Application for admission to children section in Service Homes 1. Name of the applicant .. 2. Address .. 3. Name of guardian / address / .. Occupation / Income / Relationship 4. Age of the child (Date of birth .. Male /Female relationship) 5. Whether undertaking given by the .. guardian to take back the child after............years, has been enclosed 6. Caste .. 7. Education particulars .. (Education certificate to be enclosed) 8. Particulars about parents .. 9. How and where was / were the child / .. children brought up by the guardian so far 10.Reference from three VIPs .. 11.Particulars of relatives to be permitted.. to visit the applicant (if admitted to SH ) with name, address & relationships (only 2 visitors shall be allowed) I declare that the above particulars are true and that if I am selected, I shall abide by the rules of Service Home. Signature of the applicant All the above particulars in respect of the applicant's guardian are true. If the applicant is discharged from the Service Home after 5 years due to any reason or ailment, I assure that I shall take back the applicant. Guardian's signature Certificates to be enclosed: 1. Education certificate 2. Medical Certificate (to be obtained from Registered Medical Officer in service) 3. Income certificate (below Rs.12000/-P.A to be obtained from Tahsildar)
