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F.No. /JNV/KPT/2017/ Dt: 06.07.2017
NOTICE Students who have been selected to take Admission in Jawahar Navodaya
Vidyalaya,Landiguda, Koraput (Odisha) for the Academic Session 2017-18 can download the Admission required documents directly from the web site www.jnvkoraput.nic.in or from the office of the Principal,JNV,Koraput between 09.30 hr to 13.00 hr . Further you are requested to report before the undersigned in the below mentioned date positively with the required documents dully filled in.
Result sheet Sl.No: From 01 to 40 – 17.07.2017 From 41 to 80- 18.07.2017
Principal Jawahar Navodaya Vidyalaya Landiguda, Koraput (Odisha)
CBSE J N V RESULT SHEET FOR SELECTION TEST FOR ADMISSION IN CLASS VI SESSION 2017-2018 DATE : 30.06.2017 PAGE NO : 1 STATE : 18 ODISHA DISTRICT : 04 KORAPUT
SNO BLOCK CENTRE ROLL NAME SEX CATEGORY AREA D.O.B
CODE CODE NUMBER
------------------------------------------------------------------------------------------------------------------------------------ *** URBAN DISABLE SEAT ***
01 10 01 A03430 JAGANNATH NAYAK BOY GEN URBAN 02/06/07
02 01 01 B00052 ANNANT SAHU BOY OBC URBAN 06/09/06
03 11 01 L03904 GUPTA MAJHI BOY ST RURAL 05/04/07
NO. OF CANIDATES : 3
*** URBAN OPEN SEAT *** 04 02 01 A00530 SOMYA RANJAN PANDA BOY GEN URBAN 12/02/07
05 10 01 A03416 SAGAR KUMAR MISHRA BOY GEN URBAN 02/04/06
06 10 01 A03419 RUDRA PRASAD MISHRA BOY GEN URBAN 17/04/06
07 01 01 B00046 ADITYA RAI BOY OBC URBAN 05/01/07
08 11 01 E03792 SEEMA GUPTA GIRL GEN URBAN 07/12/06
09 01 01 F00181 BANDARU SHIVANI DORA GIRL OBC URBAN 04/08/06
10 01 01 F00182 NANDITA DASH GIRL OBC URBAN 08/04/06
NO. OF CANIDATES : 7
*** URBAN SC SEAT *** 11 02 01 C00551 ADITYA KHARA BOY SC URBAN 04/10/06
12 02 01 C00562 SITUN TAKRI BOY SC URBAN 14/01/07
13 02 01 C00568 SUBHAN SETHY BOY SC URBAN 24/08/06
NO. OF CANIDATES : 3
*** URBAN ST SEAT *** 14 01 01 D00094 AJAYA HANTAL BOY ST URBAN 17/11/05
15 02 01 D00576 RAHUL SUPIA BOY ST URBAN 01/11/07
16 11 01 D03765 MOHIT MOHAN RANDHARI BOY ST URBAN 24/08/06
17 01 01 H00227 AFIYA KHATUN GIRL ST URBAN 25/03/07
18 01 01 H00238 TUNI JANI GIRL ST URBAN 17/12/06
19 01 01 H00245 SURABHI PUJARI GIRL ST URBAN 30/04/07
20 02 01 H00674 HANNA DISARI GIRL ST URBAN 05/11/06
NO. OF CANIDATES : 7
*** RURAL OPEN SEAT *** 21 01 01 I00271 UJAL KUMAR SAHU BOY GEN RURAL 22/09/06
22 03 01 I01009 SAISUMAN PANDA BOY GEN RURAL 11/08/06
23 05 01 I01707 ADITYA PADHI BOY GEN RURAL 26/10/06
24 11 01 I03828 DIVYARANJAN BEHERA BOY GEN RURAL 26/12/06
25 12 01 I04209 SWAYAMSAMPAD SATAPATHY BOY GEN RURAL 24/09/06
CBSE J N V RESULT SHEET FOR SELECTION TEST FOR ADMISSION IN CLASS VI SESSION 2017-2018 DATE : 30.06.2017 PAGE NO : 2 STATE : 18 ODISHA DISTRICT : 04 KORAPUT
SNO BLOCK CENTRE ROLL NAME SEX CATEGORY AREA D.O.B
CODE CODE NUMBER
------------------------------------------------------------------------------------------------------------------------------------ *** RURAL OPEN SEAT ***
26 12 01 I04212 KANHEYA SAHU BOY GEN RURAL 31/07/06
27 13 01 I04526 ADITYA SAHU BOY GEN RURAL 29/03/07
28 02 01 J00717 SUBHASISH ROUT BOY OBC RURAL 01/04/07
29 07 01 J02517 PRITOM BISOYI BOY OBC RURAL 13/02/07
30 09 01 J03135 OM PRAKASH JENA BOY OBC RURAL 23/10/06
31 14 01 J04935 ARINDAM PRADHAN BOY OBC RURAL 28/02/07
32 05 01 K01779 BARUN KHILLO BOY SC RURAL 31/01/06
33 09 01 K03168 SITIJ KUMAR KANDHAPAN BOY SC RURAL 20/08/05
34 10 01 K03565 RUDRA MADHAV PANGI BOY SC RURAL 09/11/06
35 10 01 K03570 PRATYSH KUMAR BHATRA BOY SC RURAL 09/02/06
36 10 01 L03583 GUPTESWAR KUMAR SUKRI BOY ST RURAL 04/10/06
37 13 01 L04660 DHANURJAYA PUJARI BOY ST RURAL 20/11/06
38 02 01 M00822 SHREYA DASH GIRL GEN RURAL 21/01/07
39 04 01 M01519 MERRYL J PETER GIRL GEN RURAL 20/02/06
40 05 02 M02022 K ANKITA PATRA GIRL GEN RURAL 09/04/06
41 06 01 M02409 SUBHANGI PATTANAYAK GIRL GEN RURAL 29/09/05
42 08 01 M02880 PRATYASA PRIYADARSINI MALLA GIRL GEN RURAL 28/05/06
43 13 01 M04691 SMRUTI MAYEE PATRA GIRL GEN RURAL 24/04/06
44 13 01 M04716 MADHUSMITA SADANGI GIRL GEN RURAL 27/03/06
45 14 01 M05081 AKANKSHA BISWAL GIRL GEN RURAL 10/04/07
46 14 01 M05084 ADITI PRIYADARSHINI PATTNAYAK GIRL GEN RURAL 02/03/07
47 08 01 O02921 HANSIKA MAHALIK GIRL SC RURAL 23/05/06
48 10 01 O03654 MANASHI BEHERA GIRL SC RURAL 24/04/06
49 01 01 P00391 SULAGNA SUBHADARSHANI GIRL ST RURAL 25/03/07
50 11 01 P04105 DEBAKI PUJARI GIRL ST RURAL 31/08/05
NO. OF CANIDATES : 30
*** RURAL SC SEAT *** 51 04 01 K01336 SUDARSHAN KHARA BOY SC RURAL 10/05/06
52 04 01 K01340 DEBRAJ BENYA BOY SC RURAL 16/04/06
53 05 01 K01788 SOUMYA RANJAN KHARA BOY SC RURAL 03/11/06
54 06 01 K02328 SUBHANKARA DANGARI BOY SC RURAL 26/12/06
CBSE J N V RESULT SHEET FOR SELECTION TEST FOR ADMISSION IN CLASS VI SESSION 2017-2018 DATE : 30.06.2017 PAGE NO : 3 STATE : 18 ODISHA DISTRICT : 04 KORAPUT
SNO BLOCK CENTRE ROLL NAME SEX CATEGORY AREA D.O.B
CODE CODE NUMBER
------------------------------------------------------------------------------------------------------------------------------------ *** RURAL SC SEAT ***
55 08 01 K02746 LAB KHILLO BOY SC RURAL 19/05/06
56 08 01 K02756 SUBASH KHORA BOY SC RURAL 16/02/06
57 08 01 K02766 JAYDEB PANGI BOY SC RURAL 15/05/06
58 08 01 O02924 AMBRUTA RANI BEHERA GIRL SC RURAL 23/05/06
59 09 01 O03298 SUNEMIA KHORA GIRL SC RURAL 13/11/05
NO. OF CANIDATES : 9
*** RURAL ST SEAT *** 60 01 01 L00323 HITESWAR SABAR BOY ST RURAL 22/04/06
61 01 01 L00345 SANIA JANI BOY ST RURAL 01/02/05
62 02 01 L00777 BISWANATH NANDIBALI BOY ST RURAL 19/06/06
63 02 01 L00795 RITESH SISA BOY ST RURAL 03/11/06
64 04 01 L01382 JITU JANI BOY ST RURAL 15/02/06
65 04 01 L01483 SANYA PRASKA BOY ST RURAL 15/08/06
66 05 01 L01833 DHANESWAR SISA BOY ST RURAL 05/10/06
67 05 01 L01846 MAHESWAR KHINABUDI BOY ST RURAL 08/01/07
68 05 01 L01870 PURNA CHANDRA KHEMUNDU BOY ST RURAL 15/02/05
69 05 01 L01885 KRUSHNA MUDULI BOY ST RURAL 12/10/06
70 05 01 L01937 DAMBARU MATAM BOY ST RURAL 22/01/06
71 05 01 L01950 NIPUNA BURUDI BOY ST RURAL 15/01/07
72 07 01 L02562 SHIBAJEE KADIASIA BOY ST RURAL 23/04/06
73 08 01 L02788 BALBHADRA BADNAYAK BOY ST RURAL 15/04/06
74 11 01 L03979 KHAGAPATI GADABA BOY ST RURAL 06/10/05
75 11 01 L03984 CHITRA NAYAK BOY ST RURAL 02/06/05
76 02 01 P00875 NILABATI HANTAL GIRL ST RURAL 17/04/06
77 04 01 P01620 SONALI MANDINGA GIRL ST RURAL 12/03/05
78 05 02 P02130 LALITA PANDRIA GIRL ST RURAL 20/03/06
79 08 01 P03016 SUNITA SISA GIRL ST RURAL 30/05/06
80 08 01 P03018 MONALISA PADUA GIRL ST RURAL 10/04/06
NO. OF CANIDATES : 21
1
JAWAHAR NAVODAYA VIDYALAYA, LANDIGUDA, KORAPUT (ODISHA)
APPLICATION FOR ADMISSION
1. Full Name of the pupil : ………………………………………….……… (CAPITAL LETTERS)
2. Date of Birth (in figure) : …………….………….………………………
(In words) : …………………………………………….……………….
3. Age at the time of Admission : ………... Year ….……… Month ….….....… Days
4. Caste : ……………………………………………………
5. Nationality/Religion : ……………………..……/ ..………………..........
6. Full Name of Father (Capital Letter) : ……………………………………………………
7. Full Name of Mother (Capital Letter) : ……….……………………………………………
8. Full Name of Guardian (Capital Letter) : …….………………..……..……….....………… (If father is not alive)
9. Complete Present Address of Father/Guardian: : ………..………………….…………………………
……………………………………………….….…
………..……………………………….………...…
Dist: ………………..…..…Pin : …..….……...….…
Mob. No. .…………..….… Tel. No. …..………..….
10. Complete Permanent Address of Father/Guardian: : ……..…...…..………….………………..……….
…………...……………….…………....……….
…..………………………………….………….…
Dist: ……….……..….…… Pin: …………...…….
Mob. No. …………….…… Tel. No. ………….….
11. Occupation/Designation of father if in service & Address : ……………………………………………………. 12. Name & Complete address of Local Guardian, if any : …………………………………….……….…...…
……………..…...………………………….....…...
…………………………………..………...………
Mob. No. …………….. Tel. No. ………..…..….
13. (i) Name of the school last attended : ……...……………….…………...……………..…
(ii) Whether it is Central/Recognized School : ………..…………………………………..……..
2
(iii) Class in which studying : ……………………….….……….……..……..
(iv) Medium of instruction : ………..……. ……....………………………..
14. Result of last Examination with percentage of marks : …………...…………………………….……..… 15. Class to which admission is sought : ………………...…………….……………..…… 16. Mother Tongue : ....…………..……….……………………..…… 17. Whether the pupil belong to Urban area or Rural area : ......……………….……………………...…… 18. The following documents filled & attached : .……………………………….……………
(i) Application for admission : ......….…………………………………………
(ii) Undertaking by the father/Guardian : …….....……...…………………………..….…...
(iii) Socio-Economic data of parents : ………………...……..…………………..……
(iv) Bio-data Form : ......………………………………….…….……
(v) Study certificate (one certificate from
each school if studied in different
schools) in classes III, IV & V. : ………………......………………………..……
(vi) Medical Fitness Certificate from a Medical Officer : ...……………………………….…...
(vii) Marks statement of Class – V. : .…..…….……………………….………..……
(viii) Residence Certificate. : .....…...………………….……………….……
(ix) Affidavit (To be submitted by children belonging to rural area) : ........………………….
(x) Caste Certificate (for ST/SC/OBC candidates only along with Xerox copy). ……….
(xi) PH Certificate : ………………………………………….…….
(xii) BPL Card (if possesses) : …………………………………………………
Signature of the Pupil Signature of Father/Guardian
(a) The name of the child/date of birth/father & mother written in the application is fully correct
& I shall not request for any change in future.
(b) I and my ward shall abide by the rules of the Vidyalaya.
Signature of Father
3
UNDERTAKING
(To be signed by the father or guardian in case father is not alive in the presence of the Principal of the concerned Jawahar Navodaya Vidyalaya).
1. I …………………………………… father/guardian of ….…………………………… who has been
selected for admission to Navodaya Vidyalaya, Landiguda, hereby undertake that I would have no
objection if my son/daughter/ward is migrated from this Navodaya Vidyalaya to another in any
other linguistic state as per the provision of the scheme. Further, I declare that I shall abide by the
condition that if my ward/son/daughter does not move to another school, she/he will not be allowed
to continue to stay in the Navodaya Vidyalaya further and his/her studies would be discontinued.
2. I do hereby undertake that my son/daughter/ward
_______________________________________________ class Vi shall not possess
Mobile/Transistor/FM Radia 7 any other electrical equipments in the dormitory/Vidyalaya Campus
which attracts indiscipline in the Vidyalaya. In case such accessories are found with my
son/daughter/ward in the Vidyalaya T.C may be issued to him/her forthwith.
3. If my son/daughter/ward leaves/absconds from the campus without permission, the Vidyalaya
administration shall not be held responsible.
4. I was made aware that
(i) If my son/daughter/ward found away from the Vidyalaya without proper information in
writing, he/she will not be taken back by the Vidyalaya.
(ii) My son/daughter/ward should follow the rules and regulations compulsorily and there will be
no compromise on any issue of indiscipline.
Date: Name of Parent : ……………………………………
Place: Signature : ……………………………………
Address : ……………………………………
……………………………………
……………………………………
……………………………………
4
JAWAHAR NAVODAYA VIDYALAYA, LANDIGUDA, DIST: KORAPUT(O)
SOCIO- ECONOMIC DATA OF PARENTS
01. Name of the Student (CAPITAL LETTERS) : ..…….……………..………………………….
02. Name of the Father (CAPITAL LETTERS) : ………………………….…..…………...…...
03. Name of the Mother (CAPITAL LETTERS) : ...………………………….…….………..….
04. a) Name of the Guardian (if father is not alive) : ...……………………………....…….……….
b) Guardian’s relationship With the student : ……………………………………………..…..
05. No. of Brother and Sister : ..…………………………………………..…...
06. No. of Family Members : ……………………………….………...………
07. a) Occupation of father : ……………….……………………………..….
b) Occupation of mother : ……………..………………………….....….…
08. Annual Income (per year) : Father - Rs ……....…… Mother- Rs.………...…
09. Educational Background (Tick mark in box):
Father Mother
a) Illitrate
b) Primary (1-5)
c) Middle (6-8)
d) Matric (9-10)
e) HR.Sec/+2
f) Graduation
g) Post Graduation
h) Any other Technical Qualification
DECLARATION
I hereby declare that the information given above is true to the best of my knowledge and belief. In case, any part of the information furnished by me is found incorrect/false, the admission of my ward/son/daughter may be cancelled. I am ready to produce the relevant certificates issued by the competent authorities as and when asked for.
Date: Signature of the Father/ Guardian
5
BIO-DATA FORM
(To be filled in by the parent of the candidate with the help of the Head of the School where the pupil has
passed Class-V Examination)
01. Name of the Pupil (In Block Letters) : …………………………………………………….. 02. Father’s Name (In Block Letters) : ……………………………………………...……... 03. Mother’s Name (In Block Letters) : ……………………………………..……………… 04. Date of Birth (In Figure) : ………………………………………………………
(WORDS) : ………………………………………………………
05. Write the Category (In Block Letters) : ………………………………………………………
(a) Sex (Male /Female) : ………………………………………………………
(b) Area (Rural/ Urban) : ………………………………………………………
(c) Caste (Gen/ST/SC/OBC) : ………………………………………………………
06. School (s) from where the pupil passed Class-III , IV, V
CLASS III IV V
Month & Year of passing
Name of the School
Is it a recognized School (Yes or No)
Name of the village or Town in which the school is located
Name of the Block
Name of the District
Whether the school is located in Rural or Urban Area
(Signature of father)
The information furnished above is verified from admission & withdrawal register and found correct.
(Signature of Headmaster) With School stamp
6
STUDY CERTIFICATE
(About the studies in Class-III, IV, & V. If the pupil has studied these Classes in different Schools,
Certificates from different schools are to be furnished.)
01. Name of the Pupil (IN CAPITAL) : ……………………………………………………… 02. (i) Date of admission in the school : ………………………………………………………
(ii) Class in which admitted. : ………………………………………………………
03. (i) Date of leaving the school : ……………………………………………………… (ii) Class in which he/she was reading at the time of leaving. : …………………………………………..…………
(iii) Whether passed to take admission in the next higher Class. : ………………………………………………………
04. Whether it is a recognized school (Yes/No) : ……………………………………………………… 05. Whether the school is located in Rural/Urban : ………………………………………………………
CLASS DATE OF JOINING DATE OF PASSING DATE OF TAKING T.C.
CLASS-III
CLASS-IV
CLASS-V
SIGNATURE OF THE HEAD MASTER/MISTRESS (With Office Seal)
7
The Head Master of the School
Dear Sir/Madam,
The information wanted in “BIO-DATA” form is required for admission of the pupil in the JAWAHAR
NAVODAYA VIDYALAYA, KORAPUT. You are therefore, requested kindly to check and verify personally
all the entries from the school record given below and issue the certificate. While issuing/verifying bio-
data form please ensure that the name of child/father/mother & date of birth tallies with the
admission & withdrawal register.
PRINCIPAL
JAWAHAR NAVODAYA VIDYALAYA,
LANDIGUDA, DIST: KORAPUT (ODISHA)
CERTIFICATE BY THE HEAD OF THE SCHOOL
This is certified that, the information given in “BIO-DATA FORM” in respect of Master/Kumari
(Write in CAPITAL LETTERS) _____________________________ is true as per school record. He/She
has passed Class-V in the year _________________ from school _________________________ which is
situated in a Rural /Urban area and has been studying in this school since ________________. This is a
recognized school.
Dated: ______________ Signature of the Headmaster
With school stamp
(Strike out what is not applicable)
8
RESIDENCE CERTIFICATE
(To be furnished by the parents of the qualified children at the time of admission to JNVs)
As per Jawahar Navodaya Vidyalaya, __________________________ District
_____________________ State ____________________ Letter No. __________________ dated
_____________ my ward Master/Kumari ______________________________ has qualified the entrance
exam for admission to Class –VI at JNV _____________________, District ________________ State/UT
__________________ during the session 2016-17.
I am residing along with my ward mentioned above at following address since ________________. Village: ……………………………..………….
Town: …………………………………….……
District: ………………………………………..
State: ………………………………………….
Pin Code: ……………………………………..
Certified that the information furnished by me is true and no fact has been concealed. Signature of Parents
Full Name:……………………………………….
Address:…………………………………………
……………………………………………
…………………………………………… Place: Date:
CERTIFICATE
(To be filled up by the District Authorities and issued under the signature of SDM/Tahasildar to the parents of the child selected for admission to Class-VI in JNVs through JNVST) This is to certify that the above information furnished by Shri/Smt.
__________________________________________ Father/Mother of Master/Kumari
____________________________________ a candidate selected for admission to Class-VI in JNV
______________________ District _____________________ has been verified from the records and is
found to be correct. The area where residence is located falls under rural/urban) area of District
______________________.
Signature SDM/Tahasildar
9
MEDICAL FITNESS CERTIFICATE
Name of the student: ................................................... Sex : ...............................
Father’s Name : ................................................... Age : ...............................
Address : ……………………………………………………………………………………………
……...……………………………………………………………………………………… Date of birth: ………………………. MARK OF IDENTIFICATION 1. …………………………….. 2. …………………………….. 3. …………………………….. INVESTIGATION Blood group RH
Haemoglobin Sickling
FAMILY HISTORY:
1. Whether father/mother is alive. If died reason of death.
2. If alive whether having any disease/treatment taken or taking.
3. No. of other siblings Alive Dead
4. Any disease
5. Whether taking treatment, if so details:
PAST HISTORY:
1. Accident with or without injury and making an impact on the child if yes, mention the event:
2. To then child Yes/No
3. To close relative Yes/No
4. Severe Burn Yes/No. if yes I. What operation: II. At what age: 5. Hospitalization Yes/No if yes I. For what II. At what age: 6. Any other event of importance: CHILDHOOD HABITS: Yes/No, if yes, up to what age:
1. Thumb Sucking
2. Lnuresis (Bed Wetting) I. Diurnal
II. Nocturnal CHILDHOOD DISEASE AND OTHER DISEASE:
1. Age Yes/No
2. Measles
3. Mumos
4. Infantile Poliomyelitis
5. Chickenpox
6. Primary Complex
10
7. Rheumatic 8. Typhoid fever 9. Dysentery 10. Sever of peculiar diarrhoea 11. Whooping cough 12. Diphtheria 13. Tetanus 14. Pneumonia 15. Severe respiratory infection 16. C.S.O.M 17. Epilepsy 18. Infantile Eczema 19. Kwashiorkor 20. Marasmus PERMANENT PHYSICAL OR FUNCTIONAL HANDICAPS 1. Paralysis I. Limbs affected II. Probable cause 2. Clubfoot 3. Flat foot 4. Knock Knee 5. Kyphosis 6. Scoliosis 7. Lordosis 8. Harelip/Cleft palate 9. Blindness of Visionless eye Right eye Left eye Spectacles Yes/No 10. Errors of vision Hypermetropia Myiopia Astimatis, Colour Blindness 11. Hearing Troubles Right ear Left ear 12. Speech Trouble 13. Mental Retardation 14. Stunted growth 15. Caries tooth 16. Body type (it can be written in Hindi also) a. Ectomorph b. Mermorph c. Endomorph 17. Malnutrition a. Over nutrition b. Under nutrition 18. Other (Specify) IMMUNISATIONS Sl.No. Vaccine Already taken Date if to be taken Doses on which date 1. B.C.G Single 2. D.P.T. 1st Below three years 2nd Intervals 3rd 18 months Booster
11
3. Measles 9 to 12 months Single 4. D.T. 1ST 5 Years Booster 5. T.T. 1st 12 years 2nd 4 to 8 weeks Booster 6. Polio Vaccine 5 years 7. Typhoid 1st 5 to 6 years 2nd 8. Cholera Primary 9. Hepatitis”B” Primary 2nd 3rd Hepatitis”A” 10. Others i) Weight ..………..…. In kgs ii) Heights . ….……..….in cms iii) Chest ……….....….in cms (a) Heart (b) Lungs (c) Expansion Range
1. Inspiration 2. Expiration
11. Abdomen and general 1. Liver 2. Spleen 12. Genital 1. Hernia 2. Hydocele (Boys) 13. Ears, Nose, Throat 14. Skeleton and joints 15. Respiratory system 1. Asthma 2. Bronchitis 16. Oral 1. Teeth 2. Gums 3. Throat 17. Skin 18. Any other complaint Signature of Staff Nurse (JNV) Signature of Medical Officer
To be signed on the date of admission Name:
(Seal)
12
AFFIDAVIT
(An affidavit to be furnished by parents on Rs. 10/- stamp paper duly attested by Notary at the time of
admission to Class-VI in JNVs through JNVST)
I_________________________________, Age _____________year, father/mother of
Master/Kum. ___________________________________ Resident of Village __________________
Tehsil ___________________ Dist: _______________ solemnly declare and affirm as under:
a. My ward is a student of ____________________________ (name and complete address of
the Institution) located in ______________________ which is a rural area in District in state
since _______________.
He has passed Class-V from this Institution during the session __________________.
b. My ward is residing with me at following address which is located in the ______________ rural
area of District __________________.
Verified on this the _____________ day _____________ 2017 at ________________ that the
contents of above affidavit are true to best of my knowledge and belief based on record and believed
by me to be true.
Signature
(DEPONENT)
Name:
Place: _________________
Date: __________________
JAWAHAR NAVODAYA VIDYALAYA, LANDIGUDA, KORAPUT (ODISHA)
AFFILIATION CERTIFICATE OF THE SCHOOL OTHER THAN GOVT SCHOOLS
Certified that Master /Ku._____________________________________________________
who has been selected to take admission in Jawahar Navodaya Vidyalaya, Koraput in Class-
VI has passed Class –V from the School _________________________________________
which is affiliated to the Board ________________________________________________
since _____________________ having affiliation No. ______________________________
and the school is located in Rural/Urban area.
Signature of the Parent Signature of the HM/Principal with seal
Countersign by Block Education Officer of the Block with seal
