relatives : Taking into consideration the safety, security, health and hygiene aspects of all the students, only Parents / Legal Guardians, maximum up to 02 members only will be permitted to visit the school. Guests \ Relatives will not be permitted to enter the school premises. Parents / Guardians are requested to take prior permission well in advance in writing from the Principal to bring the cadets’ aged Grand Parents / Guardians / Relatives / Guests to the school.

20

(d) Snacks / Eatables : Parents / Guardians are requested to ensure that no eatables are brought and given / sent to their wards during their visit to the school on second Sunday or otherwise. This is being done to ensure that the children dont consume fungus infected eatables and also avoid entry of rats, insects, monkeys, dogs, cats etc in the houses.

(e) Parking of Vehicles : Parents / Guardians are also requested to park their vehicles in the earmarked Parking Station. This is being mainly done to provide safety and security to your child in addition to avoid entry of unauthorized people into the campus to meet the students claiming themselves to be Parents / Guardians / relatives. Aged Grand Parents / Guardians if permitted to visit the school by the school authorities will be escorted from parking area to the school mess area by School Bus. On any other day, if the Parents / Guardians are permitted to visit the school, their vehicles will be parked in the allotted parking Station and no vehicles will be permitted towards living areas.

(f) Conduct and Behaviour : Parents / Guardians are requested to maintain discipline of very high order during their visit to the school. Unruly, discourteous, rude and bigheaded behavior by the Parents / Guardians in the campus or with the teachers / Administrative staff will not be tolerated. In case of any defaulters, disciplinary action including expulsion of his / her daughter will be initiated.

(g) Grievances : Grievances, if any, will be brought to the notice of the Principal and if need is so felt, may be submitted to the Principal in writing, and action taken with regard to the same will be intimated to the Parents / Guardians accordingly.

(h) Handling Cash / Valuables : Parents / Guardians are requested not to bring electronic devices, gadgets, cameras etc and / or any other valuable jewelry etcetera into the Campus and hand over the same to their children. Parents / Guardians are also requested and advised not to hand over cash to the warden / house / dormitory teacher for handing over the same to their children. Parents / Guardians are also advised not to give any cash to their ward or any kind of money to the cooperative society staff inside the Campus. The School will not be responsible for any such transaction.

(i) Entry Inside the dormitories : No Parent is permitted to enter inside the dormitory / house area. Those who violate the rules will be penalized.

(j) Visiting the School without Permission : Parents / Guardians are not permitted to visit the school without permission. Parents / Guardians visiting the school without approval / permission will not be entertained and they will be sent back from the School Main Gate itself.

(k) Interaction of the Parents / Guardians with Aayahs / Akkas : Parents / Guardians are requested not to interact with any Aayah / Akka while visiting the school. Parents / Guardians are also requested not to give any cash to the Aayah / Akkas, requesting them to make their ward speak to them (Parents / Guardians) on their personal mobiles during the night hours. Those who violate the rules will be penalized.

(l) Parents / Guardians in possessions of School Identity Cards only are permitted to meet the students.

(m) We expect that the general behavior of Parent should be conventional, socially acceptable, polite and civilized. Any thing contrary to this instruction will amount to serious action.

21

Some Do,s and Don’ts for the Parents / Guardians are as under :

DOs FOR PARENTS / GUARDIANS

n Ensure your child reports to the school in time at the time of joining, after all vacations and after

leave when ever granted.

n Ensure your child reports to the school with proper kit and clothing items and proper uniform.

n Ensure timely payment of school fee and other dues.

n Ensure your child does all her assigned vacation homework. Assist her in completing the same.

n To the extent possible talk to your child in English.

n Try and instill in your child the MORAL VALUES and a respect for our rich heritage.

n Teach her compassion and humaneness.

n Meet your child’s teachers every time you are permitted to visit the school and check on her

progress being made.

n Closely watch your child’s language. Ensure she uses refined and appropriate expressions.

n Instill in your child a love for school and home properly.

n Tell your child that it is more honourable to fail than to cheat in exams.

n Help your child develop an all round personality. Encourage participation in various activities.

n Inculcate in your child respect for Teachers and our National Symbols.

n To discipline children, make them feel good about themselves.

n Treat children with respect and they will learn, by example, to reciprocate.

n Be calm and assertive when disciplining your child, especially in the pre-teen years.

n Kids need a clear set of rules to grow up with which perhaps they may rebel against.

n Be an authoritative parent, not an authoritarian one.

n Allow kids to express themselves. See life through their eyes.

n Help your child accept failure alongside success.

n Make your child feel wanted.

DON’Ts FOR PARENTS / GUARDIANS

n Don’t encourage criticism of school and teachers by your child.

n Don’t talk ill of others in front of your child.

n Don’t encourage too much of TV viewing.

n Don’t play with emotion of your child. Help her to sublimate them.

n Don’t let your child fall in bad company and bad habits.

22

n Don’t give pocket money to your child, beyond the fixed limit.

n Don’t force your child into embarrassing social situations. Explain to her your compulsion if

any.

n Don’t treat your child like an adult. Treat him / her like child.

n Don’t undermine your child’s achievements.

n Don’t always discipline your child. May be we, as Parents / Guardians also need some

discipline.

n Don’t rebuke your child for lack of certain skills.

n Don’t punish your child for misbehaving or being self – absorbed.

n Don’t take your child’s good conduct for granted.

Part -IV INSTRUCTIONS FOR GRANT OF LEAVE TO CADETS

INTRODUCTION

1. To ensure that the Cadets of the school do not suffer any academic loss, as a matter of policy the

Cadets are not granted any leave when the school session is on except for emergencies. But at

times Parents / Guardians do come up with requests for grant of leave to their wards for some or

the other reasons such as marriages or any other functions in the family.

2. To ensure that all Parents / Guardians, House Teachers, other Members of the Staff and students

are aware of the procedural aspects to be followed for grant of leave to them, there is a need to lay

down proper guidelines and procedures that need to be followed by all concerned i.e. right from

the parent applying for leave, getting it approved and then proceeding on leave, there by

ensuring smooth and efficient functioning.

AIM

3. The aim of these instructions is to lay down proper guidelines and procedures to be followed by

Parents / Guardians & students for grant of leave to the students.

GUIDELINES & PROCEDURE

4. As per the policy of the School leave to all cadets is not granted during the school session except, in case of

emergencies. NO LEAVE WILL BE GRANTED ON cadet’s request.

5. For seeking leave, a letter from the Parent should be submitted / emailed (scanned copy only)to the

Principal well in time duly communicating the reasons and duration.

6. The application submitted should clearly indicate whether the girl child is being escorted by the Parent /

Legal Guardian, or any escort has to be provided by the School. All expenditure incurred towards

escortship of the student will have to be born by the Parent.

7. In all other cases except emergencies, leave will only be restricted to two days’ stay at home plus traveling

time. In case of emergencies, the duration may be extended as per the merit of the case, but submission of

application for grant of leave is mandatary.

8. No leave will be granted for family functions, rituals, home warming, marriages of cousins, uncle, aunt

etc. Leave can be granted for marriages only of real brother / sister. No leave will be granted for

engagement etc.

9. All requests for leave except on emergencies must be sent at least two weeks in advance. All cadets will

make their Parents / Guardians aware of the school calendar including examination schedule.

10. On receipt of the leave application by the School, the same will be processed as follows:-

(a) Leave application will be handed over to the cadet concerned.

(b) Cadets will obtain the comments/recommendations of the House Teacher, Warden and

Headmistress, on the leave application. In case of Medical leave, the same will be forwarded to the

School Resident Medical Officer (RMO) by the House Teacher / Warden for her recommendations.

(c) After all recommendations House Teacher/Warden will obtain the recommendations of the

Headmistress and finally approval of the Principal on the leave application.

(d) On accord of approval, the House Teacher/Warden will submit the leave application to the

Headmistress through Admission Section for issue of leave certificate. Leave certificate will only be

signed and issued by the Principal.

11. Leave certificate duly signed by the Principal will be forwarded to the House Teacher/Warden by the

Admission Section. The House Teacher/Warden in turn will hand over the leave certificate to the

students on due date & time, after confirming details with regard to the escort as per Para 6 and 7 above,

with the Gate Pass. In case of emergencies, Leave Certificate may be signed by the Head Mistress, but

details of the same will be immediately informed to the Principal at a later stage.

12. On expiry of leave period, the student duly escorted will report to the House Teacher / Warden. Only after

obtaining necessary permission / approval of the House Teacher / Warden the student will be permitted to

enter the House. GIRLS WILL REPORT TO THE HOUSE TEACHER / WARDEN IN THE MAIN

SCHOOL BUILDING ON RETURN FROM LEAVE. Parents / Guardians VISITING THE SCHOOL FOR

PICKING / DROPPING THEIR DAUGHTER / WARD WILL REPORT TO THE SCHOOL ONLY

DURING WORKING HOURS. THEY WILL NOT (NOT) VISIT THE DORMITORIES.

13. All are requested to follow the above guidelines and procedures towards smooth administration of the

School. All House Teachers / Wardens will educate the parents, whenever they visit the School and make

them aware of the procedures to be followed for grant of leave to cadets.

14. Parents / Guardians are also requested to refer to undertaking given at Appendix - Y

SECTION - V

MEDICAL EXAMINATION BY DISTRICT SURGEON

Though your daughter / ward had been examined by the School Medical Examination Board, deputed by the

School for this purpose at the time of Interview, a detailed medical examination of the girl by the District

Surgeon, is compulsory. Medical Fitness Certificate as per Proforma at Appendix ‘P’ will be submitted at the

time of admission. Admission will be denied, in the absence of Medical Fitness Certificate or if a girl child is not

found medically fit in the medical examination conducted at the time of admission.

23

Place : _____________________

Date : _____________________

Appendix-‘A’(Refer Page-6, Para 6)

PROFORMA ACKNOWLEDGMENT OF RECEIPT OF JOINING INSTRUCTIONS

From :

___________________________,

___________________________,

___________________________,

___________________________,

To:

The Principal,

Kittur Rani Channamma Residential

Sainik School for Girls,

A/P Kittur-591115

Tq: Bailhongal, Dt: Belagavi

Karnataka State.

JOINING INSTRUCTIONS: Academic Year 2021-22 (NEW ADMISSIONS)

Dear Sir,

1. Reference is made to your Letter No. KRCRSSG / JI / AY 2021-22, Dated ____ April /

May 2021

2. This is to confirm that I, the father/guardian of Kumari _________________________

________________________________, Hall Ticket No. ___________________

will report to School at _________hours on _____ April / May 2021 for admission to

Class VI / _______ after fulfilling all requirements as stipulated in the joining

instructions.

Yours faithfully,

Signature of the Parents/Guardian

Name in full____________________________________

_______________________________________________

Cell No. ____________________________________

24

25

Appendix-‘B’ (Refer Section - I, Note 5)

Place : _____________________

Date : _____________________

Signature of the Parent / Guardian

Name in full : __________________________________

Address :______________________________________

______________________________________________

______________________________________________

Cell No.: ______________________________________

26

UNDERTAKING

(UNDERTAKING BY PARENTS/GUARDIANS IN CONNECTION WITH REALISATION

OF ENHANCED SCHOOL FEES IN RESPECT OF THEIR DAUGHTERS/WARDS)

I, _______________________________________________________ Father/Guardian of Hall

Ticket No. ____________ Kumari _______________________________________, do hereby

undertake to pay the increase in School Fees as revised by the Board of Governors, Kittur Rani

Channamma Residential Sainik School for Girls, Kittur (Karnataka), from time to time in

respect of my daughter/ward till completion of her studies in the School.

27

INDEMNITY BOND

In consideration of my daughter/ward Hall Ticket No.___________

Name ____________________________________________ being allowed at my request for the

travel during winter / summer vacation or during organized Educational Tours / Excusion and

when called at my request on emergency with or without escort, I undertake and agree that

neither me nor my executor nor administrator will make any claim against the Government of

India / Government of Karnataka or against any Officer, Instructor or any person in the service

of KRCR Sainik School For Girls, Kittur, in respect of any loss or injury including the death

which she may suffer during the travel during winter & summer vacations or during any

organized trips like educational tours / excursion and when called at my request on emergency

with or without escort. I also understand that no compensation will be paid by the

Government of India / Government of Karnataka for any loss or injury including death and I

agree so as to bind my self, executors and administrators to indemnify the Government of India

/ Government of Karnataka or Kittur Rani Channamma Residential Sainik School for Girls,

Kittur, against any such claims.

Yours faithfully,

Signature of the Parents / Guardian

Name in full : __________________________________________________________________

Date : _________________________, Cell No : ____________________

Signed by Parent/Guardian in my presence:

WITNESS:

(1) ________________________________ Date: ____________________________

Name: ___________________________________

Address:_________________________________

Place :__________________________ _________________________________________

Date : __________________________ Cell No. : __________________________________

(2)________________________________ Date: ____________________________

Name: ___________________________________

Address:_________________________________

Place :__________________________ _________________________________________

Date : __________________________ Cell No. : __________________________________

28

Appendix-‘C’(Refer Section -II, Para 1(a))

29

RISK CERTIFICATE

In consideration of my daughter/ward Hall Ticket No._____________________

Name ___________________________________ being allowed at my request to learn

swimming in the KRCR Sainik School for Girls Swimming Pool, and to further participate in

swimming, shooting, NCC Training, School Training activities including horse riding

activities. I hereby, undertake and agree that neither me nor my executor nor administrator

will make any claim against the Government of India / Government of Karnataka or against

any Officer, Instructor or any person in the service of Kittur Rani Channamma Residential

Sainik School for Girls, Kittur, in respect of any loss or injury including the death which she

may suffer during the above training activities and I understand that no compensation will be

paid by the Government of India / Government of Karnataka for any loss or injury including

death and I agree so as to bind myself, executors and administrators to indemnify the

Government of India / Government of Karnataka or Kittur Rani Channamma Residential

Sainik School for Girls, Kittur, against any such claims.


Name in full : __________________________________________________________________

Cell No:______________________, Place :_________________________, Date :____________

Signed by Parent/Guardian in my presence:

WITNESS:

(1) ________________________________ Date: ____________________________

Name: ____________________________________

Address:__________________________________

__________________________________________

Cell No.: __________________________________

(2)________________________________ Date: ____________________________

Name: ___________________________________

Address:_________________________________

_________________________________________

Cell No.: __________________________________

30

Appendix-‘D’ (Refer Section -II, Para 1(a)

31

Annual Income (Self)

1. From Salary/Pension (only Basic) Rs. ____________________________

2. Other Sources

(a) Type of Business : __________________________________________

(b) Business Rs. ____________________________

(c) Property Rs. ____________________________

( d) Agriculture Rs. ____________________________

(e) Investments Rs. ____________________________

(f) Miscellaneous Rs. ____________________________

Note : If there is no income from any other source, write NIL against the heading instead of

drawing a line or dash.

Total Income: Rs________________ (in words) _______________________________________

__________________________________________________________________________

3. Average Monthly Income (in figures) Rs. ___________________________(in words)

Rs. _______________________________________________________________________ (Please divide the Annual Income by 12)

Place : _____________________

Date : _____________________

Yours faithfully,

Signature of the Parent /Guardian

Name & Address : ___________________________________, Cell No.: ________________

CERTIFICATE OF INCOME [PERFORMA AFFIDAVIT]

(Incomplete/illegible/over written affidavit and certificate will not be accepted)

I, __________________________________________ (Name of Parent/ Guardian

in Capital) Daughter of Kumari _____________________________________________________

_________________resident of ___________________ Mandal / Taluka ___________________

District ____________________ hereby solemnly declare on oath that the particulars of income

in respect of self are furnished below for the financial year 2020-21 (from 01, April 20 to 31,

March 2021) are true to the best of my knowledge and belief and no income has been

omitted/concealed.

Further, I agree that in case the income is found to be more than that furnished

below, I shall be liable to refund the entire amount of Scholarship availed / enjoyed by my

daughter/ward and / or any other penalty as may be imposed by the Scholarship granting

authority.

32

Appendix-‘E’ (Refer Section - II, Para 4

33

II-CERTIFICATE OF INCOME

(To be produced by Parents who are Ex-Servicemen)

(To be issued by a Revenue Officer not below rank of Taluka / Mandal Revenue Officer of

the Place of Residence of the Parent)

Certified that the Monthly Income of Shri / Smt ________________________________

_______________________________________of ____________________________(place) as

verified by me is (in figures) * Rs.______________ /- (in words) ________________________

_________________________________________________ during the Financial year 2020-21.

Signature in full _______________________________

Name of the Officer ____________________________

Designation __________________________________

Place : __________________

Date : __________________

OFFICE SEAL

* Here the income to be mentioned is monthly and NOT annual income please. In case of

salaried people, only basic pay is to be treated as Income.

34

Appendix-‘F’-1, Refer Section II

Para 5(b)

35

CERTIFICATE

(Non receipt of any Financial Assistance in respect of Ex-Serviceman)

I hereby certify that I am not in receipt of any scholarship or financial assistance from any

source towards the education of my daughter / ward Kumari ___________________

_________________________ Roll No : _______________ admitted during the year 2021-2022 to

the Kittur Rani Channamma Residential Sainik School for Girls, Kittur (Karnataka).

Place : _____________________

Date : _____________________


Name in full : __________________________________

Address :______________________________________

______________________________________________

______________________________________________

Cell No.:______________________________________

36

Appendix ‘F’

(Refer Section -II, Para

5(a) (iii) and (b)(iv))

37

DECLARATION BY PARENT / GUARDIAN

[REGARDING PARTICULARS ENTERED IN THE ENTRANCE

EXAMINATION APPLICATION FORM]

1. I, Mr. / Mrs. _______________________________ of ______________________

Village/Town/City ________________________________ Taluk __________________

District _______________, Father/Guardian of Kumari ___________________________

____________________________________ Hall Ticket No. _________________ do hereby

solemnly declare that :

(a) The above named daughter/ward of mine has applied and appeared in the Examination

for admission to Kittur Rani Channamma Residential Sainik School for Girls, Kittur for the

first time in the month of February 2021

(b) The particulars given by me in the Application Form submitted for the above Examination

in respect of the said girl are true and no information asked to be given has been concealed.

2 In the event of any information having been found incorrect at any time, I undertake to

refund the full amount of the Scholarship enjoyed by my daughter/ward immediately, on

demand and without demur and will have no objection to my above named daughter /

ward being immediately removed from the School.

Place : _____________________

Date : _____________________


Name in full : __________________________________

Cell No.:______________________________________

38

Appendix ‘G’(Refer Section -II, Para 11)

39

Place : _________________, Date :_______________ Signature of the Parent / Guardian

Name & Address : _______________________________________, Cell No.:______________

40

Appendix ‘ H’, (Refer Section -II, Para 11)

DECLARATION BY PARENT / GUARDIAN

[REGARDING PROPERTY, EMPLOYMENT AND FAMILY PARTICULARS]

1. I, __________________________________________________Father / Guardian of Hall

Ticket No. ____________ Name _______________________________________

hereunder furnish full details of the Land and other immovable properties held by me

including and upto the Finacial year 2020-21

(a) Land Survey No. Dry/Wet Extent

(b) Other Properties :

2. I further furnish the following information pertaining to my employment during the

year 2020 - 2021

(a) Nature of Employment & Designation : ___________________________

(b) Basic Pay drawn : Rs._________________________

(c) Place of employment : ____________________________

(d) Full Address of the employer : ____________________________

3. DETAILS OF FAMILY (including grand parents - maternal & paternal)

4. I hereby solemnly declare that the information furnished above is true to the best of

my knowledge and belief and that nothing is kept concealed.

Age Relationshipwith student

Date of Birth OccupationNameSl.No.

41

ADDRESS PARTICULARS

Name of the Student : ___________________________________________________________

(IN CAPITALS)

Full Postal Address : House No._______________________________________________

Street ___________________________________________________

Village __________________________________________________

Post _____________________________________________________

Taluk ___________________________________________________

District __________________________________________________

State ____________________________________________________

Pin Code ______________________________________________

Nearest Railway station _________________________ Distance from the Place of residence:

___________________ Kms.

Telephone No. where the Parent / Guardian can be contacted:

Land Line ______________________ (With STD Code)

Mobile No ______________________

E -mail ID :_________________________________________

Telephone No. where the Local Guardian can be contacted:

Land Line ______________________ (With STD Code)

Mobile No ______________________

E -mail ID :_________________________________________

I request communications pertaining to student Kumari, ____________________________ be

sent to the above address. Any change in Address / Contact Nos will be notified as and when

necessary.

Place : _________________ (Signature of the Parent/Guardian)

Date : _________________ Name : ______________________________

Mobile No. __________________________

42

Appendix ‘I’Refer Section -II, Para 12

43

Form To

Year of StudyComplete Name &

Address of the School

Year of

PassingClasse

Studied

1stSTD

STUDY DETAILS Appendix-‘J’( Refer Section-II Para 13 )

Telephone Number of the Institution with STD Code :

Form

Form

Form

Form

To

To

To

To

Year of Study

Year of Study

Year of Study

Year of Study

Complete Name &


Complete Name &


Complete Name &


Complete Name &


Year of

Passing

Year of

Passing

Year of

Passing

Year of

Passing

2ndSTD

3rdSTD

4thSTD

5thSTD





44

ClasseStudied

ClasseStudied

ClasseStudied

45

Form To

Year of StudyComplete Name &


Year of

PassingClasse

Studied

6thSTD


Form

Form

Form

Form

To

To

To

To

Year of Study

Year of Study

Year of Study

Year of Study

Complete Name &


Complete Name &


Complete Name &


Complete Name &


Year of

Passing

Year of

Passing

Year of

Passing

Year of

Passing

7thSTD

8thSTD

9thSTD

10thSTD





Declaration : We declare that the aboveinformation is true and correct to the bestof our knowledge and belief Signatures of Father & Mother

Cell (F) :______________________, Cell (M):______________________Place : ___________________________

Date : ________________

FAT

HE

R

MO

TH

ER

ClasseStudied

ClasseStudied

ClasseStudied

Off

ice

Co

py

3. Authorised Guardian and Name in Full and Relationship:

Name in full : ______________________________________________________________________

Occupation:________________________________________________________

(In detail if in Service)

Income: ____________________________________________ (Per Annum)

Specimen Signature: 1______________ , 2._______________, 3.___________

Mobile No.______________________, Email :____________________________________________

Parent's Address for correspondence

Name of the Parent_______________________________________

Permanent Address _______________________________________

_______________________________________________________

Email ID :_______________________________________

Place : Date : Signature of the Parent:

Name : ______________________________

Mobile No :____________________________

Appendix-‘K’ (Section II Para 14)

IDENTITY CERTIFICATE OF PARENT / GUARDIAN

Candidate’s Name Kum:_________________________________________________

Date of Birth & Place:___________________________________, Caste/Religion:____________________

Mother Tongue:___________________, Blood Group _________,Roll No_____________,Class/Div_______

Date of Admission__________________House_____________________FFP/Merit______________


1. Father's Name (in full)_______________________________________________________________

Occupation:_________________________________________________


Income: ____________________________________________ (Per Annum)


2. Mother's Name (in full)_____________________________________________________________

Occupation:________________________________________________


Income: ____________________________________________ (Per Annum)


Affix Latest Color

Photograph of

the Father

(stamp size)

Affix Latest Color

Photograph of

the Mother

(stamp size)

Affix Latest Color

Photograph of

the Authorised

Guardian

(stamp size)

Affix Latest Color

Photograph of

the Candidate

(stamp size)

Note : Please do not change your Mobile Number until your Daughter finishes her education in this Institution. 46

STD Code: ___________________

Landline : _____________________

Mobile 1 ____________________

2 ____________________

3 ____________________

47

Ho

use

Co

py

48

3. Authorised Guardian and Name in Full and Relationship:

Name in full : ______________________________________________________________________

Occupation:________________________________________________________


Income: ____________________________________________ (Per Annum)


Mobile No.______________________, Email :____________________________________________

Parent's Address for correspondence

Name of the Parent_______________________________________

Permanent Address _______________________________________

_______________________________________________________

E-mail : _________________________________________________

Date : ______________, Place : ______________________________

Signature of the Parent

Appendix-‘L’ (Section II Para 14)

IDENTITY CERTIFICATE OF PARENT / GUARDIAN

Candidate’s Name Kum:_________________________________________________

Date of Birth & Place:___________________________________, Caste/Religion:____________________

Mother Tongue:___________________, Blood Group _________,Roll No_____________,Class/Div_______

Date of Admission__________________House_____________________FFP/Merit______________


1. Father's Name (in full)_______________________________________________________________

Occupation:_________________________________________________


Income: ____________________________________________ (Per Annum)


2. Mother's Name (in full)_____________________________________________________________

Occupation:________________________________________________


Income: ____________________________________________ (Per Annum)


Affix Latest Color

Photograph of

the Father

(stamp size)

Affix Latest Color

Photograph of

the Mother

(stamp size)

Affix Latest Color

Photograph of

the Authorised

Guardian

(stamp size)

Affix Latest Color

Photograph of

the Candidate

(stamp size)

Note : Please do not change your Mobile Number until your Daughter finishes her education in this Institution.

STD Code: ___________________

Landline : _____________________

Mobile 1 ____________________

2 ____________________

3 ____________________

49

Place : _____________________

Date : _____________________

Signature of the Parent /Guardian

Name :

Cell No.:______________________________

50

Appendix-‘M’(Refer Section-II, Para 15)

TRANSLATION OF CERTIFICATE

(As per Previous School TC)

I hereby declare that the Transfer Certificate of my Daughter / Ward

Kumari ______________________________________has been issued in Kannada.

Important details of the Transfer Certificate duly translated in English are as given below

( Please write all details in CAPITALS with correct spelling ). If TC issued in English also

write the details

1. Candidate's full name

2. Father's name

3. Fathers occupation

4. Mother’s name

5. Mother’s occupation

6. Caste and sub caste

7. Place of birth

8. Date of birth (In figures and words)

9. Name & Full Postal Address of the school issuing Transfer Certificate

51

52

Appendix-‘N’

(Refer Section -II Para 16)

AGREEMENT BOND TO BE EXECUTED BY PARENTS / GUARDIANS FOR ADMISSION TO KRCRSSG, KITTUR Dt.Belagavi

1. To be Executed on Non Judicial Bond Paper of Rs. 100/-

2. To be Compulsorily Executed Before Taking Admission

BOND OF UNDERTAKING

I, _____________________________ S/O or D/O or W/O_________________ aged about _______ years __________ residing at ______________ hereinafter referred to as the 'Guarantor' do here by undertake and bind myself as detailed in this bond of undertaking on this the _____ day of __________ (month)________ year, at Kittur, Dt: Belagavi.

Whereas, I wish to admit my daughter/ward Kum.______________________________ ________________________ hereinafter referred to as the 'Student', to the Kittur Rani Channamma Residential Sainik School for Girls, Kittur, run by the Kittur Rani Channamma Memorial Committee, Kittur, a registered Society and hereinafter referred to as 'Society'. The Kittur Rani Channamma Residential Sainik School for Girls, Kittur is hereinafter referred to as 'Institution' and it shall mean the Residential School wherever the context so requires.

Where as, the Institution is Residential in nature.

Whereas, at the request of the Guarantor, the student has been selected for admission in the institution, on the terms and conditions as may be gathered from the Prospectus and on the following specific undertaking of the Guarantor :

Undertaking / Terms and Conditions :

1. The Guarantor shall make payment of all the fees and charges, before the specified dates, to the Institution. The Guarantor accepts that the fees and charges may be increased by the Board of Governors, Kittur Rani Channamma Memorial committee, Kittur, to maintain and keep up to the standards (in teaching, administration and infrastructure) of the Institution. The Guarantor agrees to pay such additional fee or charges levied, within such time as stipulated.

2. If at any time after the admission it is found that any of the documents like the proof of domicile, certificate of age / date of birth, caste certificate, income certificate, or any certificate / document required for the purpose of admission or proof of whatever nature, of the Student, is / are found to be false, then the Student shall be removed from the rolls of the Institution (even during the currency of the academic year) at the sole discretion of the Principal of the Institution. In such a situation Transfer Certificate will be issued only after payment of all the fees and charges and there shall be no refund of any fees or charges whatsoever, paid earlier.

3. That, as stipulated in item No. 1 above, the Guarantor undertakes to make payment of all the fees and charges to the Institution in one Installment before specified date. In default, the Principal of the Institution may levy penalty and if necessary may order for the removal of the Student from the Institution.

4. That, the Guarantor agrees to defray the costs of any co-curricular or extra-curricular activities as may be introduced by the Institution and as specified from time to time.

53

5. That, the Guarantor authorizes the Institution to deduct any fees or / and other charges from the Student's Pocket Money Account.

6. The Guarantor fully understands and agrees that the Student's continuance in the

Institution is subject to her passing previous year's examination, as per the promotion

policy of the school otherwise the T.C. shall be issued. The Guarantor shall abide by the

decision of the Principal in this regard.

7. That, the Guarantor agrees and abides by the decision of the Principal on any matter pertaining to the indisciplined behavior of the Student and he agrees and undertakes to abide by the decision of the Principal to impose / levy such penalty, including the penalty of removing the Student from the Institution.

8. That, if the Student causes any damage to any property of the Institution / Society, the Guarantor shall make payment of the necessary costs as may be fixed by the Principal of the Institution, immediately on demand. In default, the Principal may take such necessary action, including deducting the costs from the Pocket Money Account of the Student or removing the Student from the Institution or withholding of Transfer Certificate till such time the costs as specified are not paid.

9. That, if at any time after the admission of the student it is found that the student is suffering from any disease / ailment / physical incapacity, which affects the student's participation in the Curricular, Co-Curricular or extra-Curricular activities and the lodging and boarding environment of other students of the Residential School , the Principal may order for the removal of the student from the institution and fees / or charges will not be refunded whatsoever.

10. The Guarantor agrees that the Board of Governors, the Society, the Principal or the Institution shall not be liable for any damages / costs / charges / compensation on account of any injury, including those resulting in disability, fatality, etc. which may be sustained by the Student, while participating in any Curricular, Co-curricular, Extra-Curricular, Sports, Swimming, Horse Riding, Rock Climbing, Mountaineering, Cycling, Excursions, Educational cum Motivational Trips, Adventure Activities etc. The cost of treating the injury / injuries or any other charges shall be borne solely by the Guarantor and any charges / damages / costs if borne by the Institution / Society due to emergency purposes the Guarantor undertakes to reimburse / indemnify to the Institution / Society immediately on demand.

11. The Guarantor hereby gives consent to the institution to take the student for any trip, ExcursionTours, Sports Meet, Adventure Activities, etc. In case of any injury/fatality to/of the student, during such activities, the Guarantor agrees that the institution/Society is not responsible or liable in any way. The Guarantor authorizes the institution to give consent as Guardian of the student for such trip / tours /activities / Medical Treatment etc to any Government / authority, if required.

12. The Guarantor hereby authorizes the Principal or any other authority of the institution / Society to sign and act as Guardian of the student, in and on all certificates, documents connected with the various examinations (like JEE/NEET/CET/ Comed-K etc.)

54

13. The Guarantor agrees that in the event of the student not attending / joining the institution or withdrawing from the institution for reasons whatsoever, the fees and charges or part there of shall not be refunded and in case there is any balance to be paid to the institution with regard to the fees and /or other charges, the Transfer Certificate will be issued only after the clearance of all the dues. The balance to be paid to the institution may also be deducted from the Pocket Money Account of the student and the remaining balance if any, in the said Pocket Money Account will be refunded. The Guarantor agrees and undertakes that he/she or the student shall not be entitled to any refund of any fees or charges whatsoever, if the Guarantor/ Student withdraws from the institution for reasons whatsoever or is removed from the institution.

14. That the guarantor understands and agrees that it shall be the responsibility of the Parent/Guardian/Guarantor to escort the student to and from the institution on vacation breaks, permitted leave period etc,. If this is not possible for unavoidable reasons, a close relative of the student will be sent for this purpose, with a letter of authority of the Guarantor /Parent and a signed photo of such close relative will be affixed on the letter of authority.

15. In addition to the above, in case if a student admitted to the School under the Merit Scholarship Scheme, the Guarantor further agrees and undertakes as follows :

(a) That, the student shall study in the institution till the completion of Class XII Science Stream); and with subjects as available at school / college. If for any reason, not beyond the control of either the student or the Guarantor, the student fails to continue her studies at the said School till the completion of the Class XII (Science Stream); the Guarantor shall forthwith refund the entire value of the Govt. Merit Scholarship received by the student for the period she was at this School in the form of an Account Payee Demand Draft in favour of Principal, KRCRSSG, Kittur, and the student will be removed from the rolls of the School. If the amount becoming so due is not paid, the Transfer Certificate will not be issued to the student, till such time it is paid.

(b) That, the balance of fees and other charges which are not covered under the merit Scholarship shall be paid to the institution on or before the stipulated date.

16. The Guarantor understands and agrees that the Principal /Institution/Board of Governors / Society are entitled to take any decision in the interest of student and / or the institution on the matters not covered in this Bond of Undertaking and the Guarantor and the student shall abide by it.

17. The Guarantor hereby agrees that, if there is any dispute with regard to any of the matter covered herein, matters regarding the admission, continuation, residence, food, accommodation, amenities, facilities, curricular, co-curricular, extra- curricular activities, removal of the student from the institution, fees, charges, penalties, issuance or non issuance of transfer certificates, then it shall be referred to a sole arbitrator as appointed by the Board of Governors. The decision of the Arbitrator shall be final and binding on all the parties concerned including the Guarantor / Student/ Parent / Guardian and the institution. The provision of the Arbitration and Conciliation Act, 1996 shall apply. The place of Arbitration shall be decided by the Board of Governors, in consultation with the Arbitrator, which shall be final and shall bind the Guarantor/ Student/ Parent/ Guardian or any person/ authority on behalf of the student.

55

18. If the Student leaves the school without the Guarantor paying full fees, Principal is authorised to take any suitable legal action on the Guarantor / Cadet for the costs and consequences where the Guarantor alone is liable / responsible.

19. If Guarantor meets personally to Cadet, and hands over her any medicines, tablets, syrups and any eatables without knowledge of the School Doctor, then the Guarantor is fully responsible for act of Cadet / Guarantor if any thing happens to the Cadet.

20. Guarantor is fully aware and agrees that on alternate Second Sundays / Parents Meet only Father / Mother is allowed to meet Cadet, no relatives will be allowed inside the Campus.

21. The entire fees will have to be deposited by the student in one lump sum at the time of admission and thereafter every year at the beginning of the academic session as per communication sent by the Accounts Section of the School. A penalty @ Rs. 100/- per day will be levied for late deposit of fees.

22. In case where the Parent of merit Scholarship holder requests for the pre mature withdrawal of the student from the School on medical grounds, i.e. before completion of class XII, such proposal will be referred to a medical counsel appointed by the School, to examine the ailment and issue a second medical opinion, it is final and binding on the parent to stand by such opinion of the Medical Counsel.

23. Should the School be required to consult any medical/legal authority for any dispute arising due to pre mature proposal by the Parent of merit Scholarship holder requesting for issue of the Transfer Certificate, all the costs incidental to the services availed from such medical / legal or any other professional will be borne by the concerned parent only.

24. The Guarantor hereby agrees and undertakes that, except the place of Arbitration as may be decided as specified in the paragraph above, all disputes, including consumer disputes, are subject to the Courts / Forums / Authorities in the Kittur Dist. Belagavi jurisdiction only. That, the contents of this Bond of Undertaking have been read over to the Guarantor in his/her vernacular language and the Guarantor has understood the same and has after understanding and accepting/ agreeing for the same, has put his/ her signature to this Bond of Undertaking, thereby binding himself / herself to the undertakings / terms and conditions as specified herein.

IN WITNESS WHEREOF, the said Guarantor __________________________has set his / her

hand on the day, month and year here in first above mentioned, at Kittur, Dist: Belagavi.

SIGNATURE OF THE GUARANTOR

Parent(Father/Mother) / Legal Guardian of the Student)

Witnesses:

1) _______________________________, 2) _______________________________

Name : Name :

Cell No.: Cell No.:

(Photograph of

the Guarantor

(Father /

Mother) to be

affixed and

signed across.)

56

Certificate of the Notary:

I certify that I have verified the identity of the Guarantor and I hereby attest that the Guarantor has

affixed his / her signature / thumb impression to this document, in my presence.

(Signature of the notary with the seal)

Place : Name of the Notary _______________

Date :

Signature of The Principal ________________________________________________ (Name)

Kittur Rani Channamma Residential Sainik School for Girls, Kittur -591 115, Dist: Belagavi

On behalf of Board of Governors,

¸ÀÆZÀ£ÉUÀ¼ÀÄ :

1) E ¸ÁÖA¥ï£ÀÄß «zÁåyð¤AiÀÄ vÀAzÉ/vÁ¬Ä/¥ÉÆÃµÀPÀgÀ ºÉ¸Àj£À ªÉÄÃ¯É

vÀUÉzÀÄPÉÆ¼Àî¨ÉÃPÀÄ.

2) - «zÁåyð¤AiÀÄ vÀAzÉ/vÁ¬Ä/¥ÉÆÃµÀPÀgÀ ¥ÀÆtð ºÉ¸ÀgÀÄFirst Party

3) Second Party - Principal KRCRSSG, Kittur, Belagavi

57

58

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ÀÄ ÀÆ ÀÄ£Á£ (¥ tðºÉ¸Àg )_______________________________________________ ª i ¸ ì__________ªÀµð, Hg :____________________________, E£ ß ª zÉ " wæzÁgÀg " z ÀA ÀÄ ÀÄ ÀÀ ÀÄ ÀÄ ÀÄÄA SÁ ÀÄ JA ÀÄ

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ÀÄ ÀÄUÀ ÀÄ ÀA PÀÄ£Á£ £À£Àß ª ¼ /¸ §A¢üAiÀiÁzÀ ||_______________________________________________ EªÀ¼À£ ß ªÀw¬ zÀ £Àq i ªÀ Qv gÀ ±Á¯ i °è z ¯Áw¸ wÛz £É. E£ ß ª zÉ £À£Àß ÀÄ KRCMC ÄA ÉA ÀÄÄ KRCRSSG ÀÆÛ ÉA ÀÄ ÁR ÀÄ ÉÝÃ ÀÄ ÀÄÄAª ¼À£ ß "«zÁåyð¤" z ¥Àj tÂ¸À¯ zÉ. £ zÁ¬ÄvÀ ̧ ¸ n Ez ¤«Äv EzÀ£ ß "¸ ¸n" z ÀÄUÀ ÀÄ JA ÀÄ UÀ ÁV KRCMC ÉÆÃA ÉÆ ÉÊ ÀÝ ÀÛ ÀÄ ÉÆ ÉÊ JA ÀÄ¥Àj tÂ¸À¯ zÉ. F ̧ ¸ i ªÀ¸Àw ̧ À»vÀ ±Á¯ iÀi zÉ.UÀ ÁV ÀA ÉÜA ÀÄÄ ÉA ÁV

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23) MAzÀÄ ªÉÃ¼É «zÁåyðªÉÃvÀ£À ¸Ë®¨sÀå ºÉÆA¢zÀ «zÁåyðAiÀÄ ¥Á®PÀgÀÄ ºÀ£ÉßgÀqÀ£ÉAiÀÄ ªÀUÀðzÀ ªÀgÉV£À ªÁå¸ÁAUÀªÀ£ÀÄß ªÉÆlPÀÄUÉÆ½¹, ªÀUÁðªÀuÉ ¥ÀvÀæPÁÌV «£ÀAw¹zÀ ¥ÀPÀëzÀ°è ±Á¯ÉAiÀÄ ¥ÁæZÁAiÀÄð / DqÀ½vÀ ªÀUÀð F ¸ÀA§AzsÀ AiÀiÁªÀÅzÉÃ ªÉÊzÀåQÃAiÀÄ / PÁ£ÀÆ£ÀÄ CxÀªÁ EvÀgÉÃ ªÀÈwÛ¥ÀgÀgÀ£ÀÄß ¸ÀA¥ÀQð¸À®Ä C¢üPÁgÀAiÀÄÄvÀgÁVzÀÄÝ, EAvÀºÀ ¸À¤ßªÉÃ±ÀUÀ¼À°è vÀUÀÄ®ÄªÀ RZÀÄð, ªÉZÀÑUÀ¼À£ÀÄß ¨sÀj¸ÀÄªÀ ¸ÀA¥ÀÆtð ºÉÆuÉAiÀÄÄ SÁwðzÁgÀgÀzÀÄÝ ªÀiÁvÀæªÁVzÉ.

24) ªÉÄÃ°£À 17 £ÉÃ RArPÉAiÀÄ°è vÉÆÃjzÀ Dgï©mÉæÃlgÀÀ PÁAiÀÄðPÉëÃvÀæzÀ ¸ÀÜ¼À ºÉÆgÀvÀÄ¥Àr¹ EvÀgÀ AiÀiÁªÀÅzÉÃ ªÁådåUÀ¼ÁzÀ £ÁåAiÀiÁ®AiÀÄ / UÁæºÀPÀgÀªÉÃ¢PÉ / EvÀgÀ ªÁådåUÀ½zÀÝgÉ £ÁåAiÀiÁ®AiÀÄ, QvÀÆÛgÀ f¯Áè ¨É¼ÀUÁ« ªÁå¦ÛAiÀÄ°è §gÀÄvÀÛzÉ JAzÀÄ SÁwæzÁgÀ£ÁV M¦àUÉ ¤ÃrgÀÄvÉÛÃ£ÉÉ, F M¦àUÉ ¥ÀvÀæzÀ°èzÀÝ J®è PÀgÁgÀÄUÀ¼ÀÄ / ±ÀgÀvÀÄÛUÀ¼À£ÀÄß SÁwæzÁgÀ£ÁV ̧ ÀA¥ÀÆtð CjvÀÄPÉÆArzÀÄÝ ªÀÄvÀÄÛ EzÀgÀ ̧ ÀA¥ÀÆtð «µÀAiÀÄ N¢ ºÉÃ½ SÁwæzÁgÀgÀ ¨sÁµÉAiÀÄ°è w½¸À¯ÁVzÉ. ̧ ÀA¥ÀÆtð M¦àUÉ ¥ÀvÀæ N¢ CjvÀÄPÉÆAqÀÄ SÁwæzÁgÀ£ÁV gÀÄdÄ ªÀiÁr M¦àPÉÆArzÉÝÃ£É.

61

F M¦àUÉ ¥ÀvÀæzÀ ¸ÁQëAiÀiÁV SÁwæzÁgÀ£ÁzÀ £Á£ÀÄ ²æÃ ________________________________

_____________________________________________ ªÉÄÃ¯É £ÀªÀÄÆ¢¹zÀ ¢£ÁAPÀzÀAzÀÄ J®è

RArPÉAiÀÄ£ÀÄß CjvÀÄPÉÆAqÀÄ M¦àUÉAiÀÄ£ÀÄß ¤ÃrzÉÝÃ£É JAzÀÄ ¥ÀæªÀiÁtÂÃPÀj¹ ̧ À»ªÀiÁrzÉÝÃ£É.

SÁwæzÁgÀ£ÀÀ ̧ À»/-

(¥Á®PÀ/¥ÉÆÃµÀPÀ)

¥ÁæZÁAiÀÄðgÀÄ ____________________________ ºÉ¸ÀgÀÄ Q.gÁ.ZÀ.¨Á.ªÀ.¸ÉÊ¤PÀ ªÀ¸Àw ±Á¯É, QvÀÆÛgÀ-591115, f. ¨É¼ÀUÁ«

EªÀgÀ ¥ÀgÀªÁV

¸ÁQëzÁgÀgÀÄ

1)______________________________, 2) __________________________________

ºÉ¸ÀgÀÄ :___________________________ ºÉ¸ÀgÀÄ :___________________________

zÀÆgÀªÁtÂ ̧ ÀASÉå :___________________ zÀÆgÀªÁtÂ ̧ ÀASÉå :___________________

£ÉÆÃlj ¥ÀæªÀiÁt ¥ÀvÀæ

£Á£ÀÄ ¥ÀæªÀiÁtÂÃPÀj¸ÀÄªÀÅzÉÃ£ÉAzÀgÉ SÁwæzÁgÀgÁzÀ ²æÃ_____________________________ EªÀgÀ

¥ÀjZÀAiÀÄ«zÀÄÝ ºÁUÀÆ SÁwæzÁgÀgÀ ¥ÀgÀ ¸À» ªÀiÁrzÀ ¸ÁQëzÁgÀgÀ ¥ÀjZÀAiÀÄ«zÀÄÝ, SÁwæzÁgÀ£ÀÄ £À£Àß ¸ÀªÀÄPÀëªÀÄ

ªÉÄÃ°£À J®è RArPÉUÀ¼À «µÀAiÀÄUÀ¼À£ÀÄß ºÉÃ½/PÉÃ½/w½zÀÄPÉÆAqÀÄ M¦àUÉ ¤Ãr £À£Àß ¸ÀªÀÄPÀëªÀÄ ºÉ¨ÉâgÀ½£À

UÀÄgÀÄvÀÄ/gÀÄdÄ ªÀiÁrzÁÝgÉ JAzÀÄ ¥ÀæªÀiÁtÂPÀj¸ÀÄvÉÛÃ£É.

£ÉÆÃlj EªÀgÀ ¸À» ªÀÄvÀÄÛ ¹PÁÌ

(ºÉ¸ÀgÀÄ)

¸ÀÜ¼À : __________________

¢£ÁAPÀ : _________________

¸À» ªÀiÁrzÀ

SÁwæzÁgÀgÀ/

¥Á®PÀ£À/¼À

¥Á¸ï¥ÉÆÃmïð

¸ÉÊeï ¨sÁªÀavÀæ

®UÀwÛ¹j

¸ÀÆZÀ£ÉUÀ¼ÀÄ :

1) E ¸ÁÖA¥ï£ÀÄß «zÁåyð¤AiÀÄ vÀAzÉAiÀÄ ºÉ¸Àj£À ªÉÄÃ¯É vÀUÉzÀÄPÉÆ¼Àî¨ÉÃPÀÄ.

2) - «zÁåyð¤AiÀÄ vÀAzÉAiÀÄ ¥ÀÆtð ºÉ¸ÀgÀÄFirst Party

3) Second Party - Principal KRCRSSG, Kittur, Belagavi

Place : _____________________

Date : _____________________


Name in full : __________________________________

Cell No: __________________

OR

LANGUAGE PREFERENCE

I, Shri ________________________________________________________________________, the

Parent of Kumari ___________________________________________________________ Hall

Ticket No.____________________________ here by confirm the details of Languages to be

offered to my daughter for class VI to VIII are as under

1st Language (English )

2nd Language (Kannada / Hindi)

3rd Language (Sanskrit / Hindi)

_

1st Language (Kannada)

2nd Language (English)

3rd Language (Sanskrit / Hindi)

62

APPENDIX – ‘O’

Refer Section II Para 17

63

MEDICAL FITNESS CERTIFICATE

1. Name of the cadet in full_______________________________________ Age _____

2. Registration No____________________ Date of the Birth____________________

3. Height -------------------------------------- Weight ____________________

4. Chest Measurement------------------ a] Normal ____________________

b] Expanded ____________________

5. Blood Group & Hb% ---------------------------------

6. Blood Reports for TB / HIV / ____________ / ______________ / ____________

NOTE: The standards of height, weight and chest generally accepted for Admission to Kittur Rani Channamma Residential Sainik School for Girls, Kittur are as under:

Age Height Weight Chest Chest Expansion

Years Cms Kg Cms Cms

10 131 23 58 1.5

11 133 25 59 1.5

6. Visual Standard.

(a) Near Vision Right------------------------- Left-----------------

[Without glasses]

(b) Distant Vision Right------------------------- Left--------------------------

[With glasses]

(c) Colour Vision-------------------------------------------

NOTE:

a) The minimum visual standards accepted are as under:

1. Distant Vision Better Eye Worse Eye

V6/6 V 6/6 correctable to 6/6

2. Near Vision Reads 0.5 or JI Reads 0.5 or JI

3. Colour Vision Safe or defective Safe

4. Field of Vision Normal in each eye as tested by confrontation test

5. Binocular Vision The Candidate must possess good binocular vision

[Squint of any type is a definite disqualification]

Affix Latest Color Photograph of the

candidate(stamp size)

64

APPENDIX – ‘P’

Refer Section II Para 18

65

FOOT NOTE

(b) Fundus and media to be healthy and within normal limits.

(c) No undue degenerative signs of vitreous choice retina to be present suggesting progressive myopia.

(d) Must possess good binocular vision [fusion faculty and full field of vision in both eyes].

(e) There should be no organic disease likely to exacerbations or deterioration.

(f) Myopia of not more than 2.5 D in any one meridian.

(g) Hypermetropia of not more than 3.5 D in any one meridian.

7. FLAT FOOT

(a) Method of examination:

(I) The candidate will be examined bare footed, standing erect and the presence

OR

absence of normal arch of the feet should be noted.

(ii) The candidates should be asked to stand on toes with the feet and heel kept separated and the restoration or otherwise of the arch noted.

(iii) The candidates should be made to skip on forefeet, and the suppleness and springiness of the feet observed. Tarsal joints will be examined for suppleness or movements.

(b) Acceptable for admission :

(i) Milder degrees of flat foot where the arches of the feet are restored on standing on toes, with supple and painless feet should not be bar to acceptance.

(ii) Severe degree of flat foot where the arch does not re-appear on standing on toes and where the feet are rigid should be a permanent causes for rejection.

(iii) Rigidity of the foot, wherever be the shape of the foot is a cause for rejection

8. KNOCK KNEE

(a) Method of Examination :

(i) The candidates will be examined standing erect.

(ii) The Knee joints will be kept fully extended with the feet parallel and the patellae facing directly forwards.

(iii) If a candidate is able to stand to attention without flexion of Knees irrespective of any inter malleollar measurements, such candidates can safely be declared. as fit

66

67

9. IS THERE:

(a) Any evidence of weak constitution , imperfect development serious malformation or obesity or congenital deformities?

________________________________________________________________________________

(b) Any maldevelopment or impairment of function of the bones or joints? Does She suffer from any kind of physical deformity like clubbed feet, flat feet, deformed spine etc?

________________________________________________________________________________

(c) Any impediment of speech ? ________________________________________________

(d) Any malformation of the head , deformity from fracture or depression of the bones or joints?

(e) Any impaired hearing, discharge from or disease of either ear unhealed preformation of tympanic membranes or signs of acute or chronic suppurative Otitis media or evidence of radical or modified radical mastoid operation?

______________________________________________________ __________________________

NOTE: A soundly healed perforation without any impairment of hearing should not be a cause for rejection _______________________________________________________________________

(f) Any disease of the bones or cartilages of the nose or nasal polyps of disease of the nasopharynx?

(g) Any enlarged gland in the neck and other parts of the body, and thyroid gland.

________________________________________________________________________________

NOTE: Scars of operations for the removal of tuberculosis glands are not a cause for rejection provided that there has been no active disease within the preceding 5years is clinically and radiologically clear.

________________________________________________________________________________

(h) Any disease of the throat, palate, tonsils or gums or disease or injury affecting the normal function of either mandibular joint?

________________________________________________________________________________

NOTE: Simple hypertrophy of the tonsils, if there is no history of attacks of tonsilitis, is not a cause for rejection.

______________________________________________________ __________________________

(i) Any sign of functional or organic disease of the heart and blood vessels?

______________________________________________________ __________________________

(j) Any evidence of pulmonary tuberculosis or previous history of this disease or any other chronic disease of the lungs?

________________________________________________________________________________

(k) Any evidence of disease of the digestive system including abnormality of the liver and Spleen ?

________________________________________________________________________________

68

69

(l) Any Complaints of Chest pain, Breathing difficulties while running or doing day to day regular exercise / work ?

________________________________________________________________________________

(m) Any complaints of recurrent abdominal pain?

________________________________________________________________________________

10. IS THERE:

(a) Any disease or defect of the genital organs?

______________________________________________________ __________________________

(b) Any fistula and/ or fissure of the anus or evidence of hemorrhoids?

______________________________________________________ __________________________

(c) Any disease of the kidneys? [Cases showing albuminuria or glycosuria will not be accepted.

________________________________________________________________________________

(d) Any disease of the skin other than temporary or trivial one? [Scars which by their extent or position cause OR likely to cause disability to a marked disfigurement are a cause for rejection.

________________________________________________________________________________

(e) Any active latent or congenital venereal disease?

________________________________________________________________________________

(f) Any history of deficiency of mental disease? [Candidates suffering from epilepsy, incontinence of urine or enuresis will not be accepted].

________________________________________________________________________________

(g) Any squint or morbid condition of the eye or of the lids which is liable to a risk of aggravation or recurrence?

________________________________________________________________________________

(h) Any active trachoma or its complications?

________________________________________________________________________________

Remarks of the Medical Officer : 1. Medically Fit :

2. Unfit :

3. Temporarily unfit :

Office Seal

Date : Name and Signature

Place : (Government District Surgeon)

70

71

PAST / PRESENT MEDICAL HISTORY

[This certificate must be filled up and signed by the Parent / Guardian in consultation with their family Doctor. The suppression of important information as to past or present health or as to exposure to infection is liable to be regarded as a breach of contract]

Name of the Girl: ________________________________________________Age:________

1. Has she had

Chickenpox? If yes, when? ________________

Diphtheria? If yes, when? ________________

Rubella (German Measles) If yes, when? _________________

Measles? If yes, when? ________________

Smallpox? If yes, when? ________________

Whooping Cough? If yes, when? ________________

Enteric Fever? If yes, when? ________________

Rheumatic Fever? If yes, when? ________________

2. Has she been successfully

Vaccinated against Smallpox? If yes, when? ________________

Re-vaccinated against Smallpox? If yes, when? ________________

Inoculated against Typhoid? If yes, when? ________________ Actively immunized against

Diphtheria? If yes, when? ________________

Whooping cough? If yes, when? ________________

Hepatitis-B If yes, when? ________________

Any other diseases? If yes, when? ________________

3. Has she :

Fits? If yes, Since when?________________

Been ruptured tympanic membrane? If yes ,when? ________________

Any discharge from Ear? If yes, when? ________________

Asthma? If yes, when? ________________

Incontinence of urine ? If yes, when? ________________

Bed wetting problem ?

4. Has she had any other serious illness? If yes give particulars and dates/duration

________________________________________________________________________________

72

73

5. Has she had any surgical operation? If yes, give particulars.

________________________________________________________________________________

6. Does she suffer from any ailment or constitutional peculiarity, affecting to general health, sight, hearing etc?

________________________________________________________________________________

7. Are her teeth in good order?

________________________________________________________________________________

8. Is she in your opinion fit in all respects for participation in all the activities of the school and live as a group?

________________________________________________________________________________

10. Is there any other information that you think the school authorities and Medical Officer should have known about the child?

________________________________________________________________________________

11 Does the child wear glasses?_____________________(if yes, the prescription may be attached with the certificate)

________________________________________________________________________________

12. Does the child have any Drug Allergy? if so the details of the same be given.

_______________________________________________________________________________

Any Other Remarks of the Parent

________________________________________________________________________________

________________________________________________________________________________

Place : _____________________

Date : _____________________


Name in full : __________________________________

Cell No,: ___________________

74

75

CAT Blank for full subjects ,1 for improvement

C NAME Name of the candidate (max 32 characters)

(In Capital letters )

M NAME Mother's Name (max 32 characters)

(In Capital Ltr)

F NAME Father's Name( max 32 characters)

(In Capital Ltr)

SEX M or F

CASTE Blank for GEN,C for SC,T for ST & O for OBC

HANDICAP Blank for none, S for Spastic, C for Dyslexia,

B for Blind, H for Handicapped, D for deaf

SUB 1 & 2 Any two prescribed Languages (out of two Sub 1 : English

Languages one shall be English or Hindi) Sub 2 : Kannada / Hindi / Sanskrit

SUB 3,4,5 Maths, Science, Social Science Sub 3 : Maths

Sub 4 : Science

Sub 5 : Social Science

ANNUAL Annual Income of Mother & Father.

INCOME Please enter only number

ONLY CHILD Y =YES, N =NO

EMAIL ID

MOBILE No.

KITTUR RANI CHANNAMMA RESIDENTIALSAINIK SCHOOL FOR GIRLS, KITTUR - 591 115

CBSE REGISTRATION FORM

DISTRICT: BELGAUM, STATE: KARNATAKA

CERTIFICATE

I, __________________________________________________ Parent of

Kumari __________________________________Hereby certify that the particulars of my

daughter furnished above have been verified by me and found to be correct. I hereby give my

consent to incorporate the above particulars for CBSE uploading process. After the

uploading is done, I will not ask the school authorities to make any changes / amendment in

the particulars of my daughter.

Sign. of the Parent / Guardian

Name :_________________________

Mobile : ____________________

APPENDIX – ‘Q’

Section II / para 19

76

Place :

Date :

CBSE Affiliation No : 830488 School Code : 45438

77

STUDENT NAME : _________________________________________________

ROLL NO: _______________ CLASS: __________ Div: _____________

FFP/MERIT: ______________ HOUSE: _____________________________

Date : _______________

APPENDIX – ‘R’

Section II/ para 20

Copy 1

Parent’s Name (Father): ____________________________________

Contact No : ______________________________________________

Address :_________________________________________________

____________________________________________________

____________________________________________________

PARENT IDENTITY CARD

Parent’s Name (Mother): ____________________________________

Contact No : ______________________________________________

Address :_________________________________________________

____________________________________________________

____________________________________________________

Guardian’s Name: _________________________________________

Contact No : ______________________________________________

Address :_________________________________________________

____________________________________________________

____________________________________________________


GUARDIAN IDENTITY CARD

78

Affix Latest Colour Passport Size

Photograph of the Father


Photograph of the Mother


Photograph of the Guardian

KITTUR RANI CHANNAMMA RESIDENTIAL SAINIK SCHOOL FOR GIRLS, KITTUR-591 115

Ph No: 08288-234601, 234605 Cell : 9483501100 E-mail: [email protected], [email protected] Website: www.kittursainikschool.org

DISTRICT: BELAGAVI, STATE: KARNATAKA

PROFORMA IDENTITY CARD


Name :_________________________

Mobile : ____________________

DISG TN II NV CE TI IH O

C N

A

79

APPENDIX – ‘R’

Section II/ para 20

Copy 2

STUDENT NAME : _________________________________________________

ROLL NO: _______________ CLASS: __________ Div: _____________

FFP/MERIT: ______________ HOUSE: _____________________________

Date : _______________

Parent’s Name (Father): ____________________________________

Contact No : ______________________________________________

Address :_________________________________________________

____________________________________________________

____________________________________________________


Parent’s Name (Mother): ____________________________________

Contact No : ______________________________________________

Address :_________________________________________________

____________________________________________________

____________________________________________________

Guardian’s Name: _________________________________________

Contact No : ______________________________________________

Address :_________________________________________________

____________________________________________________

____________________________________________________


GUARDIAN IDENTITY CARD

80


Photograph of the Father


Photograph of the Mother


Photograph of the Guardian

PROFORMA IDENTITY CARD


Name :_________________________

Mobile : ____________________

DISG TN II NV CE TI IH O

C N

A

KITTUR RANI CHANNAMMA RESIDENTIAL SAINIK SCHOOL FOR GIRLS, KITTUR-591 115

Ph No: 08288-234601, 234605 Cell : 9483501100 E-mail: [email protected], [email protected] Website: www.kittursainikschool.org

DISTRICT: BELAGAVI, STATE: KARNATAKA

81

No. KCS / New Admission /2021-22 / Date:

To,

The Principal

_______________________

_______________________

_______________________

Subject : Issue of Transfer Certificate of Kum.______________________________

Respected Sir/ Madam

With reference to the above subject, Kum._____________________________

Hall Ticket No. _________________ has joined this school in ____________ Std, during

the Academic year 2021-22. You are hereby requested to kindly issue her Transfer

Certificate at the earliest.

You are also requested to indicate your School SATS (Student Achievement

Tracking System)No. and DISE Code No. / Affiliation No. / School Code No. on the

Transfer Certificate.

Thanking You,

Yours faithfully

Principal

School DISE Code No. : 29010206724

APPENDIX – ‘S’

Section -II,

Para 21

PROFORMA REQUEISTION FORISSUE OF TRANSFER CERTIFICATE

CBSE Affiliation No : 830488 School Code : 45438

KITTUR RANI CHANNAMMA RESIDENTIALSAINIK SCHOOL FOR GIRLS, KITTUR - 591115

Phone : 08288-234601 / 234605, Cell : 9483501100, E-mail : [email protected], [email protected]

Website : www.kittursainikschool.org

Dist.: Belagavi, Karnataka State [India]

82

83

APPENDIX – ‘T’Para 22,

Section II

Signature of Student.

Name: _________________________

Date : _______________

Place : _______________

Signature of Parent/Guardian.

Name: _________________________

Date : _______________

Place : _______________

UNDERTAKING BY THE CADET[CONDUCT AND ANTI-RAGGING]

I, ______________________________________________________________________

( ful l name of s tudent with Admiss ion/Regis trat ion/Enrolment Number )

D _ N/o _______________________ _____________, of _________________________ ( ame of the

institution previously studied) , am fully aware of the penal and administrative action that is

liable to be taken against me in case I am found guilty of or abe�ing ragging actively or

passively, or being part of a conspiracy to promote ragging.

I hereby undertake that

a) I will not indulge in any behavior or act that may be constituted as ragging.

b) I will not participate in or abet or propagate through any act of commission or

omission that may be constituted as ragging.

I hereby that, if found guilty of ragging, I am liable for punishment also agree

according to Regulations, without prejudice to any other criminal action School Rules and

that may be taken against me under any penal law or any law for the time being in force.

I hereby declare that I have not been expelled or debarred from admission in any

institution in the country on account of being found guilty of, abe�ing or being part of a

conspiracy to promote, ragging; and further affirm that, in case the declaration is found to be

untrue, I am aware that my admission is liable to be cancelled.

Declared this day of month of year._______________ ___________________ __________

84

85

APPENDIX – ‘U’

Para 22,

Section IIUNDERTAKING BY PARENT/GUARDIAN[CONDUCT AND ANTI RAGGING]

I, Mr./Mrs./Ms. _________________________________________________________

(full name of Parent/Guardian) father/mother/guardian of ri ____________________ Kuma

_____________________________ (full name of student with admission/registration/enrolment

number)_________________, am fully aware of the penal and administrative action that is liable

to be taken against me in case I am found guilty of or abetting ragging, actively or passively, or

being part of a conspiracy to promote ragging.

I hereby undertake that

a) My ward will not indulge in any behavior or act that may be constituted as ragging.

b) My ward will not participate in or abet or propagate through any act of commission

or omission that may be constituted as ragging.

I hereby also agree that, if found guilty of ragging, my ward is liable for punishment as per

School Rules and Regulations, without prejudice to any other criminal action that may be taken

against me under any penal law or any law for the time being in force.

I hereby declare that my ward has not been expelled or debarred from admission in any

institution in the country on account of being found guilty of, abetting or being part of a conspiracy

to promote, ragging; and further affirm that, in case the declaration is found to be untrue, I am

aware that the admission of my ward is liable to be cancelled.

Declared this ___ day of ____________month of ____year.


Name : __________________________________

Mobile : ______________________________

86

87

APPENDIX – ‘V’Para 23,

Section IITRANSFER CERTIFICATE FORMAT[To be filled up neatly by the Parent]

(On a stamp paper of Rs.20.00 non judicial )

[As per previous School Transfer Certificate records. Fill details in English only]

1. Registered No. of the Student : _______________________________________

2. Name of the Student in full (Capital letters only) : _______________________________________

3. Father's Name : _______________________________________

4. Mother's Name : _______________________________________

5. Nationality : ___________________________ : 6. Blood Group : ________________________

7. Religion and Caste : _______________________________________

8. Mother Tongue : _______________________________________

9. Whether the Student belongs to SC / ST / OBC : _______________________________________

10. Date of Birth according to Christian Era (in figures & words) according to should agree with School Admission Register : _______________________________________

11. Place of Birth : _______________________________________

12. Medium of Instruction : _______________________________________

13. Previous Passed Class : _______________________________________

14. Promotion Result (If leaving at the end of the year) : _______________________________________

15. Conduct in the School : _______________________________________

16. Date of issue of the T.C. : _______________________________________

17. School DISE Code : _______________________________________

18. Student Achievement Tracking Number (SATS) : _______________________________________


Name: _________________________

Mobile No.: _____________________

Affix Latest Color

Photograph of

the Parent

(stamp size)

88

89

UNDERTAKING

[RESTRICTION ON DEMAND OF LEAVE FOR TAKING HOME THE WARD]

I ________________________ father/mother of Kumari___________________________

Hall Ticket / Application No. ______________ selected for admission to class ______ at the

KRCRSSG Kittur . for the academic year 2021-22 do hereby submit that I am aware of the

norms of discipline for the cadets, set forth by the KRCMC/KRCRSSG and hereby undertake

to abide by them in letter and spirit:

1. I am aware that I shall not take my child on leave by producing invalid or unreliable reasons especially on the pretext of illness, healthcare etc of the cadet by producing false Medical Certificate.

2. I understand that in case if I produce false Medical Certificate, with an intention to availing a temporary leave for my ward, it is liable to attract a Second Medical Opinion by any Medical Authority appointed by the KRCMC/KRCRSSG/ BOG/Principal and stand by the result of such second opinion and ready to accept the decision of the School which may lead up to expulsion of my ward from the School.

3. I understand and accept that temporary leave for the cadet shall not be permitted by the School Authority for reasons such as death / funeral of distant relative, maternal/paternal grandparent, betrothal, marriage of cousin, uncle, niece, nephew etc of the cadet. I also understand and accept that no leave will be granted for engagement of even her real brother / sister.

4. I understand that any temporary/short term leave shall not be demanded by me for grant to the cadet for occasions like family functions, festivals, pooja, birthdays, rituals, house warming etc.

I here by solemnly affirm and declare that the above guidelines have been fully understood / explained in the language I understand best, and that I shall not place any requests for grant of short/long leave for my ward on above cited and such other grounds, till my ward completes her education in the School.

Place

Date Signature

Name ________________________

Cell No __________________

APPENDIX – ‘W1’

ENGLISH VERSION

Refer Section II

Para 27

90

SCHOOL COPY

91

UNDERTAKING

[RESTRICTION ON DEMAND OF LEAVE FOR TAKING HOME THE WARD]

I ________________________ father/mother of Kumari___________________________

Hall Ticket / Application No. ______________ selected for admission to class ______ at the

KRCRSSG Kittur . for the academic year 2021-22 do hereby submit that I am aware of the

norms of discipline for the cadets, set forth by the KRCMC/KRCRSSG and hereby undertake

to abide by them in letter and spirit:

1. I am aware that I shall not take my child on leave by producing invalid or unreliable reasons especially on the pretext of illness, healthcare etc of the cadet by producing false Medical Certificate.

2. I understand that in case if I produce false Medical Certificate, with an intention to availing a temporary leave for my ward, it is liable to attract a Second Medical Opinion by any Medical Authority appointed by the KRCMC/KRCRSSG/ BOG/Principal and stand by the result of such second opinion and ready to accept the decision of the School which may lead up to expulsion of my ward from the School.

3. I understand and accept that temporary leave for the cadet shall not be permitted by the School Authority for reasons such as death / funeral of distant relative, maternal/paternal grandparent, betrothal, marriage of cousin, uncle, niece, nephew etc of the cadet. I also understand and accept that no leave will be granted for engagement of even her real brother / sister.

4. I understand that any temporary/short term leave shall not be demanded by me for grant to the cadet for occasions like family functions, festivals, pooja, birthdays, rituals, house warming etc.

I here by solemnly affirm and declare that the above guidelines have been fully understood / explained in the language I understand best, and that I shall not place any requests for grant of short/long leave for my ward on above cited and such other grounds, till my ward completes her education in the School.

Place

Date Signature

Name ________________________

Cell No __________________

APPENDIX – ‘W1’

ENGLISH VERSION

Refer Section II

Para 27

92

PARENT’S COPY

93

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___________gÀ°è ______ ªÀUÀðPÉÌ DAiÉÄÌUÉÆAqÀ PÀÄªÀiÁj _____________________________ EªÀ¼À

vÀAzÉ/vÁ¬Ä AiÀiÁzÀ £Á£ÀÄ ²æÃ/²æÃªÀÄw_______________________________________F ªÀÄÆ®PÀ

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gÀÆ¦¹gÀÄªÀ ¤Ãw, ¤AiÀÄªÀiÁªÀ½UÀ¼À£ÀÄß £Á£ÀÄ ¸ÀA¥ÀÆtðªÁV CjvÀÄPÉÆArzÀÄÝ, CªÀÅUÀ¼À CPÀëgÀ±ÀB C£ÀÄ¥Á®£ÉUÉ

§zÀÞ£ÁVzÉÝÃ£É, ºÁUÀÆ F ̧ ÀA§AzsÀ PÉ¼ÀV£À ¥ÀæPÁgÀ ªÀÄÄZÀÑ½PÉUÉ ̧ ÀªÀÄäw¹gÀÄvÉÛÃ£É.

1) C¸ËRå, DgÉÆÃUÀå¥ÀgÀ PÁgÀtUÀ½UÁV C¤AiÀÄ«ÄvÀ, DzsÁgÀgÀ»vÀ ºÁUÀÆ C¸ÀªÀÄäPÀªÁzÀ DgÉÆÃUÀå

¥ÀæªÀiÁt¥ÀvÀæ ¸À°è¹ £À£Àß ªÀÄUÀÄªÀ£ÀÄß gÀeÉAiÀÄ ªÉÄÃ¯É PÀgÉzÀÄPÉÆAqÀÄ ºÉÆÃUÀPÀÆqÀzÀÄ JA§ CA±ÀªÀ£ÀÄß

¸ÀA¥ÀÆtðªÁV CjvÀÄPÉÆArzÉÝÃ£É.

2) vÁvÁÌ°PÀªÁzÀ gÀeÉAiÀÄ ªÉÄÃ¯É ªÀÄUÀÄªÀ£ÀÄß ªÀÄ£ÉUÉ PÀgÉzÉÆAiÀÄåªÀ GzÉÝÃ±À¢AzÀ MAzÀÄ ªÉÃ¼É £Á£ÀÄ

C¹AzsÀÄªÁzÀ ªÉÊzÀåQÃAiÀÄ ¥ÀæªÀiÁt ¥ÀvÀæªÀ£ÀÄß ¸À°è¹zÀ ¥ÀPÀëzÀ°è, CAxÀ ¥ÀæªÀiÁt¥ÀvÀæzÀ ¹AzsÀÄvÀéªÀ£ÀÄß

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GzÉÝÃ±À¢AzÀ AiÀiÁªÀÅzÉÃ ªÉÊzÀåQÃAiÀÄ ¥Áæ¢üPÁgÀªÀ£ÀÄß £ÉÃ«Ä¸À§ºÀÄzÁVzÉ, ªÀÄvÀÄÛ EAvÀºÀ ¥Áæ¢üPÁgÀªÀÅ

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GZÁÑl£ÉUÉÆ½¸ÀÄªÀzÀ£ÉÆ¼ÀUÉÆAqÀÄ AiÀiÁªÀÅzÉÃ PÀæªÀÄªÀ£ÀÄß £Á£ÀÄ ªÀÄ¤ß¸ÀÄªÀzÁV ªÀÄ£ÀB¥ÀÆªÀðPÀ M¦àgÀÄªÉ.

3) PÉqÉmïUÀ¼À CdÓ,CfÓ zÀÆgÀzÀ ¸ÀA§A¢üUÀ¼À ¸ÁªÀÅ/CAvÀåQæAiÉÄ, UÀÈºÀ¥ÀæªÉÃ±À, ¸ÉÆÃzÀgÀ ¸ÀA§A¢üUÀ¼À «ªÁºÀ

¤²ÑvÁxÀð EvÁå¢ PÁAiÀÄðPÀæªÀÄUÀ½UÉ ªÀÄUÀÄªÀ£ÀÄß PÀgÉzÀÆAiÀÄåªÀ GzÉÝÃ±ÀPÁÌV C®à CªÀ¢ü gÀeÉUÀ¼À£ÀÄß ±Á¯Á

DqÀ½vÀªÀÄAqÀ½AiÀÄÄ ªÀÄ¤ß¸ÀÄªÀÅ¢®è JA§ «µÀAiÀÄªÀ£ÀÄß £Á£ÀÄ ªÀÄ£ÀUÀArzÉÝÃ£É.

4) PËlÄA©PÀ PÁAiÀÄðPÀæªÀÄUÀ¼ÀÄ, ºÀ§â ºÀj¢£ÀUÀ¼ÀÄ, ¥ÀÆeÉ ̧ ÀªÀiÁgÀA¨sÀUÀ¼ÀÄ, d£Àä¢£ÁZÀgÀuÉ EAvÀºÀ ̧ ÁªÀiÁ£Àå

¸ÀªÀiÁgÀA¨sÀUÀ½UÁV ªÀÄUÀÄ«UÁV C®à ©qÀÄªÀÅ, gÀeÉUÀ¼À£ÀÄß ̈ ÉÃqÀÄªÀAw®è JA§ CA±ÀªÀ£ÀÄß £Á£ÀÄ CjwgÀÄªÉ,

ªÉÄÃ¯É «ªÀj¹zÀ ªÀiÁUÀð¸ÀÆaUÀ¼À£ÀÄß £Á£ÀÄ ¸ÀA¥ÀÆtðªÁV CjvÀÄPÉÆArzÀÄÝ EAvÀºÀ CxÀªÁ

E£ÁßªÀÅzÉÃ PÁgÀtUÀ¼À ªÉÄÃ¯É C®à/¢ÃWÀð CªÀ¢üUÀ½UÉ gÀeÉUÀ¼À£ÀÄß, £À£Àß ªÀÄUÀÄ ±Á¯ÉAiÀÄ°è ªÁå¸ÀAUÀªÀ£ÀÄß

¸ÀA¥ÀÆtðUÉÆ½¸ÀÄªÀªÀgÉUÉ PÉÆÃgÀÄªÀÅ¢®è JAzÀÄ F ªÀÄÆ®PÀ ¥ÀæªÀiÁtÂÃPÀj¹ WÉÆÃ¶¸ÀÄvÉÛÃ£É.

¸ÀÜ¼À: ¸À»

¢£ÁAPÀ: ºÉ¸ÀgÀÄ:

zÀÆgÀªÁtÂ ̧ ÀASÉå:

APPENDIX – ‘W2’KANNADA VERSION

Refer Section IIPara 27

94

95

AUTHORITY LETTER

To

Principal

KRCRSSG

Kittur

1. Mr/ Ms_________________________________________ whose above photo and three

signatures are appended below is authorized to pick up my daughter/ ward from

the School :-

2. I hereby take full responsibility for the safe passage of my ward to me through

above escort and indemnify the School from all risks etc.

Appendix-‘X1’(Refers to Section -II, Para 24)

Affix photo here and sign across it in such a manner that a part is on the photo and balance on the application. Affix with gum/ paste.

96

Signature : ___________________

Name of the Parent : ___________________________________________________________

Name of Cadet : ____________________________________________ Roll No___________

Class____ Section________ Dorm No: _________ House____________________________

Cell No: _________________ Email ID _______________________________

Date & time :______________ (_________am/pm)

97

¨ÉAUÁªÀ®Ä C¢üPÁgÀ ºÀ¸ÁÛAvÀgÀ WÉÆµÀuÁ ¥ÀvÀæ

UÉ,

¥ÁæA±ÀÄ¥Á®gÀÄ,QvÀÆÛgÀ gÁtÂ ZÀ£ÀßªÀÄä ¨Á®QAiÀÄgÀ ¸ÉÊ¤PÀ ªÀ¸Àw ±Á¯É,QvÀÆÛgÀ

1. ²æÃ / ²æÃªÀÄw s_________________________________________ CªÀgÀ ¨sÁªÀavÀæ ªÀÄvÀÄÛ

ªÀÄÆgÀÄ ªÀiÁzÀj ̧ À»UÀ¼À£ÀÄß F PÉ¼ÀUÉ zsÀÈrÃPÀj¸À¯ÁVzÀÄÝ £À£Àß ªÀÄUÀ¼À/¥ÉÆÃ¶vÉAiÀÄ£ÀÄß Q.gÁ.ZÀ.¨Á.ªÀ.¸ÉÊ.

±Á¯ÉUÉ ºÁUÀÆ EAzÀ ©qÀ®Ä / PÀgÉvÀgÀÄªÀ C¢üPÁgÀªÀ£ÀÄß F CªÀjUÉ ¸Àé-EZÉÒ¬ÄAzÀ ºÀ¸ÁÛAvÀgÀªÀiÁr

WÉÆÃ¶¸ÀÄvÉÛÃ£É. :-

2. ªÉÄÃ¯ÁÌtÂ¹zÀ ¨ÉAUÁªÀ®ÄUÁgÀgÀÄ £À£Àß ªÀÄUÀ¼ÀÄ /¥ÉÆ¶vÉAiÀÄ£ÀÄß £À£ÀUÉ /±Á¯ÉUÉ vÀAzÀÄPÉÆqÀÄªÀ §UÉÎ £À£Àß

¨ÉÃµÀgÀvï M¦àUÉ¬ÄzÉ. ºÁUÀÆ Q.gÁ.ZÀ.¨Á.ªÀ.¸ÉÊ.±Á¯ÉUÉ F «µÀAiÀÄzÀ°è AiÀiÁªÀÅzÉÃ C¥ÁAiÀÄ / C»vÀPÀgÀ

£ÀµÀÖ / ̧ ÀAzÀ¨sÀð §AzÀgÉ CzÀgÀ ̧ ÀA¥ÀÆtð £ÀµÀÖ ¥ÀÆwð ªÀiÁr PÉÆqÀ®Ä £Á£ÀÄ ̧ ÀévÀB dªÁ¨ÁÝgÀ£ÁVzÉÝÃ£É

JAzÀÄ F ªÀÄÆ®PÀ WÉÆÃ¶¸ÀÄªÉ£ÀÄ.


¥Á¸ï¥ÉÆÃmïð C¼ÀvÉAiÀÄ ¨sÁªÀavÀæ

CAn¹, WÉÆµÀuÁ¥ÀvÀæ ºÁUÀÆ ¨sÁªÀavÀæUÀ¼À ªÉÄÃ¯É ¨sÁUÀ±ÀBªÁV §gÀÄªÀAvÉ ¸À» ªÀiÁqÀvÀPÀÌzÀÄÝ.

98

¸À» _______________________

«zÁåyð¤AiÀÄ vÀAzÉ/vÁ¬ÄAiÀÄ ºÉ¸ÀgÀÄ : __________________________________________

PÉqÉmï¼À ºÉ¸ÀgÀÄ ___________________________________ zÁR¯É ¸ÀASÉå ____________

ªÀUÀð ______ «¨sÁUÀ ______ ªÀ¸ÀwUÀÈºÀ _____________ ¸ÀzÀ£À _____________________

ªÉÆ¨ÉÊ¯ï ¸ÀASÉå _____________________ «ÄAZÀAZÉ _____________________________

¢£ÁAPÀ ªÀÄvÀÄÛ ¸ÀªÀÄAiÀÄ ___________________ (__________ ªÀÄÄA/ªÀÄ)

99

100


To,

The Principal

KRCRSSG, Kittur

REQUEST FOR TRANSFER CERTIFICATE

Please issue Transfer Certificate with effect from _________________ to my ward

whose particulars are given below :-

Name :

House No. :

Street :

Village :

Post :

Taluk :

District :

State : Pin Code :

I am aware that Transfer Certificate will be given not before ten days of receipt of the

application. I shall collect the TC by hand / Please send the TC by post ( for which I

may be billed) on the address given below :-

Signature : ___________________

Name of the Parent : ___________________________________________________________

Name of Cadet : ____________________________________________ Roll No___________

Class____ Section_____ Dorm No: _______ House________________Merit/FFP Student

Cell No: _________________ Email ID _______________________________

Date & time :______________ (_________am/pm)

101

102


UÉ,

¥ÁA±ÀÄ¥Á®gÀÄ,

QvÀÆÛgÀ gÁtÂ ¨Á®QAiÀÄgÀ ¸ÉÊ¤PÀ ªÀ¸Àw ±Á¯É, QvÀÆÛgÀ

ªÀUÁðªÀuÉ ¥ÀæªÀiÁt ¥ÀvÀæPÁÌV «£ÀAw Cfð

¢£ÁAPÀ/E¹éé ___________ EAzÀ eÁjUÉ §gÀÄªÀAvÉ £À£Àß ªÀÄUÀ¼À / ¥ÉÆÃ¶vÉAiÀÄ ªÀUÁðªÀuÉ ¥ÀæªÀiÁt

¥ÀvÀæªÀ£ÀÄß PÉÆqÀªÀiÁqÀ®Ä PÉÆÃjzÉ. ¸ÀA§A¢¹zÀ «ªÀgÀUÀ¼ÀÄ F PÉ¼ÀV£ÀAwzÉ :-

ºÉ¸ÀgÀÄ :

ªÀÄ£É ¸ÀASÉå :

NtÂ/UÀ°è :

HgÀÄ :

CAZÉ :

vÁ®ÆPÀ :

f¯Éè :

gÁdå : ¦£ïPÉÆÃqÀ :

CfðAiÀÄ£ÀÄß ¹éÃPÀj¹zÀ ºÀvÀÄÛ ¢£ÀUÀ¼À £ÀAvÀgÀ ªÀUÁðªÀuÉ ¥ÀæªÀiÁt¥ÀvÀæªÀ£ÀÄß ¤ÃqÀ¯ÁUÀÄªÀzÀÄ JA§ CA±ÀªÀ£ÀÄß

£Á£ÀÄ CjwzÉÝÃ£É. £Á£ÀÄ ªÀUÁðªÀuÉ ¥ÀæªÀiÁt ¥ÀvÀæªÀ£ÀÄß PÉÊAiÀiÁgÉ / CAZÉ ªÀÄÆ®PÀ PÉ¼ÀV£À «¼Á¸ÀPÉÌ (CAZÉ

ªÉZÀÑªÀ£ÀÄß ¨sÀwðªÀiÁr) ¥ÀqÉAiÀÄ®Ä EaÒ¸ÀÄvÉÛÃ£É.

¸À» _______________________

«zÁåyð¤AiÀÄ vÀAzÉ/vÁ¬ÄAiÀÄ ºÉ¸ÀgÀÄ : __________________________________________

PÉqÉmï¼À ºÉ¸ÀgÀÄ ___________________________________ zÁR¯É ¸ÀASÉå ____________

ªÀUÀð ______ «¨sÁUÀ ______ ªÀ¸ÀwUÀÈºÀ _____________ ¸ÀzÀ£À _____________________

¥sÀÆtð ±ÀÄ®Ì / ªÉÄjmï «zÁåyð, ªÉÆ¨ÉÊ¯ï ¸ÀASÉå _______________________

«ÄAZÀAZÉ ___________________________ ¢£ÁAPÀ ªÀÄvÀÄÛ ¸ÀªÀÄAiÀÄ ___________________

(__________ ªÀÄÄA/ªÀÄ)

103

APPENDIX – ‘Y’Refer Section II,

Para 26

104

105

APPENDIX – ‘Z’Refer Section II

Para 25

106

107

Ph No: 08288-234608, 234605, Fax : 08288-287299,E-mail: [email protected],[email protected],Website: www.kittursainikschool.org

KITTUR RANI CHANNAMMA RESIDENTIALSAINIK SCHOOL FOR GIRLS - KITTUR-591 115Dist: Belagavi Karnataka State, INDIA