Class________________ Arts/Sc./Com.
Roll No._____________ Div.:________
DECCAN EDUCATION SOCIETY’S
KIRTI M. DOONGURSEE COLLEGE
DADAR, MUMBAI-400028
DECLARATION
Form of declaration in regard to free education to girls studing in Jr.College.
I, Shri_____________________________________________________ Parent/Guardian of below mentioned,
girl student seeking admission/studing in the Std.(s) shown against her/their name(s) hereby declare that I am
a resident of Maharashtra State for not less than 15 years and that my daughter/daughters is are not the
fourth subsequent child/children born after 15 August, 1968.
TOTAL NUMBER OF LIVING CHILDREN AND DATE OF BIRTH OF EACH CHILD ARE GIVEN BELOW:
(PLEASE TICK (√) AGAINST THE NAME OF STUDENT IN WHOSE RESPECT THIS DECLARATION IS MADE).
Sr.No. NAME DATE OF BIRTH STANDARD_________________
1st __________________________________________________________________________________________________________________
2nd __________________________________________________________________________________________________________________
3rd __________________________________________________________________________________________________________________
4th __________________________________________________________________________________________________________________
5th __________________________________________________________________________________________________________________
6th __________________________________________________________________________________________________________________
I know that if this information is proved to be false, the concession of free education to my ward(s) will be
cancelled.
Date: _______________
Signature
Parent/Gurdian
Full Name & Address: _____________________________
_____________________________
_____________________________
Note: The Concession of Free Education is not applicable to a Girl Student if :-
i. If She is a repeater, She is not eligible for girl Freeship.
ii. Her Parents is a resident of MAHARASHTRA STATE for more than 15yrs.
iii. The Forth Child is not eligible to Girls freeship.
[ This Declaration must be accompanied by Photo copies of the relevant pages of the Ration Card (First & Last Page),
School Leaving Certificate, SSC and FYJC Marksheet, Aadhar Card required. ]
