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YA GOLE MARKET
PM SHRI ICENDRIYA VIDYALA ~ . . tftO"
Jrft.l{1f.~ - JTAL
tfl\R LOHIA ttOSP
OEIIIND RAM MI\N~.211 •7395, FU 23361502
QfT-Pf'Wl': ,,...,t.on•"° o I markctfll&mall.corn
E M~II Id, kvgo :markct.k \ '1.11c.in/
Website httn~;//gol ON NO· 1700009
AJ: HLA1 I ·
SCH..9..Ql CODE: 89001
h. \ ' '( 11001, C OIU.,. 1~ 11

DA TE· 01J0512()7•
REF NO - l<VGM,ilf2024-25,1

TO,

THE REGION,\l OFFICER

CBSE REGIONAL OfFICE CAST
PS 1•2 INSmUTIO NALAREA
I p EXTENSION PARTPARGANJ
DELHI - 110092 '

(8 BAl..'JI) bearing roll

SUB Request for change Ol lllldent Inane in daa, tO" & 1~ oert,icalel in r-.pec:I of BA.I.AJI BABU
no • 1•111471(2 02V10'") & 1.-72607(2024112"') from ldl00I no - 89001

R~eci Sir,
8(202.2110'"1
Wth ~ to 8')JICcat,on 14Dni!llld by perenu 01 BALAJI BABU (8 BALAJIJ bearing roll no.-14118'7
& 14172507(2 02.,12"') It• to mlorm '°"
ltla1 c,,e .,.,..,. wara IO change 1111 son I
l1llatod 10
name
Change
from
ol
D,
name
MWI
and 11
TO
•
SALA.JI
apprcr.~
DABU n hm
oy Deputy
-Ar10"" & 1~ oar\.fic:aiea He II• completed ,1 111e formal,t•
Kindly mal'.e
CommilllOner, KVS DeN Reg100 All the required documents have bNn lltuted and enc!Oled for your reference
cort'CC!.IOn5 of his name in daM-10" & 1'2" c:enib1II a aoon a po1sti1 end 1UUe the new eertJ6caliH
TM deta:!s are giv-. below

SNO ROU.NO NAME OF STUDENT EXISTING STUDENT'S NAME PROPOSED/NEW STUDENrS

NAME
t 1•118471 BAIAJIBAB U B BALAJI BAIAJIBAB U
(2022/IOTH I
BAIAJIBAB U 8 BALAJI BAIAJI BABU
2 14672507
(2024112TH)

Thinking You
Yours Fa thfu!1y

PJ1M1Cn Kumar Ma ~
Pnnctpal

~! lTll 'Pnnc,pat
L1r.t of (nc:l~I ~-~~11 filr'.n,-1~
t• Attested Cory of Parents Request ~ t ; o n Kcndriya V1d~ t1I ' )'"'
z. Ar.tl$1ed Copy ol School AdmiSSiOf'I and W,tlldraNII Reg.stet Pago ,.
'Iii".. "l
., 1
• , •fJi• • .. 1
\~-0
3- Ath clud CoP)' of Admission rorrn .,010 Market New nHlh•-o•
" . Attealcd Copy ot e,rm eort,rato
5- At1e1ted C...,py of Clasa 10" cert.fas. and 1.2W' admit cu,d
6- Atte$!ftd CoPY ol KVS DC DELHI REGION AiJpro-.-al
7. AIIHIOCI Copy olAadl\a( Card end PAN c:ard of Student
8- AIIMted Copy ol GoYi of India Gazette Not,f,catlon
9 Attested Copy of Two ~.vspllpCfl (EngltSh & H:ndiJ
10. Art~ Copy of F1tSt ClaSs Magi$trate AIT'tdevll

Scanned with ComSconner

 t - :"'\ qu st of n ing naIne of 1

D- , ~ir,

V\fith due respect it is to be stated that rny S01 s name has been
chsri .;,ed fron1 B. BalaJi to Balaji Babu through central Gazzai1e of
Indie. I request you to change my son's name on all the officials of
school. I also request you to change the na,ne of my son on all the
school records So that it didn't Cause any problem in future. I shall
be vefy grateful to tl1is regard .

Than 'ing you in the anticipation

\Jf}~
~I~ , f'nnc1pal
~.!):.1 f4l¥1h•l1J

\ l\undrlya V1d, altl}'a

r~~u-o,
.,,,. 41 .~<= .ft
'3010 t.larkot. New f"olM-0~
Yours sincerely

l<.BABU
' ~~~IKENORIYAVIOVAlAYASPUGA1'1-iAU
~ ff'-wt J DEU·ll REGIOI-:
ftrr.r ~ iltr a.~ ~flrtr.nl
·ous BODY u·roER MIWSTRY OF EDUCA.1101.
Al, AUTONO~ 'tm'I' ~ /GOVERNMENT or t· DI/,
...........,.:r,;m:rlfl' ~ fbNfbuiNZi ~ . : m l ~ lWi,/
t\lllitFkl PUS ,~· ,, H I no•·"'
JA' AH/\.R LAL UE.tlR
u urllVERSITY ;r:tft'R:ft,
CN!.
/ EW' Otl.HI- 110 "'"'
G7
~,;i, / iELEPHONE tlO 7~2 51707
t~/V.'EBSrrt:: ~~~~....____......_

~:- 3ytn;;,2024
tnT -~. 19044/51-2/e). <f>l ~(lffll)l 2023-24-~

li>s!lq Rta1cltJ,
~tt,f&>e~cm;ft)

'34-{hfi ~ 01.04.2024 tf> q,r ~ 1417~ ~ fa'~

Fcrti?J CR~ kll!l lclll ·~
1:flW2023-24/988tn ~ . f ~ ~ fcl;lrr ~ t fc); XII ~ tmr B. BALAJJ ~ ~ <ffl'
BALAJl BABU ~~TffclWc'flf~ ll ~~~~mH c!fdl~W ~ ~ t R
RGR<fit~ t- 1

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:nit Ma nt New rinu,1.0· (~~"llR}
l-1~1 R1P,Q> 3 I ~
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2 Name and address of t

Poren1 /guardian

3 Closs in whlch the studen1 \ -:)_lt-V\

Is studying

4 Name as anter&d In school '3.~o..loj~

registered

5 Date of admfsslon

(, Assumed/proposed name S~o.1\ BDI>~

7 Reason for reque.s1 mg Ihe "'\O
proposed change

s Whether the following documents

~t11UTU , Pnnapat
~ Q ~~,•fU
Arc attached (soy "'Yt.s"' or "No-) 9'.endriya Vldy&l!Y•
'11-a inJ~ ~ f'UAl-01
qi! f ocurnents cnclo$ed . . ;'11• Mar " ' ew n111t,1-f."'
fkb~.t.A·e ,._ tJ, (J) /\ff'dov11 sworn befol'e. o First Clar'" Magh,tra1e.
(2) Cu111ng of Newspaper in which pub! c no1icc regard 9 ,hange of
5.!tS~ ,. name has bertn pub11she.d.

. \ Stgnnture. of Porcnr/Gua1 can

Nome 1r Block Letters)
d- Kt Bf\£, u.
Addre.s~ ' Lf oYJJ/7v f .l
V,O!\C:,\ ~~~ t~.L.:
~los,\)ti'pW\tl
I I .•
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I.

~q~h 1, ~~~ir~~ ~ ;:{'@J f'iti rotHnlf tf,r ;r.m-XII itmsr £3.BALAJI if;~ir. ~
if f.h~mitu,;m~~m~t1

l~arnc of the student El.isting Namc(Prcsent Proposed Nanie(to !Je

Nnme) chanced)
B.BAWl(ClASS >:II) B.BALAJl(CLASS XII) BAtAJIBABU

.. -
~ uan ij oiftriiit ~ ~ f.li~ ;;mrr ~ f t ~ ~ qr ~;;,rt~ it am'l'tfl'ifl.TT m-miT
t
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sraiml ti

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2 ,mf,rr G"JII (2-4)
S ri°fl q:taf{dan~r.-1 f l ~ (5-15}
.iQ \rmJ li'l "CR'N (-nll' ~ 1lmrt) (16-17>
5 ~ lftl'l (18- 19)
B. (;QonOmfc Times ~ ffllfi 'TTH:t i"i t,fT1T 'lfllflfu ,'.°;f)I (20.21)
1.Mn:K~ ~ m fl 1.-ft' C22·2!3>
a UN~w:. ~ 1i'i ,r.t 11-m x.a mrfitq$,~ , .fi if 1 (2-.-25)
 11 1
o ,n In
a car ·o
co .. tlt1 .. ·d 11 :r· 1t
be. all r1gl

Z ,'\n) oiher special pom1 \'.h,ch the. ~rinctpaJ ltkc!i 'to m. . . n1it
PRINCIPAL

(Tobe f11led in by 1hc Cho!rman )

l:)c. t e. ...
(.o
'---~
The proposed chung~ nome/assutned name ............ ····-···... . . .... 1s
recom1nenoed/not recommendc.d:-...___
~

CHAIRMAN

( To be fillGd in by 1hc KVS OFFICE)

f'Jo ~ Da1e
~,iPJ , P11nc1pa1
,c4, • ..,! 1 · I •"') \:11"1~
Kendrlya V1d(,\ah"ya
Th~ proposed change in name./surnome...... !ITil.~l©~ ..,: ..~..;,/~~~~-o.. . . s agreed
~01t, Ma1\0 ''1 0 , ••

iO, -

Assistant Com,nissinncr
Kendi Iyo Vidyaloyc 5ungathaft

r
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ft,
(1 )

2-

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4.
2.F/11
3 l'OTHErtSIJ
5. 1 STUOEl•ff , ~ - 81\l.P.JI e,..au
2.fATHER'S Nf..UE K 8/£U
3.MOTHER'S fJAMI:• OHANVv'J,U

6. qf. c1 ti., l(lJ lfirolI PAREI-ITS REQUEST

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ndriya Vid)'alaya, Golc r.~arltct, New Delhi-110001
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' ( ~ ~~ m lfil (RH I ~)/Blood Group ol tho clllld (With Rh raclor) ,':l ·I
~ /The ca:egory lo which chlld belong ( ~ ~ i ~ 'ffl1J it~ mt( J ) ~)
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5 ~- m "'l lflf<Wl/Oclalls of Mother/Father lflffl / Molhor tit/ F11t11cr

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(111) «f1'ffllf / Occupaltan ..........'" c,a.att_ _ ........_. -"'·- ........-. CoC.JJ;.;

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Name ot Clfice and lull address with
,_(:{IJ.J.~ tfl.!J:J.t' )- ..- - - - - - -·
Telephone number

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Full 1cs1dc'1tr.nl address wl!h ~£.! ri.1-. 6l.=L..l) ~ I Q l. k~_.___ -·
Totcphonc numbor (v.1th proof)
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{v 11) NAT~Hvit ,(.t "ffi'.1fl Sn Ma r New no1t,1.tJ •
No ot ·trnnslors •• •
fix) 1f.1 ~ / Cnteoory of tho Parent
-
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(Q lf>li,m} lffl'(life t 'ffl ) Employee Codo (1! nny)

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~ ~ mu ti& 1P!l'fi'IB "firat { / 1fi«TI "! 1$ .Jftglfn vfq~uj-i\ij vTRttiRI -i\ Titq t I ",
I cert.it, lhat lhe obtM? Cn1Jii?s nro 11t10 to tho best of m y ~ { l~~ l
1 11n1 / ~ ~ ~ t • r i l t t t T~dUi:t II ~IG.!J:i.ai
JM'q/Oato · ·- "' • .. • 'El -IPJ/ Fiji~ .. /.)11 i'Jc\/, f t-1 \11,J. .

----------------,--------------------
Kendriya Vidyalaya
'llatffli!llf;;
ar,,uiq
Fllllll'JI Uaeiff
Home al blr,et/Moltillt Occupa~,on Rank
~dS!lncr .l 10 tle ll1!ln!IOnOO In
theC850 of
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IS'SIC WITHDRAWL REGISTER JAGDISH 989114.!!>13

~
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~11, EV~'ll Name ol No,&Datll ~ ~Ill C1JSS lln I.Dahl
P"1:trn11llfnt Local la5iSd!ool ol TC. ~ \'t'llch cf l C
~ Addll?Sl Resld..~.i:il Issued Studleil oomlncd ~
S{b) 8{c) 10 II 12 13 l<(o) 1'4(1>)

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 5. J will not m.tsu the rcvL d document
responsJble for the documents '»h1ch hn\·e been submit e
epplice.tion arc , crlficd by me.
6. Th t il is my true ond correct ctatCJ! cnt.

VEHI7 1CATUOI;:.
Dr'!'UO T
Venfied a.t Delhl on this ............................... that all the contents or thls
my a.ffid....~t are true and co.rrcct to the best of my knO\\ ledge wid be: f.
D..- ...., IT
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11 Enclosures:
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R
..., \ ( 1 • ,, r.>rr= , •
D
---\~u1.v.:-.- ~ < [ ~Q(clq /l~ENDRIYA VIDYALAYA..,_
II ~ D
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•• ~ ~'i:V .. ·.~, . r ll !T~"I ~ 3ITTIT-r 'I';! /Application for Admission \ D
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?· !foci! flm-•t
v ) iHd!lfl I KVTC ) -
'l't>l ~ ii Class In which tho adml .. ton Is •ougbl1 '-'. U. .... •
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