DOCUMENTS TO BE SUBMITTED DURING ADMISSION TO SAINIK SCHOOL GOALPARA
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DOCUMENTS TO BE SUBMITTED DURING ADMISSION TO SAINIK SCHOOL GOALPARA
Sl Documents Reference
(a) Transfer Certificate (Transfer Certificate countersigned by the
Inspector of Schools of the District concerned with name of the signatory).
(b) Birth Certificate (Original certificate issued by the State Govt)
Caste/ Tribe Certificate in case of SC/ST candidates issued by the competent District or
State Authority or as per Appendix ‘A’.
(c) Certificate of Domicile or Permanent Resident certificate, in original, Appendix ‘B’ (to be
signed by the District Commissioner with office stamp and name of signatory, failing which
the form will not be accepted).
(d) Address and particulars of student and Parent/ Guardian, as per Appendix ‘C’.
(e) Medical Fitness Certificate as per Appendix ‘D’.
(i) Your child should be inoculated against Typhoid, Cholera, Hepatitis B, Chicken Pox.
(ii) You are requested not to send your child if he is suffering from any communicable
disease like Chicken pox or Mumps. In such cases, the Child will be admitted only after
completion of the inoculation/ treatment period.
(iii) Blood Group of the boy must be mentioned in the Medical Certificate. Past history of
illness of the boy, if any, to be submitted separately mentioning the illness & treatment
administered. In addition to medical certificate a certificate indicating the candidate’s blood
group should be brought.
(iv) Non disclosure of information on history of illness such as epilepsy will lead to
cancellation of admission and withdrawal, when manifested.
(f) Income Certificate
(a) Parents / Guardian. Income Certificate (from all sources that is salary, property in
town, property in village, business and other sources),.as per Appendix ‘E’. All parts of the
Income Certificate must be completed and signed by the competent authority only with
official stamp and name of the signatory in capital letters.
(b) Only for Defence Personnel. Defence personnel (both serving and retired) are
to submit documents as indicated below for Income certificate :-
(i) Serving personnel : As per Appendix ‘F’.
(ii) Ex – Servicemen : As per Appendix ‘G’ (with a photocopy of Discharge Certificate).
(g) Agreement to be executed at Sainik School Goalpara by Parents/ Guardians of the student
in receipt of Govt Scholarship (on Rs 10.00 Stamp Paper) as per Appendix ‘H’.
(h) Agreement Forms to be executed at Sainik School Goalpara by Parents/ Guardians for full
Fee paying student (on Rs 10.00 Stamp Paper) as per Appendix ‘I’.
(j) Indemnity Certificate (on Rs 10.00 Stamp paper) as per Appendices ‘J’ & ‘K’.
(k) Undertaking for New Admission (on Rs 10.00 Stamp Paper) as per Appendix ‘L’.
(l) Affidavit by Parent / Guardian and Undertaking by the Cadet as per Appendix ‘M’ & ‘N’.
(m) Details of sibling i.e. real brothers and sisters duly signed by the parents on the performa
enclosed as Appendix ‘O’.
(n) (i) Eight passport size photographs of child
(ii) Four postcard size photographs of the child along with parents, only blood
brothers and sisters for school record.
(iii) Four passport size photographs of Guardian, authorised by the Parent, if any.
(p) Assam and Arunachal domicile Cadets are required to submit the State Bank Saving
Account in the name of Cadet. The front page of the passbook to be submitted at the time of
admission for transfer of Govt Scholarship.
(q) Photocopy of Aadhaar Card of candidate and parents.
(r) You are to bring the ‘Personal Clothing ‘listed at Appendix ‘P’ of this letter at the time of
admission.Appendix - A
SCHEDULED CASTE / SCHEDULED TRIBE CERTIFICATE
(Photostat copy to be submitted with application form and original certificate during admission)
1. This is to certify that Shri..............................................................................................................
son of..............................................................of Village */town.........................................................
in District* / Division of.......................................................................................of the State* /Union
Territory of.........................................................................................................................belongs to
the.............................................................................................Caste*/Tribe which is recognized as
a scheduled Tribe under the Scheduled Caste and Scheduled Tribes List (Modification) order,
1956*.........................................................................................the Constitution (Jammu * Kashmir)
Scheduled Caste Order, 1956*............................................... .............................................. The
Constitution (Andaman and Nicobar Islands) Scheduled Tribes order, 1959* the constitution
(Dadar & Nagar Haveli) Scheduled Caste order, 1962*.................................................................
the Constitution (Pondicherry) Scheduled Caste order, 1964*...................................................the
constitution(Uttar Pradesh) Scheduled Tribe order, 1967*...............................................................
2. Shri................................................................................................................................................
and */or his family reside (s) in Village*/Town....................................................................................
........................................................................of District*/Division.....................................................
..............................................................................................................of the State*/Union Territory
of.........................................................
Place : Signature..................................................
Date :
Designation :....................................................................
(with Seal of Office)
* Please delete the words which are not applicable State / Union Territory
Note : The term ordinarily reside (s) used here will have the same meaning as in section 20 of
the Representation of the People Act 1950.
Officers competent to issue Caste / Tribe Certificates
(i) Dist. Magistrate / Addl. District Magistrate / Collector / Deputy Commissioner / Addl. Deputy
Commissioner / Deputy Collector / 1st Class Stipendiary Magistrate / City Magistrate / Sub-
Divisional Magistrate / Taluka Magistrate / Executive Magistrate / Extra Assistant Commissioner
(Not below the rank of 1st Class Stipendiary Magistrate).
(ii) Chief Presidency Magistrate / Addl. Chief Presidency Magistrate / Presidency Magistrate.
(iii) Revenue Officer not below the rank of Tehsildar.
(iv) Sub Divisional Officer of the area where the candidate and / or is family normally resides.Appendix - B
CERTIFICATE OF DOMICILE
(Photocopy to be submitted with application form. Original to be submitted at the time of admission)
1. Certificate of domicile of Parents / guardian of School No..........................................................
(to be left bank) Name .............................................................................................is a candidate
for admission to Sainik School, Goalpara.
2. This is to certify that Mr. / Mrs. ..........................................................................father / mother/
guardian of the above candidate is a permanent resident of village / town...................................
.....................................................P.O.........................................in Tehsil......................................
Dist ............................................. State........................................
3. The above village / town is within the jurisdiction of the Gram Panchayat / Police Station of
which I am the Pradhan / Station Officer of Police Station.
4. Certified that the above named individual has been actually residing in that village / town for
the last.........................................years and is residing therein on the date of certificate.
Seal & Date (Name of the Pradhan of the Gram Panchayat/
Station Officer of the Police Station signing this
Certificate)
Seal & Date (Signature of the Pradhan / Station Officer of the
Police Station)
Seal & Date (Name and designation of Gazetted Office /
District Officer other than DM / ADM)
Seal & Date (Signature of the District Officer / Gazetted
Officer other than DM / ADM
COUNTERSIGNED
Date Name and Signature of the
Seal Countersigning District Magistrate
Note. This certificate is to be attested by the District Magistrate / Additional District Magistrate of
the district to which you belong.Appendix -C
ADDRESS & PARTICULARS OF STUDENT AND PARENT / GUARDIAN
(To be submitted during Admission)
1. Name of Student :
2. School Roll No. :
(To be given by School)
3. Name of Father / Guardian :
4. Educational Qualification :
5. Occupation of Father / Guardian :
6. If in Govt. or Private service
Designation & Department :
7. Mother’s Name :
8. Educational Qualification & Occupation :
9. Full Postal Address :
(a) Present Address
Vill....................................... P.O................................ Dist...........................................
State.................................... Pin :............................... P.S..........................................
(b) Permanent Home Address
Vill....................................... P.O................................ Dist..........................................
State.................................... Pin :............................... P.S..........................................
10. E-mail................................................... Alternate E-mail.............................................
11. Telephone No, if any (Mobile)
(R) STD Code.................... No.......................... Mob ................................
(O) STD Code.................... No........................... Mob ................................
12. Nearest Railway Station :
13. Name and address of Local Guardian with Telephone No if any, who can be contacted in
case of emergency. Name ....................................... Mob No...............................................
I Certify That :-
(a) The above particulars are correct.
(b) I will intimate change in address, if any, on occurrence.
(c) Responsibility of non-receipt of any letters etc sent by school but not received by me
on account of my failure to intimate change in address, will be mine.
Date : (Signature of Father / Mother / Guardian)Appendix - D
Note : This Proforma should be countersigned by a Medical Officer
MEDICAL FITNESS CERTIFICATE
(To be submitted during Admission)
1. This certificate must be filled up and signed by the parent / guardian before the boy is sent to
the school. The suppression of important information as to past and present health or as to
exposure to infection is liable to be regarded as a breach of conduct.
Name....................................................Roll No..............Age..............Blood Group........................
2. Did he have Chicken Pox............................................... If so, when.......................
Diphtheria...................................................................... If so, when.......................
Rubella (German Measles)........................................... If so, when.......................
Small Pox...................................................................... If so, when.......................
Enteric Fever................................................................. If so, when.......................
Rheumatic Fever........................................................... If so, when.......................
Mumps........................................................................... If so, when.......................
3. Has he been successfully
(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.......................
4. 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.......................
5. Has he :
(a) Suffered from Fits...........................................................
(b) Ear Drum Perforation.................................................. If so, when.......................
(c) Had any discharges from the ear.............................. If so, when.......................
(d) Had incontinence of bladder........................................ If so, when.......................5. Did he undergo any surgical operation :
(if yes, give details with dates). ........................................................................................
6. Did he have any serious illness
(if yes, give details with dates). ........................................................................................
7. Does he suffer from any ailment or constitutional peculiarity affecting the general health.
eg. Night blindness ............................................................................................................
8. Is he in your opinion fit in all respects for 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 be attached with the certificate).................................................................
Note : Parents are to be honest and faithful in filling the Medical History. If any Vaccination is not
given, the School would co-ordinate vaccination.
_________________________
Date : Signature in full of Parents / Guardiann
Place :
Countersigned
(Medical Officer)Appendix - E
INCOME CERTIFICATE IN RESPECT OF PARENT / GUARDIAN
FOR THE YEAR...................
(To be submitted during Admission)
PART - I
Roll No.........................................Name of the boy.................................................................
SALARIES
(In the case of employed person)
This is to certify that the monthly income of Shri.....................................................................
father / guardian of the above boy from his salary is as follows :
Ser Particulars Income per month
No.
1. Pay (Basic) Rs.
2. Dearness Allowance Rs.
3. House Rent Rs.
4. City Compensatory Allowance Rs.
5. Children Education Allowance Rs.
6. Hill Compensatory Allowance Rs.
7. Any other source Rs.
8. Pension Rs.
(a) Special Duty Allowance
(b) Special Compensatory Allowance
(c) Transport Allowance
Total Rs.
.............................................................
Date : Signature of Controlling Officer
.............................................................
Office Seal (Name in block letter)PART - II
Property in Town
1. Name of Municipality/Corporation/Local Bodies where the property is situated :
2. Name of the Street / Ward and number of property :
3. Where the property is situated in a Municipality / Corporation :
4. The name of the person in whose name the property stands in the Municipality /Corporation
Register :
5. Whether the property is occupied by the owner or is let out :
6. If you are a part owner of the property, state the amount of your share and the names of
the other part owners and their shares :
7. Ground rent paid for the property :
8. Land revenue paid for the property :
9. Taxes paid to Municipality / Corporation / Local Bodies :
10. Annual Municipal / Corporation valuation of the property and annual income from
the property :
Property in Village
1. Name of the village, Taluk and District in which the land is situated :
2. Survey No. :
3. Area (in Acres) :
4. Kind of crops raised :
5. State whether, land lord, or any other receiver of rent of revenue (indicate nature of tenure) :
6. If you are only a part owner etc. :
7. Amount of basic Tax and surcharge paid, Agricultural income tax paid :
8. Gross annual Income (in kind and in cash) :
Signature ..................................................
Name in block letters.................................
(Sub Deputy Collector/Circle Officer/Tehsilder/Commissioner/District Panchayat Officer)PART - III
(Business, Profession or Vocation)
(Amount shown in Part - I above not to be included here)
1. Place or places of business / profession / Vocation :
2. Nature of Business (Whether registered or not and the nature of goods bought or sold) :
3. Amount or gross turn over :
4. Profit and gain of concern :
5. If you are entitled only to a share of the profit and state your share and the basis of
your claim :
6. Sales Tax :
7. Income from profession or vocation :
8. Amount of Income tax and other taxes paid (give separate figure) :
Signature........................................................
(Office Seal) Name in block letters......................................
Sale Tax Officer / Income Tax Officer
Part -IV
Other Sources
1. Interest on securities etc. dividends from Companies gross amount interest on mortgage,
loans, fixed deposits, current account etc. :
2. Ground rents :
3. Sources other than those mentioned above (give details) :
Declaration by the Parent / Guardian
I declare that the above details are true to the best of my information and knowledge.
I also declare that I have no income other than those specified above.
..............................................................................
Signature of Parent / Guardian
Name in block letters :..........................................
Address :..............................................................
Countersigned by
...................................................
(Office Seal) Sub-Deputy Collector / Tehsildar
Date :
Note : The Income Certificate is to be completed on a Non judicial stamp paper worth
Rs10/-. The necessary stamp papers are to be purchased from the Local Revenue Office.
Part I Countersigned by the Controlling Officer.
Part II Countersigned by Tehsildar / Commissioner / District Panchayat Officer.
Part III Countersigned by the Sale Tax / Income Tax Officer.
Part IV Attested by any person authorized to swear Affidavits.Appendix - F
INCOME CERTIFICATE IN RESPECT OF A BOY FOR RECEIPT OF MINISTRY
OF DEFENCE SCHOLARSHIP
(To be submitted during Admission)
Name of the boy ............................................................Son of .......................................................
Studying in Sainik School Goalpara, Class :................Statement of Income for the Year................
__________________________________________________________________________
Income from Pay/Pension Income from Income from Any other Total
including allowances or immovable land, shares etc. source of (per annum)
business etc. per month Property etc.
_______________________________________________________________________ ____________
Income
Self’s/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 Parent’s / Guardian’s
Station :............................... Occupation .........................................
Class I Gazetted Officer
(Signature with Stamp)
Date :...................................
(Office Seal)
---------------------------------------------------------------------------------------------------------------------
TO BE COMPLETED BY SERVICE PERSONNEL
Particulars of Parent :
No..................... Rank ................. Name......................................................Unit ............................
Unit Address .....................................Scale of Pay...........................................................................
Details of son : Roll No.....................................Name........................................Class.....................
(will be given by school)
This is to certify that the monthly income of No.................................Rank..............................
Name....................................................................................is as under :
Pay.............................. DA ...............................................House Rent.....................................
CCA ............................CEA .......................................... HCD .................................................
Any other Income.........................................................As per record .....................................
Total Rs .......................................................................
Office seal Signature of the Disbursing Officer/OC
Date : .......................................Appendix - G
AFFIDAVIT AND CERTIFICATE OF INCOME OF EX-SERVICEMAN
(Incomplete / Illegible / Over written affidavit and certificates will not be accepted)
(To be submitted during Admission)
I - AFFIDAVIT
1 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 April.............................to 31st Mar.................................) are
true to the best my knowledge and belief 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. Head Annual income
1. From Salary Head / Pension (only Basic) :
2. Other Sources (a) Business
(b) Property
(c) Agriculture
(d) Investments
(e) Miscellaneous
Note : If there is no 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.
3. Average Monthly Income (in figure) Rs................................................
(in words) Rupees..........................................................................only.
(Please divide the Annual Income by 12)
Place :
Date : Signature of the Parent / Guardian
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..........................................
Place..................................... Name.........................................................
Date...................................... Designation................................................
Office Seal :
* Here the income to be mentioned is monthly and NOT annual income. In case of salaried
people only Basic Pay is to be treated as income.Appendix - H
AGREEMENT FORM TO BE EXECUTED AT SAINIK SCHOOL
GOALPARA BY PARENT / GUARDIAN OF STUDENT IN RECEIPT OF
GOVT SCHOLARSHIPS
(To be submitted during Admission)
I - AFFIDAVIT
1. THIS AGREEMENT is made this....................day of....................between.............................
of.................................
(hereinafter called the ‘Guarantor’ which expression shall unless excluded by the context of the
meaning there of be deemed to include his heirs by the executors, administration and local
representatives) of the one part and the ‘Board of Governors’ which expression shall unless
excluded by the context or the meaning thereof be deemed to include the Principal of Sainik School
Goalpara, of other part.
2. WHERE AS....................................................................son of............................................
(hereinafter called the student) is son/ward of the Guarantor and has at the request of the
Guarantor been selected for admission to the Sainik School Goalpara inter alia on the Terms and
conditions hereinafter appearing for the purpose of receiving education with a view to making the
regular Armed Forces as profession in life, if considered by the appropriate authority to be suitable
and if there is any vacancy and if he be selected.
3. NOW IT IS HEREBY AGREED BY and between the parties here to as follows :
4. That in consideration of the student being admitted by the Governors to the Sainik School
for the purpose of the aforesaid education at the request of the Guarantor, convenient with
Governors, that the 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 declared as fit for
admission to any institution as may from time prescribed as 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 prescribed, if he is not in receipt of any
scholarship.
5. That if for any reason 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 any
institution as may from time to time be prescribed by the Governor for training for entry to the
regular armed forces or fails to appear for the said selection or in the event of him not succeeding
in the said selection, fails to reappear for selection till such time as his age permit 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 institutions to which he may be
directed to proceed for being trained for entry into the regular armed forces or fails to join the
regular armed forces after completing the training at the said institution then and if any such case
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.6. That if after admission any of the following viz, Proof of domicile, certificate of age and
statement or 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.
7. That if after admission the student is found to be medically unfit in any way at the time
which might according the opinion of the appropriate medical authority, render him unfit for his
future 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
Governor from the date student is found medically unfit.
8. That the Governors will not liable for any damage / charges in account of injuries which
may be sustained by the student at any time during the stay in the school while taking part in
sports or other extracurricular activities of the school. All expense that may be incurred in
treatment of such injuries will be borne by the parent/guardian, as provided in the rules of the said
School.
9. And that if there is any dispute as to the effect of meaning of this agreement, the same shall
be referred to the sole arbitration of the Board of Governors, Sainik School Society, whose
decision shall be final.
10. IN WITNESS WHEREOF.......................................................................................has set
his hand and the Principal, Sainik School Goalpara by order and direction of the Board of
Governors has set his hand the day and the year first above written.
...............................................
Signature of Parent Signed by for on behalf of the Board of
Governors, Sainik Schools Society,
in the presence of parent/Guardian.
.............................................
Signature of Gazetted Officer
with Office SealAppendix - I
AGREEMENT FORM TO BE EXECUTED BY THE PARENT / GUARDIAN OF FULL
FEE PAYING STUDENTS AT SAINIK SCHOOL
(To be submitted during Admission)
1. THIS AGREEMENT is made this......................................................................................day
of....................................between..........................................................................(hereinafter called
the ‘Guarantor’ which expression shall unless excluded by the context of the meaning there of be
deemed to include his heirs by the executors, administration and local representatives) on the one
part and the ‘Board of Governors’ which expression shall unless excluded by the context or the
meaning thereof be deemed to include the Principal of Sainik School Goalpara, of other part.
2. WHEREAS......................................................................................................................son
of................................................(here in after called the Student) is son/ward of the Guarantor
and has at the request of the Guarantor been selected for admission to the Sainik School
Goalpara inter alia, on the Terms and conditions hereinafter appearing for the purpose of
receiving education in a Sainik School.
3. NOW IT IS HEREBY AGREED BY and between the parties hereto as follows :
4. That in consideration of the Student being admitted by the Governors to the Sainik School
for the purpose of the aforesaid education at the request of the Guarantor, convenient with the
Governors, that the student will attend the Sainik School regularly and will observe and comply
with the rules and regulations thereof for the prescribed period and that he, the Guarantor, shall
pay to Governors regularly and promptly and whenever called upon to do so all the fees
prescribed for education in the Sainik School.
5. That the Governors will not be liable for any damage/change 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 extracurricular activities of the school or on account of any reason directly or
indirectly related to his stay as a student in the school, All expenses that may be incurred in the
treatment of such injuries will be borne by the parent/guardian as provided in the rules of the said
School.
6. And that if there is any dispute as to the effect or meaning of the agreement, the same shall
be referred to the sole arbitration of the Board of Governors, Sainik Schools, whose decision will
be final.
7. IN WITNESS WHEREOF........................................................................................has set
his hand and Principal, Sainik School Goalpara by order and direction of the Board of Governors
has set his hand the day and the year first above written.
............................................. ....................................................................................
Signature of Parent Signed by for and on behalf of the Board of Governors,
Sainik Schools Society, in the presence of Parent/
Guardian.
..............................................
Signature of Gazetted Officer
with Office SealAppendix - J
INDEMNITY CERTIFICATE - A
(To be submitted during Admission)
In consideration of my son/ward Roll No...............................................................................
Name..............................................................................................................................................
being allowed at his/my request to swim in the Sainik School Goalpara Swimming Pool, to partici-
pate 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 Goalpara or
the Sainik Schools Society in respect of any loss or injury including death which he may suffer
during the above training / swimming. 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 Goalpara against any claim.
Signature of the Parent/Guardian
Address
Signed by Parent/Guardian in my presence :
WITNESS
1..................................................................... Date...........................................................
Name.........................................................
Address......................................................
1..................................................................... Date...........................................................
Name.........................................................
Address......................................................Appendix - K
INDEMNITY CERTIFICATE - B
(To be submitted during Admission)
__
In consideration of my son/ward Roll No...............................................................................
Name.........................................................................................being allowed at his/my request for
travel during winter / midterm and summer vacation or during organized Educational and Motiva-
tional 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 Society in
respect of any loss or injury including the death which he may suffer during the above travel during
winter/midterm 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 Goalpara against any claim.
Signature of the Parent/Guardian
Address
Signed by Parent/Guardian in my presence :
_____________
WITNESS
1..................................................................... Date...........................................................
Name.........................................................
Address......................................................
1..................................................................... Date...........................................................
Name.........................................................
Address......................................................Appendix - L
UNDERTAKING ON NEW ADMISSION
(To be submitted during Admission)
1. Shri/Mrs.......................................................................................................father/Guardian of
Master.....................................................................................................Roll No...............................
Hereby undertake as follows :
(a) That I shall pay all dues (fees and other charges) to the school in respect of my son/ward
regularly for the period he remains on the roll of the school. In case my son/ward, paid by me as
granted any type of scholarship, the same will be adjusted against the dues paid by me to the
school and the balance, if any, will be paid by me in time.
(b) The Principal will in the interest of the school can order for withdrawal of my son / ward from
the School, should the boy’s conduct, behaviour or influence, in the opinion of the Principal be
detrimental to the general discipline/interest of the school. Under such eventuality, I will be liable
for refund to the school total scholarship/fees/dues etc as awarded by the Government to my
son/ward.
(c) I am also aware of the fact that my son/ward being recipient of the Govt Scholarship will
have to prepare and avail all admission chances for appearing in UPSC written examination/SSB
for entry into National Defence Academy, failing which, the scholarship amount as received by my
son/ward will be refunded back to the Government.
(d) I also guarantee that under no circumstances I will seek transfer of my said son/ward to
other Sainik School till he completes the school course at Sainik School Goalpara.
(e) In case Govt. do not agree to pay scholarship amount at enhanced rate per year, I am liable
to pay the difference of scholarship amount each year so long my son’s/ward’s name remains in
School Roll. I am also liable to pay any enhanced fees in future.
(f) I have no objection if my child is sent unescorted from the school to home.
Station : Sainik School Goalpara, (Assam) ..................................................
Date :....................................................... (Signature of Parent/Guardian)
.......................................
(Name in Block Letter)
WITNESS
1..................................................................... Date...........................................................
Name.........................................................
Address......................................................
2..................................................................... Date...........................................................
Name.........................................................
Address......................................................Appendix - M
AFFIDAVIT BY PARENT / GUARDIAN
(To be submitted during Admission)
1. Mr./Mrs. ........................................................................................................(full name of
parent/guardian) father / mother / guardian of..................................................................(full name
of student with admission / registration / enrolment number), having been admitted to Sainik
School Goalpara.
2. I am fully aware of what constitutes ragging.
3. I am also fully aware of the penal and administrative action that is liable to be taken against
my ward in case he is found guilty of indulging in or 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 will 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 only
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 in 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 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 mis-stated therein. Verified at (place) on this
day of (months), (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 COMMISSIONERAppendix - N
UNDERTAKING BY THE CADET
(To be submitted during Admission)
1. __________________________________________________ (full name of student with
admission/registration/ enrolment numbers) S/o D/o Shri/Smt.______________________having
been admitted to Sainik School Goalpara am fully aware of what constitute 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 of indulging in or abetting ragging, actively 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 contents of this undertaking are true to the best of my knowledge and no part of the
same is false and nothing has been concealed or mis-stated therein.
Verified at________________________(place) on this the____________ (day) of___________
(month)______________
___________________________
Signature of deponentAppendix ‘O’
Details of Real Brother (s) and Sister (s) of Cadet
(To be filled by the Parent)
Ser. Name Age Date of birth Relation Occupation
No
I hereby certify that the above details are correct in all respects.
____________________________
(Signature of the Parent/ Guardian)
Telephone No.: Name :
Mobile No. : Date :Appendix ‘P’
Personal Clothing/Other items
. Parents are required to provide/ bring the items listed below at time of admission:-
Ser Items Quantity
No
1 Steel box coloured black (Trunk) (size 34” x 20” x 12”), with Name 1 No
of boy written in white
2 Hold-all (Bedding Cover) 1 No.
3 Cotton Mattress Khaki (Bedding) 1 No.
4 Pillow Cotton Khaki 1 No.
5 Mosquito net (size L 6 ½ W3” H5 ½) superior quality 1 No
6 White Cotton Vest without sleeves 4 Nos
7 Under wears (briefs) 5 Nos
8 Handkerchief (white) 5 Nos
9 Socks Black Nylon 5 Nos
10 Socks White Nylon 4 pairs
11 Shorts Black Terry cotton 2 pairs
12 Socks Nylon blue 2 pair
13 Bath Towel 2 Nos
14 Hand Towel 02 Nos.
15 Bed sheet white 2 Nos
16 Pillow cover white (24” x 13”) 2 Nos
17 Night suit – Shirt – Pyjama (Light Colour) 2 Nos
18 Shoes black (Oxford Shoes) 1 prs
19 Shoes Sports (Pure white) 1 Prs
20 Slippers 1 pr
21 Water proof khaki (Rain Coat) Superior quality 1 No
22 Duree (sataranci) 77” x 36” 1 No
23 Blanket woolen / Quilt (can be provided later also) 1 No
24 Hanger 6 Nos
25 Lock and Key 3 Nos
26 Tumbler Steel 1 No
27 Table spoon 1 no
28 Steel quarter plate 1 No
29 Soap and soap case 2 Nos
30 Bucket plastic with mug 1 No
31 Looking glass (Mirror) small 1 No
32 Black Permanent Marker 1 No
33 House wife kit (Small Box containing thread – white, khaki, blue: 1 No
Needle, Buttons – white, Blue, Scissors small)
34 Nail cutter 1 No
35 Key chain with Ring 2 Nos
36 Torch Light 1 No
37 Shoe brush (One hard, one soft) 2 Nos
40 Boot polish black 2 Nos
41 Hair oil 1 bottle
42 Hair Brush, Comb 1 each
43 Toot-paste and brush 1 No
44 Cloth brush 1 No
45 Ball pen/ Gel pen/ Fountain pen (Blue) 2 Nos
46 Dictionary (English to Hindi or English to Assamese, as required) 1 No
Contd……..P/2-2-
47 Exam Pad 1 No
Optional
48 Football shoes, Badminton racket. -
49 Musical Instruments (Keyboard, Guitar), if the child plays them. -
Note : - The school has not contracted any vendors for supplying these items.You can also read
