Ho$r` {dmb`

AmB.AmB.Q>r. H$ng, MoZ - 600 036.

KENDRIYA VIDYALAYA
I.I.T. CAMPUS, CHENNAI - 600 036. CATEGORY
Ph : 044- - 2257 0907, Fax : 044 - 2257 0906 Website : kviitchennai.tn.nic.in
email : kviitprince@yahoo.com, kviitchennai2012@gmail.com

BH$bmVr
H$`m
SG Child
(x) A{^^mdH$ H$m loUr :
Category to which the parent belongs to

1. AmB.AmB.Q>r. / I.I.T.

2. Ho$r` gaH$ma / Central Govt.

3. Ho$r` gaH$ma Ho$ dm`V gWmZ

/ PSU / Autonomous bodies of Central Govt.

4. am` gaH$ma / State Govt.

5. am` gaH$ma Ho$ dm`V gWmZ /
PSU / Autonomous bodies of State Govt.

6. A` / Others

-2-
-3-
-4-
Round
Seal

-5-
-6-
UNDERTAKING FOR SGC

(Attach affidavit from notary public)

IIT, Chennai.

-7-
 Session 2016 - 2017

-8-