To List of Documents/items required during Admission 

1. List of items required at the time of admission in the School (Annexure – A) 2. Caste Certificate (SC/ST candidates only) – as per prescribed format issued by 

State Govt, signed by BDO/CO. (Annexure ‐ B) 3. Domicile Certificate – as per prescribed format issued by State Govt and signed 

by BDO/CO. (Annexure ‐ C) 4. Income Certificate ‐ as per prescribed format issued by State Govt and signed 

by the BDO/CO. (Annexure ‐ D) 5. Agreement Form to be executed by parents/guardians of students other than 

full fee paying as Sainik School Gopalganj – To be prepared on stamped paper for Rs. 100. (format enclosed in Annexure ‐ E) 

6. Agreement Form to be executed by parents/guardians of students full fee paying as Sainik School Gopalganj – To be prepared on stamped paper for Rs. 100. (format enclosed in Annexure ‐ F) 

7. Agreement by parent/guardian for putting up scholarship claim by the school (format enclosed in Annexure ‐ G) 

8. Bond to be executed by parents/guardian of scholarship holders from the state of Bihar/Defence – To be prepared on non‐judicial stamped paper on Rs. 20/‐ only (format enclosed in Annexure ‐ H) 

9. Statement of Income for the year 2016‐17 (format enclosed in Annexure ‐ J) 10. Health Certificate (format enclosed in Annexure ‐ K) 11. Affidavit by Parents/Guardian (format enclosed in Annexure ‐ L) 12. Undertaking by the Cadet (format enclosed in Annexure – L (i)) 13. Indemnity Certificate (format enclosed in Annexure ‐ M) 14. Indemnity Certificate (format enclosed in Annexure ‐ N) 15. Affidavit & Certificate of Income (format enclosed in Annexure – O Part I & II) 16. Certificate (format enclosed in Annexure ‐ P) 17. Declaration (format enclosed in Annexure ‐ Q) 18. Undertaking (format enclosed in Annexure ‐ R) 19. Declaration by the parent (format enclosed in Annexure ‐ S) 20. Address Particulars (format enclosed in Annexure ‐ T) 

   

Annexure-A

lSfud Ldwy xksikyxat

fo|ky; esa izos'k ds le; Nk=ksa }kjk yk, tkus okys lkeku dh lwph

dzñ lañ lkekuksa ds uke la[;k 1- gkQ “kVZ (lQsn jax dh) 02 2- gkQ iSaV (lQsn jax dh VsjhdkWVu) 01 3- lSaMks xath 06 4- xath ¼gkQ ckgh½a 06 5- vaMjoh;j 06 6- gokbZ pIiy 01 tksM+h 7- ukbZV lwV ¼ikiyhu LdkbZ Cyw Iysu½ 01 lsV 8- LVhy dk cDlk ¼dkyk & 30”x16”x12” ½ ftl ij Nk= dk uke fy[kk

gks ,oa ,;j cSx 01 izR;sd

9- Rkkyk 03 10- lkcqunkuh 01 11- lwbZ] /kkxk ¼ [kkdh] lQsn] dkyk½ ] cVu] CysM] usy dVj 01 izR;sd 12- cwV czl 01 13- gSaxj 06 14- “kh”kk 01 15- :eky dkWVu (06) 02 iSdsV 16- rkSfy;k 02 17- cSM”khV ¼lQsn jax dh½ 01

18- IykfLVd ckYVh 01

19- IykfLVd ex 01

Ldwy dSaVhu ,oa LVksj esa miyC/k lkeku dh lwph

dzñ lañ lkekuksa ds uke la[;k 1- cwV ikfy”k 01 2- VwFk isLV 01 3- VwFk cz”k 01 4- da?kk 01 5- eSVªl rfd;k ds lkFk 01 6- cSM”khV ¼gjs jax dh½ 02 7- ePNjnkuh 018- ekstk ¼lQsn ,oa dkys jax ds Iysu½ 03 tksM+h izR;sd 9- LiksVZ “kw 01 tksM+h 10- gkml Vh-”kVZ 02

11- gkQ iSaV ¼LiksV~l fudj½ 02 12- Ldwy Vh&”kVZ 01 13- CySd “kw vkDlQksMZ iSVZu 01 tksM+h

 

Annexure - B

CERTIFICATE OF SCHEDULED CASTE/SCHEDULED TRIBE

(To be prepared on prescribed format issued by State Govt and signed by the BDO/CO) ………………………………………………………………………………………………………….

Annexure - C

CERTIFICATE OF DOMICILE

(To be prepared on prescribed format issued by State Govt and signed by the BDO/CO) ………………………………………………………………………………………………………..….

Annexure - D

INCOME CERTIFICATE

(To be prepared on prescribed format issued by State Govt and signed by the BDO/CO)

(ON Rupees 100/- Stamp Paper)

Annexure‐E  

AGREEMENT FORM TO BE EXECUTED BY PARENTS/GUARDIANS  OF STUDENTS OTHER THAN FULL FEE PAYING AT SAINIK SCHOOL GOPALGANJ 

 

  This  agreement  is  made  this………………..day  of…………..201……….between …………………….of……………….(hereinafter called the Guarantor which expression shall unless excluded by the context or the meaning there of the deemed to include his heirs, executors, administrators and  legal  representatives)  of  the  one  part  and  the  Board  of  Governors  Sainik  Schools Society(hereinafter) called the ‘Governors’ which expression shall unless excluded by the context or the meaning thereof be deemed to  include the Principal of Sainik School ……………….. of the other part.   Whereas  Master  …………………..(hereinafter  called  the  student)  is  the  son/ward  of  Shri ……………….the guarantor and has at the request of the guarantor been selected for admission to the Sainik  School…………………inter‐alia,  on  the  terms  and  conditions  hereinafter  appearing  for  the purpose of receiving education with a view to making the Regular Armed Forces, his profession in life, if considered by the appropriate to be suitable and if there is any vacancy and if he be selected.  

NOW IT HEREBY AGREED BY and between the parties hereto as follows:‐  

   That in consideration of the student being admitted by the Governors to the Sainik School for the purpose of aforesaid education at the request of the Guarantor, convenient with Governors that student will attend the Sainik School regularly and will observe and comply with all the rules and  regulations  thereof  for  the prescribed  period  or  until he  is  declare  fit  for  admission  to  any institution  as may  from  time  to  time  prescribed  by  the Governors,  for  training  for  entry  to  the Regular  Armed  Forces  and  that  he,  the  guarantor  shall  pay  to  the  Governors  regularly  and promptly) and when‐ever called upon to do so all the fees as prescribed,  if he  is not  in receipt of any scholarship.  

  That  if  for an  reasons not beyond  the  control of either  the  student or  the guarantor  the student fails to pursue his studies at the said school before appearing for selection for entry to an institution as may  from  time  to  time be prescribed by  the governors  for  training  for entry  to  the Regular Armed Forces or fails to appear for the said selection till such time as his age permits him to do so, according to the rules and regulations. For the time being  in force or having been declared successful at the said selection does not proceed to one of the said institution to which he may be directed to proceed for being trained for entry into the Regular Armed Forces of having joined the said  institutions, then and  if any such case the guarantor shall forth‐with pay to the Governors  in cash  the  sum  the  student  has  received  form  the  school  and  /or  the  State Government/Central Government  the value of  the  scholarship he has  received  for  the period  the  student was  in  the school.   That  if  after  admission  any of  the  following  viz, proof of Domicile,  certificate of  age  and statement of income supplied by the guarantor, is found to be false in any way or not in order the guarantor shall forthwith pay to the Governors in cash the sum the student has received from the school  and/or  the  state  Government/Central  Government  (the  value  of  the  scholarship  he  has received) for the period the student was at the said school.    That  if after admission,  the student  is  found  to be medically unfit  in any way at  the  time which may be might, according to the opinion of appropriate medical authority, render him unfit for his  further entry  to  the Regular Armed Forces,  the  student will be withdrawn at once, but  it would be open to the guarantor to retain him at the school on/payment of the full fee prescribed by the Governors from the date student is found medically unfit.  

…2/‐ 

‐2‐   That the Governors will not be  liable  for any dames/charges on account of  injuries   which may be sustained by the student at any time during his stay in the school while taking part in sports or  other  co‐curricular  or  extracurricular  activities  of  the  school.  All  expenses  that may  be  incurred  in treatment on such injuries will be borne by the parent/ guardian as provided in the rules of the said school.  And  that  if  there  is any dispute as  to  the effect of meaning of  these presents of  in any way  touching or arising out of these presents, the same shall be referred to the sole arbitration of the Board of Governors, Sainik Schools, whose decision shall be final.  In witness thereof …………………..has set his hand and by order and   ……………………..direction of the Board of governors has set his hand the day and the year first above written.      Signed by              Signed by in presence of              for and on behalf (See note (b) below)            of the Board of Governors,                 Sainik Schools, in the presence of   WITNESS:  1.  ………………………………………………………..  (Gazetted Officer)  2.  ………………………………………………………..  (Gazetted Officer)  Note  (a) The agreement form  is to be fully stamped. The necessary stamped paper for Rs. 100/‐  is to be 

purchased by the guarantor from the Local Revenue Office.   (b) the signature of the guarantor is to be witnessed by any Government servent of gazette status.   (c) the space provided for the date  in the Ist para of the agreement form should not be filled  in by 

the  guarantor.  This will  be  filled  in  on  the  date  on which  the  Agreement will  be  signed  by  the Principal, Sainik School Gopalganj. 

 

(ON Rupees 100/- Stamp Paper)

Annexure‐F  

AGREEMENT FORM TO BE EXECUTED BY PARENTS/GUARDIANS  OF FULL FEE PAYING STUDENTS SAINIK SCHOOL GOPALGANJ 

   This  agreement  is  made  this………………..day  of…………..201……….between …………………….of……………….(hereinafter called the ‘Guarantor’ which expression shall unless excluded by the context  or  the  meaning  thereof  be  deemed  to  include  his  heirs,  executors,  administrators  and  legal representatives) of the one part and the Board of Governers Sainik Schools Society (hereinafter) called the ‘Governors’ which expression  shall unless excluded by  the  context or  the meaning  thereof be deemed  to include the Principal of Sainik School Gopalganj of the other part.    Whereas Master …………………..S/o Shri …………………..(hereinafter called the student)  is the son/ward of  the  guarantor  and  has  at  the  request  of  the  guarantor  been  selected  for  admission  to  the  Sainik School…………………inter‐alia, on the terms and conditions hereinafter appearing for the purpose of receiving education in a Sainik School.  NOW IT HEREBY AGREED BY and between the parties hereto as follows:‐     That  in consideration of the student being admitted by the Governors to the Sainik School for the purpose  of  aforesaid  education  at  the  request  of  the Guarantor,  he,  the  covenants with Governors  that student will attend the Sainik School regularly and will observe and comply with all the rules and regulations thereof  for  the  prescribed  period  and  that  he,  the  guarantor,  shall  pay  to  the  Governors  regularly  and promptly ad whenever called upon to do so all fees prescribed , for education in the Sainik School.  

That  if Governors will not be  lable  for any dameges/charges on account of  injuries which may be sustained by  the  student any  time during his  stay  in  the  school while  taking part  in  sports or other extra curricular activities of the school or on account of any other reason directly or indirectly related to his stay as a student in the school. All expenses that may be uncured in the treatment of such injuries will be borne by the parent/guardian as provided in the rules of the said school.    And that if there is any dispute as to effect or meaning of these presents or in any way touching or arising out of these presents the same shall be referred to the sole arbitration of the Board of Governors, Sainik Schools, whose decision shall be final.   In witness  thereof …………………..has  set his hand  and …………………..by order  and direction of  the Board of governors has set his hand the day and the year first above written.   Signed by              Signed by in presence of              for and on behalf (See note (b) below)            of the Board of Governors,                 Sainik Schools, in the presence of WITNESS:  

1.  ………………………………………………………..  (Gazetted Officer)  2.  ………………………………………………………..  (Gazetted Officer)  

Note  (a) The agreement form  is to be fully stamped. The necessary stamped paper for Rs. 100/‐  is to be purchased by the guarantor from the Local Revenue Officer. 

  (b) Government servent of gazette status who should sign together with his seal of officer taken of having witnessed the Signature of the guarantor. 

  (c) the space provided for the date  in the Ist para of the agreement form should not be filled  in by the  guarantor.  This will  be  filled  in  on  the  date  on which  the  Agreement will  be  signed  by  the Principal, Sainik School Gopalganj. 

Annexure‐G  

AGREEMENT BY PARENTS/GUARDIANS  FOR PUTTING UP SCHOLARSHIP CLAIM BY THE SCHOOL 

   I ………………………………………resident of (full address) Village ……………………Post  ………………….Block …………………District ……………………………..do hereby authorize the Principal, Sainik School Gopalganj to claim the scholarship in respect of my son Maser ……………..School No……………. studing in Sainik School Gopalganj and I hereby agree to abide by the rules laid down by the rules laid  down  by  the  said  received  by  me  amount  of  scholarship  received  by  my  son  Master ………………………from me or my legal heir on the following grounds:‐  

(a) If  in the opinion of the Principal, Sainik School Goaplganj my son named above  fails to accept  the  discipline  of  the  School  and  his  continued  presence  is  detrimental  to  the interest of other. 

 (b) If for any reason not beyond the control of either the boy named above or me the boy 

fails to pursue his studies at the said school before appearing for selection for entry to any  institution as may  from  time  to  time be prescribed  for  training  for entry  in  to  the Regular Armed Forces or fails to appear for the said selection or in the event of his not succeeding in the selection fails to reappear for selection till such time as his age permits him to do so, according to the rules and regulations for the time being in force of having been  declared  successful  a  the  said  selection  does  not  proceed  to  one  of  the  said institution which  he may  be  directed  to  proceed  for  being  trained  for  entry  into  the Regular Armed Forces. 

 (c) If after admission any of the following viz, proof of domicile, certificate of age, school‐

leaving certificate, medical Certificate and statement of income supplied by me is found to be false in any way or not in order. 

  Place ……………………….           Signature Date                of Parent/ Guardian       Address            Signature of Gazetted Officer____________ 

Witness            Name and Designation______ ___________ 

                 Place ……………………… Date                Office Seal  

(On Rs 20/- Non-Judicial stamped paper)

Annexure – H

BOND TO BE EXECUTED BY PARENTS/GUARDIANS OF SCHOLARSHIP HOLDERS FROM THE STATE OF BIHAR/DEFENCE

Be know to all that at present we, (1) Shri ..............................................................

aged............... Son of ...............................................Block .................. Dist.......................

(hereinafter called the bounden) and (2) Shri/Smt...............................................................

Son/daughter of .................................................. and (hereinafter the relationship with the

student/guardian for himself and on behalf of the bounden (minor) and (3) Shri/Smt..........

.................................................................................................... Son/daughter of ..............

....................................................................House.................. Town/Village........................

Block ....................... District ........................ and (4) Shri/Smt.............................................

Son/daughter of ..........................................................House ................. Town/Village ......

............................. Block ......................... District ..........................................................

(hereinafter called the sureties)do hereby bind ourselves, our heirs, executors,

administrators jointly and severally to pay into the Governors of (hereinafter called the

Government) on demand, the ................................................................Rupees

....................................................................... (in words also to be entered here) ...........

..........................................................................................................

Signed and dated this the ................... day of .................... two thousand and ...................

Signature of Bounded ............................................................. (Student)

Signature of the guardian/parent on his own behalf and on behalf of the minor Shri/Sht

..............................................................................................

Signature of the First Surety ..........................................................(Ser No. 3 above)

Signature of the Second Surety .................................................... (Ser No. 4 above)

Witness 1. .................................................................................... (Gazetted Officer)

2. .................................................................................... (Gazetted Officer)

Whereas the Bounded applied for admission to the Sainik School at .......................... and Whereas the Bounded has been granted scholarship of Rs........................... annually for a period of .......... years from ......... subject to the continuity for a period of ........ years from ...................... subject to the conditions that.

(i) The Bounden shall strictly conform to the rules for the award of scholarship for students in the Sainik School issued under Government order and the instructions which may be issued by the Government of by the authorities of the school from time to time (hereinafter referred to as the Rules and instructions).

2 (ii) The bounden shall not discontinue the course, except for reasons beyond his control and beyond the control of the parent/guardian and with the written permission of the Principal of the School. (iii) The Bounden shall conform to and observe all the rules and conditions regarding the study, discipline and conduct as may be prescribed by the authorities of the school from time to time. (iv) The Bounded shall appear for the Union public Service Commission Examination for admission to the National Defence Academy as long as he is within the age limits and shall join the National Defence Academy if selected. (v) The amount of the scholarship shall vary under rule 10 of the rules in case of increase in the annual income of the Parent/guardian provided that the scholarship shall cease in case the change is such the Bounden is no longer eligible for scholarship under the said rule. (vi) In case there is change in the income group of the Parent/Guardian for purpose of Rules for the same shall be communicated to the Principal, Sainik School Gopalganj immediately by the parent or guardian. Now the condition of the above written obligation is that in the event of the Bounden

not conforming to or observing the rules and instructions and conditions regarding the studies or discontinuing the course without the prior permission in writing of the Principal or of continued adverse reports regarding the progress of his studies or of the conduct or of his failure to appear for the Union Public Service Commission Examination for admission to the National Defence Academy or his failure to join the National Defence Academy if selected for that if for any reason not beyond the control of either the student or the parent/guardian, the student fails to purse his studies at the said school before appearing for selection for entry to any institution as may from time to time be prescribed by the Sainik School Authorities or training for entry to the Regular Armed Forces or fails to appear for the said selection or in the event of his not succeeding in the said selection fails to appear for the said selection or in the event of his not succeeding in the said selection fails to appear for selection till such time as his age permits him to do so, according to the rules and regulations for the time being in force or having been declared successful at the said selection does not proceed to one of the regular Armed forces or having joined the regular Armed Forces after completing the training at the said institution or breach of all or any of the conditions mentioned in the previous paragraph the Bounden, the parents/guardians and the sureties shall forthwith pay to the Government a sum of Rs .......................................... (hereinafter the amount of scholarship plus a sum by way of damage) Rs........................... (in word) ......................... .............................................................................................................................................. and upon payment of such sum the above written obligation shall be void and of no effect, otherwise this shall remain in full force and effect.

3 Provided further that the Bounden, the Parent/guardian and the sureties do hereby agree that all sums found due to the Government under or by virtue of these presents may be recovered jointly and severally from them and from their properties, moveable and immovable if such dues arrears of land revenue under the provision of the Revenue Recovery Act for the time being in force and in such other manners as the government may deem fit. The liability of the Parent/guardian and the sureties under this bond shall not be affected by the Government giving time or any other indulgence to the bounden. In witness where of the Bounden Shri ................................................... the parent/ guardian

Shri ..........................................., on his own behalf and on behalf of the bounden, the

sureties Shri .................................................. and Shri.................................. .....................

have herein to set their hands the day ad year first above written.

Signed by ................................................ The Bounden (Student)

Signed by ................................................. The Parent/Guardian

Singed by ................................................. The Surety (Ser No. 3 above)

Signed by .................................................. the surety (Ser No. 4 above)

In presence of witnesses:- 1.................................................... 2 ................................................ (Gazetted Officer) (Gazetted Officer) Note:- The agreement form is to be made on a Non-Judicial stamped paper worth Rs. 20/-. The necessary stamp paper is to be purchased by the guarantor from local Revenue Office.

ONLY DEFENCE PERSONNEL Annexure – J

SAINIK SCHOOL GOPALGANJ

(Income Certificate in respect of boys in receipt of Ministry of Defence Scholarship)

Name of the boy....................................................... son of ......................................... studying in Sainik School Gopalganj in Class ..........................

STATEMENT OF INCOME FOR THE YEAR : 20…. – 20…...

Income from Pay/ Pension including

allowances per month

Income from Land/ Immovable property

Income from business Stocks and Share etc.

Any other Sources

Total Per Annum

Self /Guardian

Wife’s

Child’s Name

AGGREGATE INCOME PER ANNUM

I hereby solemnly declare that the above information is true to the best of my knowledge and belief and that nothing is kept concealed.

Date: Signature of Parent’s/Guardian’s

Station: Occupation:

Note: - Please enclose last month’s pay slip in support of income mentioned above.

Annexure ‘K’

Note: - This proforma shoul be countersigned by the competent Medical Officer.

HEALTH CERTIFICATE

1. This certificate must be filled up and signed by the parent/ guardian before the boy

sent to the School. The suppression of important as to past and present health or as to

exposure to infection is liable to be regarded as a breach of contact.

Name ................................................................................................

Roll No./School No. .......................... Age.........................................

2. Has he had chicken pox .................................... if So, when ...........................

Diphtheira .......................................................... if So, when ...........................

Rubella (German Measles) ................................ if So, when ..........................

Small Pox .......................................................... if So, when ............................

Enteric Fever...................................................... if So, when ............................

Rheumatic Fever ............................................... if So, when ............................

Mumphs ............................................................ if So, when .............................

3. Has he been successfully ................................. if So, when .............................

(a) Vaccinated for Small Pox ............................ if So, when ............................

(b) Revaccinated for Small Pox ........................ if So, when ............................

(c) Inoculated against typhoid ........................... if So, when ............................

(d) Hepatitis ‘B’ Injection ................................... if So, when ............................

Actively immunised against:-

(a) Diphtheria ?................. ................................ if So, when ............................

(b) Tetanus......................................................... if So, when ............................

(c) Whooping Cough ......................................... if So, when ............................

(d) Any other disease ........................................ if So, when .............................

Contd....2/-

-2-

4. Has he:-

Had fits ...........................................................................................................

Been ruptured ?................................................. if So, when ..........................

Had any discharges from the ear ...................... if So, when ..........................

Had in-continence urine?...................................if So, when ...........................

5. Has he had any surgical operation?...................if So, give ............................

particulars and date ........................................................................................

6. Has he had any serious illness ? if So, give particulars........................

7. Does he suffer from any ailment or constitutional peculiarty affecting the general health. Eg. Night Blindness ...............................

8. Is he in your opinion in all respects for ordinary school life ..............................

9. Is there any other information that you think the Medical Officer should have?

...................................................................................................................

10. Does the boy wear glasses ? (if so, the prescription may be attached with the

certificate) ..................................................................................................

Date: Signature in full of Parent/ Guardian

Place:

Countersigned

(Medical Officer)

Annexure - L

AFFIDAVIT BY PARENT/GUARDIAN

1. Mr./Mrs./Ms. ___________________ (full name of parent/guardian) father/mother/guardian of, (full name of student with admission/registration/enrolment number), having been admitted to Sainik School. 2. I am fully aware of what constitutes ragging. 3. I am also fully aware of the penal and administrative action that is liable be taken against my ward in case he is found guilty of indulging in a abetting ragging, actively or passively, or being part of a conspiracy to promote ragging. 4. I hereby solemnly aver and undertake that a) My ward not indulge in any behaviour or act that may be constituted as ragging. b) My ward will not participate in or abet or propagate any act of commission or omission that may be constituted as ragging. 5. I hereby accept that, if found guilty of ragging, my ward is liable for punishment 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. 6. 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, the admission of ward is liable to be cancelled. Declared this _________ day of __________ month of __________ year. _________________ Signature of deponent Name: Address:

Telephone/Mobile No.:

VERIFICATION Verified that the contents of this affidavit are true to the best of my knowledge and no part of the affidavit is false and nothing has been concealed or misstated therein. Verified at _______(place) on this the ____(day) of ____(month), _________(year). ________________ Signature of deponent Solemnly affirmed and signed in my presence on this the (day) of (month) (year) after reading the contents of this affidavit. OATH COMMISSIONER

Annexure – L(i)

UNDERTAKING BY THE CADET

1. ____________________ (full name of student with admission/registration/enrolment number)

s/o d/o Shri/Smt________________, having been admitted to Sainik School

_________________________ am fully aware of what constitutes ragging.

2. I am fully aware of the penal and administrative action that is liable to be taken against me in

case I am found guilty or including in or abetting ragging, activity or passively, or being part of a

conspiracy to promote ragging.

3. I hereby solemnly aver and undertake that

a) I will not indulge in any behaviour 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

any act that may be constituted as ragging.

4. I hereby affirm that, if found guilty of ragging, I am liable for punishment 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.

5. Declared this __________ day of _________month of_____ year________.

( ________________ )

Signature of deponent

Name:

VERIFICATION

Verified that the contents of the undertaking are true to the best of my knowledge and no part

pf the same is false and nothing has been concealed or misstated therein.

Verified at _____________(place) on this the __________ (day) of__________ (month)

__________ (year).

_________________

Signature of deponent

Annexure – M

INDEMNITY CERTIFICATE

In consideration of my son/word Roll No ....................... Name ................................ ................................................................ being allowed at his/my request for travel during winter/mid term and summer vacation or during organized Educational and Motivational tours and when called at my request on emergency with or without escort. I undertake and agree that neither I nor my executor nor administrator will make any claim against the Government of India or against any Officer, Instructor or any person in the service of Sainik School Gopalganj or the Sainik Schools Society in respect of any loss or injury including the death which he may suffer during the travel during winter/mid term and summer vacations or during any organized trips like educational and motivational tours and when called at my request on emergency with or without escort. I understand that no compensation will be paid by the Government of India for any loss or injury including death and I agree so as to bind myself, executors and administrators to indemnify the government of India or any Officer/Instructor of Sainik School Gopalganj against any claim.

Signature of the Parent/Guardian

Address: Signed by Parent/Guardian in my presence:

Witness:

1_______________________________ Date ___________________________

Name ___________________________

Address ________________________

________________________________

2_______________________________ Date ___________________________

Name ___________________________

Address _________________________

_________________________________

Annexure – N

INDEMNITY CERTIFICATE In consideration of my son/word Roll No ....................... Name ................................ ................................................................ being allowed at his/my request to swim in the Sainik School Gopalganj Swimming Pool, to participate in shooting and horse riding activities and Adventure training activities, I undertake and agree that neither I nor my executor nor administrator will make any claim against the Government of India or against any Officer, Instructor or any person in the service of Sainik School Gopalganj or the Sainik School Society in respect of any loss or injury including the death which he may suffer during the above trainings/swimming and I understand that no compensation will be paid by the Government of India for any loss or injury including death and I agree so as to bind myself, executors and administrators to indemnify the Government of India or any Officer/Instructor of Sainik School Gopalganj against any claim.

Signature of the Parent/Guardian

Address: Signed by Parent/Guardian in my presence: Witness: 1_______________________________ Date ___________________________

Name ___________________________

Address __________________________

_________________________________

2_______________________________ Date ___________________________

Name ___________________________

Address __________________________

_________________________________

Annexure – O (Part-I)

AFFIDAVIT AND CERTIFICATE OF INCOME

(Incomplete/Illegible/Over written affidavit and certificates will be accepted)

I. AFFIDAVIT BY THE PARENT/GUARDIAN

I ___________________________ (Name of Parent/Guardian in Capitals) son of Shri

__________________________ resident of _____________________ Block ______________

District ____________________________ hereby solemnly declare on oath that the particulars of

income in respect of self furnished below for the year __________ from 1st Apr ________ to

31 Mar __________) are true to the best of my knowledge and no income has been

omitted/concealed.

2. 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 son/ward and or any other

penalty as may be imposed by the Scholarship granting authority.

Sl. No. Annual Income

1. From Salary/Pension (only Basic):

2. Other Sources

(a) Business (b) Property (c) Agriculture

(d) Investments (e) Miscellaneous

Note: If there is not income from any other source, write NIL against the heading instead of drawing a

line of dash.

Total Income Rs. ________________________ (In figure)

(in words) Rupees ________________________________________________________ only)

(Please divide the Annual Income by 12)

Signature of the Parent/Guardian

Place: ___________________________

Date: ____________________________

Annexure – O (Part-II)

II CERTIFICATE

(To be issued by a Block Officer not below rank of Block Development Officer)

Certified that the Monthly Income of Shri ___________________________ of _____________ (place)

as verified by me is (in figures)* Rs ____________________________/- (in words) Rupees

_________________________ only) during the year ___________________.

Signature in full __________________________

Name __________________________________

Designation _____________________________

Place _________________________

Date __________________________

OFFICE SEAL: *Here the income to be mentioned is monthly and NOT annual income please. In case salaried people. Only basic pay is to be treated as income.

Annexure - P

CERTIFICATE

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

any source other than Ministry of Defence Scholarship towards the education of my son

studying in Sainik School Gopalganj (Bihar).

Place : Signature of the Parent/Guardian Date : (Name in Block letters) ------------------------------------------------------------------------------------------------------------------------- Annexure - Q

DECLARATION 1. I, ……………………………………………………..of ……………………………………..

Village/Town/City ………………………………………….Block Office…………………………

District ………………………….………………Father/Guardian of Roll No ………………..….

Master …………………………………………….., do hereby solemnly declare that :-

(a) My above name son/ward has applied and appeared in the examination for admission to Sainik School Gopalganj for the first time in the month of January …………. . Also he has not appeared at any time for admission to any other Sainik School. (b) The particulars given by me in the application form submitted for the above examination in respect of the said boys is true and no information asked to be furnished has been concealed. 2. In the event of the above information having been found incorrect at any time, I undertake to refund the full amount of the Scholarship enjoyed by son/ward immediately, on demand and without demur and will have no objection to my above named son/ward immediately removed/withdrawn from Sainik School Gopalganj. (Signature of the Parent/Guardian) Name in full ………………………………….. (in Capital letters) Address ………………………………………. …………………………………………………

Annexure – R

UNDERTAKING

(UNDERTAKING BY PARENTS/GUARDIANS IN CONNECTION WITH REALISATION OF

ENHANCED SCHOOL FEES IN RESPECT OF THEIR SONS/WARDS)

1. ___________________________________Father/Guardian of Roll No ________

Master ___________________________________, do hereby undertake to pay the increase

in School Fees as revised by the Board of Governors, Sainik Schools, from time to time in

respect of my son/ward till the completion of his studies in Sainik School Gopalganj (Bihar)

Signature of the Parent/Guardian Name in full ………………………………… Place : Address …………………………………….. Date : ……………………………………………….. …………………………………………………

Annexure-S

DECLARATION BY THE PARENT

1. I, _________________________________ Father/Guardian of Roll No. __________________

Name ____________________________ hereunder furnish passion of the Land and other immovable properties possessed during the year ________________________.

(a) Land Survey No. Dry/Wet Extent

(b) Other Properties

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

(a) Name of Employment & Designation : _________________________________

(b) Basic Pay drawing : Rs. ______________________________

(c) Place of Employment : _________________________________

(d) Full address of the employer : _________________________________

3. Details of Family

Sl. No. Name Son/Daughter Date of Birth

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.

(Signature of the Parent/Guardian

Name in CAPITAL LETTERS: _____________________________

Place:

Date:

Annexure – T

ADDRESS PARTICULARS

Name of the Cadet : ________________________________________________________ (NAME IN CAPITAL LETTERS)

Full Postal Address : House No. ___________________ Streat ______________________

Village ____________________________________________________

Block ___________________ Post Office ________________________

District _____________________ State _________________________

PIN -

Nearest Telegraphic Office _________________________________________________ and distance

from the place of residence _______________________________________ kms.

Nearest Railway Station ___________________________________________________ and distance

from the place of residence _______________________________________ kms.

Nearest Police Station ____________________________________________________ and distance

from the place of residence _______________________________________ kms.

Telephone Nos.

(a) Residence (Landline/ Mobile)

(b) Office (Landline/Mobile)

I request all telegrams and other communications pertaining to Cadet _______________________

be sent to the above address, Change in address will be notified as and when necessary.

Signature of the Parent/Guardian

Name in CAPITAL LETTERS ___________________________

Place:

Date: