S.No.

1.

2.

3.

4.

5.

6.

7.

8.

9.

10.

11.

12.

13.

14.

15.

16.

17.

18.

19.

20.

21.

22.

23.

24.

25.

26.

27.

28.

29.

30.

31.

32.

33.

34.

Appendix 'C'ARTICLESTO BEPROVIDED BYTHE PARENTS/GUARDIANS

PART I

Items Quantity

Steel Trunk size 24"x15"x15" (painted Black with School No. on right hand side)

Lock Navtal 4/5 levers with duplicate keys and key ring

Hold all (with Quilt after Dusserah Vacation)

Mattress Coir foam 72"x36"x4"

Steel Glass (250ml)

Bed Sheets White 90"x60"

01

02

01

01

01

03

03

01

01

06

01

04

(a) Pillow covers white full size

(b) Pillow

Torch with cells

Hangers

SchoolBag

Name Tab (in Hindi and English)

Full Sleeve Shirts White T/Cotton with pointed Collar 2 %" and with one

breast pocket on the left side

T-Shirt (Plain White, Half Sleeves)

Shorts - Navy Blue

Trousers White

Trousers Black

04

02

03

02

02

06

06

01

02

01

01

06

02

04

02

01

01 Pair

<>

Vest cotton white sleeveless (victor/prince or any other good quality)

Unqer wears cotton 'V' shape

Dressing Gown

Night suits white (Kurta pyjama)

Swimming Trunk

Swimming Cap for Sikh boys

Handkerchiefs

fJ:

Towels Bath 69x135 Cms- ~

Patkamargan(fromClassVI to VIII) (ForSikhStuael1tsOnly)

MaroonTurban(fromClassIXonwards)(ForSikhStudents~OnlyBlazer MaroonafterDusserahVacation

BathRoomchappals

Black ShoesOxfordPatternLeather 01 Pair

01 PairShoesCanvasWhiteonly

FootballShoesBlack

SocksWhite

01Pair

04

04

01

SocksBlack

BootPolishBlack

30

35.

36.

37.

38.

39.

40.

41.

42.

43.

44.

45.

46.

47.

48.

49.

50.

51.

52.

53.

54.

55.56.

BrushBootPolish

BlancoWhitebottle

PolishingCloth(yellow)

ToothBrush(Regular)

ToothPaste(BigSize)

BathingSoaps&washingsoaps

SoapCase

WashingPowderPacketHairOilbottle

Comb

Cream(Pondscold&talcumpowder)

BucketPlastic(12litres)

MugPlastic

NailclipperNeedles

Buttonwhitelkhaki,hooks:

(a) Shirts

(b) ShortsfTrousers(large)

(c) ShortsfTrousers(small)

ThreadrollsWhite,Khaki&NavyBlue

QuiltRequiredafterDusserahVacation

QuiltcoversRequiredafterDusserahVacation

Penffiencilasperrequirement

GeometIYBoxcompleteNavyBlueSweater

PART II(LIST OF ITEMS TO BE ARRANGED BY THE SCHOOL)

I. Clothing:1. KhakiShirt(Full)

2. KhakiShirt(Hal~3. KhakiPant4. TrackSuit

Accessories:

1. BadgeCap/Pagri2. TitleShoulders

3. Tie(Maroon)

4. Scarf(Maroon) . . . ~

5. Beltleatherwithbuckle2",

6. Beltleatherwithbuckle1"

7. Beret(Maroon)8. Hackles

9. ShoulderBadges(SSKP)

02

04

01

01

01

0101

01

01set

'if

02

02

02

01

II. .

31

02

02

01

01

01

04each

01

01

01

01

01each

01

01

01

03

12

12" 12

01each

01

02

01set

.

...

Appendix '0'

1.

Affidavit Regarding Domicile(to be typed on non-judicial paper worth Rs. 15/-)

S/o Mr father of

student

my State of Domicileis

School No. -Tehsil

hereby solemnly affirm and declare that

, Distt

(A Domicile Certificate duly countersigned

is enclosed herewith.

from the SDD (Civil)State

2. That I also guarantee thafin case my domicile is found incorrect or false, I shall be liable to refund the entire

amount of scholarship awarded to the student and/or any other penalty as may be imposed by the Government.

3. That Ifurther declare that my above statement regarding my State of Domicileis correct to the best of my

knowledge and belief and that nothing has been concealed.

DEPONENT(Address:

ATTESTED

<>

(1ST CLASS MAGISTRATE)

e

*

Appendix ';E'

DOCUMENTS REQUIRED FOR MINISTRY OF DEFENCE SCHOLARSHIP

The following documents are to be furrnshed for claiming this Scholarship:'"'"

(a) For Serving Personnel -Latest Serving Certificate from OC Unit

(b) For Ex-servicemen -

Attested photostat copy of Discha']e / ~sion Book.

32

1. For the Govt merit-cum-means scholarship in respect of CadetClass year who is my son.

2. I, S/o Mrresident of village PO

hereby solemnly declare and affirm as under:-That I am working as . My department is my date of increment falls on

every year. The details of emoluments are Basic Pay/Basic Pension Rs. p.m. DA/DRHouse Rent Rs. Other allowances Rs. . Reimbursement of Medical

Total Rs. --1- PM and Yearly Rs. /-(OR)

3.

Station:Date

Income Affidavit ForThe Year(to be typed on non-judicial paper worth Rs. 15/-)

Appendix 'F'

School No.

permanentDisttTeh

(a)

Rs.Allowances Rs.

(b) For Business/Self-employed cersons:-

In case of businessmen or self-employed persons, copy of income tax return should be enclosed. Ifno income tax)spayable, certificate from income tax authority stating clearly that "Gross Annual Income for the year under referegceis must be enclosed.

(OR)Income from Agriculture etc, Certificate should be produced from the SDO (Civ)/District RevenueOfficer/Collector/Tehsildarofthe area concemed alongwiththe latest Land Jamabandi stating. "Agricultureincomeis Rs. /-"(copyof certificateto be attached).And having followina Extra Familv Income(i) From wife (Ifworking)(ii) From unmarried son (IfWorking)

(iii) From any other source like Dairy Farming, Poultry Farming/ Transport Business etc.I solemnly declare that:-(a) The facts and figures mentioned above are correct to the best of my knowledge and belief and nothing has been

concealed.

I guarantee that in case my family income is found excess to that stated above,.! shall be liable to refund toGovernment the entire amount of scholarship awarded to my son/ward and other penalty as may be imposed by theState Government.

I agree to send my son/ward to NDA and undertake to bear penalty in,Gase of son/ward leaves school midwaywithout legitimate reasons.I also know that my son/ward has to appear and qualify in NDA examination, even after leaving the school, tillall thepossible chances are availed. In case my son/ward does not take examination after leaving the school, Ifurtherundertake to refund full scholarship"amount enjoyed by my son/ward during his stay in the school.

#-

(c)

(d) Amount.

(b)

(c)

(d)

Deponent.Address:

Signed in my presence4

ATTESTED

{by 1"Class Magistrate)EXPLANATION FOR FILLING OF INCOME AFFIDAVIT

1. No colnmn ofIncome Affidavit is to be left blank. H any column is not applicable, 'NOT APPLICABLE' is to be mentioned against it.2. Every page of the affidavit is reqnired to be affixed with round stamp of the Court and signed by the parent.

3. Full permanent address along with Contact No of the individual is required to be mentioned at the end of the income affidavit wherever

deponent is required to sign. . \t.

No cutting in the affidavit will tJe ,,~cepted. -The Income Certificate is required to be obtained by the individual according to proforma given below along with Income Affidavitwhichever is applicable:- 4

For Businessmen/Self-emvloved versons. th~ Income Certificate is reauired from Income Tax Officer :-Certified that Sh S/o Sh

village , post Teh-His annual income for the year ftom all sources is Rs.records.

,. 4.5.

DATE:

is permanent resident of, Distt ~ ( ).

/- and he is not income tax payee according to our

(Income Tax Officer)

For the Persons engaged in affriculture. farminl! etc. the Income Certificate is required from SDO/Civil as under:-

Certified that Sh S/o Sh is a permanent resident of

village ,Post Teh , Distt .-His annual incolJleftomagriculture and other sources viz Milk Dairy Farm, Poultry Farm etc. for the year is Rs. as verified by theTehsildar

DATE: (Sub Divisional Officer)

33

Appendix 'G'

(Agreement Form to be executed by Parent/Guardian of student(if seeking Scholarship) with Board of Governors at Sainik School, Kapurthala)

(to be typed on non-judicial paper worth Rs. 15/-)

THISAGREEMENTismadethis dayofyear200- between Sh of(hereinaftercalledtheGuarantorwhichexpressionshallunlessexcludedbythecontextorthemeaningthereofbe

deemedto includehisheirs,executors,administratorsandlegalrepresentatives)oftheonepartand theBoardofGovernorsSainikSchoolsSociety(hereinaftercalledthe'Governors'whichexpressionshallunlessexcludedbythecontextorthemeaningthereofbedeemedtoincludethePrincipaloftheSainikSchool ) oftheotherpart.

WHEREASSh S/o (hereinaftercalledthestudent)istheson/wardoftheguarantorandhasattherequestoftheguarantorbeenselectedforadmissiontotheSainikSchoolKapurthalainter-alia,onthetermsandconditionshereinafterappearingforthepurposeof receivingeducationwithaviewtomakingtheArmedForceshisprofessioninlife,ifconsideredbytheappropriateauthoritytobesuitableandifthereisanyvacancyandif hebeselected.NOWITISHEREBYAGREEDBYandbetweenthepartieshereinasfollows:-

ThatinconsiderationofthestudentbeingadmittedbytheGovernorstotheSainikSchoolforthepurposeoftheaforesaideducationattherequestoftheguarantor,covenantswithGovernorsthatthestudentwillattendSainikSchoolregularlyandwillobserveandcomplywithalltherulesandregulationsthereoffortheprescribedperiodoruntilheisdeclaredfitforadmissiontoanyinstitutionasmayfromtimetotimeprescribedbytheGovernors,fortrainingforentrytotheRegularArmedForcesandthathe,theguarantorshallpaytotheGovernorsregularlyandpromptlyandwhenevercalledupontodosoallthefeesasprescribed,if heisnotinreceiptofanyscholarship.

ThatforanyreasonsnotbeyondthecontrolofeitherthestudentortheguarantorthestudentfailstopursuehisstudiesatthesaidschoolbeforeappearingforselectionforentrytoanyinstitutionasmayfromtimetotimebeprescribedbytheGovernorsfortrainingforentrytotheRegularAl11!edForcesorfailstoappearforthesaidselectionorintheeventofhisnotsucceedinginthesaidselection,failsto reappearforselectiontillsuchtimeashisagepermitshimtodo,accordingtotherulesandregulationsforthetimebeinginforceorheavingbeendeclaredsuccessfulatthesaidselectiondoesnotproceedtooneofthesaidinstitutiontowhichhemaybedirectedtoproceedforbeingtrainedforentryintotheRegular-ArmedForcesorhaVingjoinedthesaidinstitutionfailstocompletethetraining,thereat fortheentryintotheRegularArmedForcesorfailstojointheRegularArmedForcesaftercompletingthetrainingatthesaidinstitutionthenandifanysuchcasetheguarantorshallforthwithpaytotheGovernorsincashthesum,thestudenthasreceivedfromtheschooland/ortheStateGovernment/CentralGovernmentthevalueofthescholarshipshehasreceivedforthestudentwasatthesaidschool. <>

Thatifafteradmission,anyofthefollowing,viz.,proofofDomicile,CertificateofAgeandStatementofIncomesuppliedbytheGuarantorisfoundtobefalseinanywayornotinorder,theguarantorshallforthwithpaytotheGovernorsincashthesumthestudenthasreceivedfromtheschooland/ortheStateGovernment/CentralGovernment(thevalueofthescholarshipshehasreceived)forthestudentwasatthesaidschool.

Thatif afteradmission,thestudentisfoundtobemedicallyunfitinanywayifthetimewhichmight,accordingtotheopinionoftheappropriatemedicalauthority,renderhimunfitforhisfutureentrytotheRegularArmedForces,thestudentwillbewithdrawnatonce,butitwouldbe<mentotheguarantorto retainhimattheschoolonpaymentofthefullfeeprescribedbytheGovernorsfromthedatestudentisfoundmedicallyunfit.

ThattheGovernorswillnotbeliableforanydamage/chargesonaccountof injurieswhichmaybesustainedbythestudentatanytimeduringhisstayintheschoQrwhire;@kifflJiP~rtinsportsofotherextracurricularactivitiesoftheschool.Allexpensesthatmaybeincurredintreatmentofsuchinjurieswillbebornebytheparent/guardianasprovidedintherules.@fthesaidschool.

Andthatif thereisanydisputeastotheeffectormeaningoftheseparentsorinanywaytouchingorarisingoutofthesepresentthesameshallbereferredtothesolearbitrationoftheBoardofGovernors,SainikSchools,whosedecisionshallbefinal.

INWITNESSWHEREOF hassethishandand-byorderanddirectionoftheBoardofGovernorshassethishandthedayandtheyearfirstabovewritten.

Signaturebytheparent(Father)" 'k

Signedby

(Guarantor)

Inthepresentof (seeNote(b)below - (torandonbehalfoftheBoardofGovernors,SainikSchoolsinthepresenceof)

ATTESTED

!1~CLASSMAGISTRATE)

Note:

(a) Theagreementformistobefullystamped.ThenecessarystamppaperforRs.5/-istobepurchasedbytheguarantorfromthelocalRevenueOfficer.

(b) ThesignatureoftheguarantoristobewitnessedbyanyGovernmentservantofGazettedstatus.

Thespaceprovidedforthedateinthe" paraoftheagreementformshouldnotbefilledinbytheguarantor.ThiswillbefilledinonthedateonwhichtheagreementwillbesignedbythePrincipal,SainikSchool.

..

Appendix 'H'

(Bondto be executed by the Parents/GuardianwithPunjabState Government (if seekingScholarship)

(to be typed on non-judicial stamp paper worth Rs. 15!-) .

Knowall men by these presents that we (i)(here give the name of the parents/guardian son of Shriresident of ViliageITown House No.Distt (hereinafter called the Principal), (2) ShrL

,VillagelTown HouseNo.- Street(hereinafter called the firstsurety and (3) Shri.S/o Shri Resident of Village!Town.House No. Street No. Distt (hereinaftercalled for the second surety), do hereby bind ourselves, our heirs, executors, administrators and legalrepresentatives jointlyand severally to pay upto the Governor of Punjab(hereinafter called theGovernment, which expression shall, unless excluded by or repugnant to the context, include hissuccessors in officeand assign) on demand and withoutdemur and the sum of Rs.together withinterest thereon fromthe date of demand at Government rates for the time being in force onGovernment loans.

iI

Street No.Resident of

Distt

Signed and dated this day of

Signature of the Principal (Sign. of Father)

Signature of the 1st surety-

Signature of the 2nd surety:

WHEREAS the above bounden Principal is the parent/guardian of a minor Shri

School No. (hereinafter referred to as the student) who has been admitted to the SainikSchool, Kapurthala (hereinafter referred to as the school) for the purpose of receiving education with theobject of joining the Regular Armed Forces of India, if considered suitable and selected by the appropriate

authority. at the concl~sion of studies in the school;AND WHEREAS at the request of Principalthe Government has agreed to pay to the student for a

period of 7 years from a yearly scholarship (including clothing allowance, if grantedsuch rate as may from time to time be sanctioned by the Government in respe~t of fee and clothing etc, onthe condition, interalia, of the Principal and the sureties executing a bond.

AND WHEREAS the above bonded persons have executed the above written bond:NOW THE CONDITION OF THE ABOVE WRITTEN BOND IS that if:-

200

(i) The student shall regularlyand diligentlypursue his stl!dies at the School and go on taking NatiollalDefence Academy Examination so long his age permi~ him so according to the rules andregulations for the time~eing in force for entry to the Regular Armed Forces of India till he isselected therein and when selected, the student shall proceed to-the institution to which he may bedirected for being trained f~r entry into the ReglJlarArmed Forces. .The student shall observe and comply with all the rules and conditions regarding the study,discipline and conduct as may be pr.esentedby the authorities of the School from time to time.

The student shall show diligence in the pursuance of his studies at School and strictly conform tothe rules for tile award of scholarship fra'medby the Government and the instructions which may beissued by the Government or by the authorities of School from time to time.

The student shall attend the school regularly;

The abo,,~ bonded parent shall communicate any change in his income to the Principal of theSchool immediately;

The student shall not leave school atanyintert:nediary stage, unless his name is struck off by the35

(ii)

(iii)

(iv)

(v)

(vi)

school authorities from the school registers on account of his failure in pursuing the studies at hisown cost or on default or breach of any of the above mentioned conditions the above bondedpersons shall well and truly pay all money paid to the students on account of scholarship andclothing allowance if granted with interest thereon from the date of demand at Government rates forthe time being in force on the Government loan then the above written bond or obligation shall bevoid, otherwise the same shall remain in full forces and virtue.

(vii2 He will continue to appear for the NDA even after leaving the school till his age permits.

Provided always that the decision of the Government whether the conditions hereinafter recitedhave been performed and observed shall be final and binding on the parties mentioned hereto:

Provided further that if it comes to the knowledge of the Government that a scholarship or partthereof has been obtained on the basis of false information furnished by the Principal, the amount ofscholarship so obtained shall become immediately repayable on demand and may be reqovered by theGovernment from the Principal and the sureties jointly and severally.

Provided further that the liability of the sureties under this bond shall not be affected by theGovernment giving time or showing any other indulgence to the Principal and that the Government maysue the sureties or any of them before suing the Principal. The stamp duty, if any, on this document shall beborne by the Government.

In Witness whereof the parties hereto have here-unto set their hands the day and year first abovewritten.

In the presence of witnesses

With full address:..

€

(Principal)(Nameof Father)

"Certified that the Principaland sureties are solvent

to the extent of the amountmentioned in the Bond".

1.

2. -II:

Accepted. ~ " "i!"-

For and on behalf of the Government of Punjab.

~

A3I~SJED

1st Class Magistrate

Note: Sureties &.witnesses should be different persons.The same person can't sign as surety and witness both.

36

I,

THISAGREEMENTismadethe dayof 201- between of

I

(hereinafter called the "Guarantor" which expression shall unless excluded by the contest or the meaning thereof be

deemed to include his heirs, executors, administrators and legal representatives) of the one part and the Board of Governors, the Sainik

Schools (hereinaftElrcalled the 'Governors') which expression shall unless excluded by the context or the meaning there be deemed to

I

include the Principal of Sainik School, Kapurthala) on the other part.

WHEREAS SioSh (hereinaftercalledthestudent)isson/wardofthe .

guarantorandhasat therequestoftheguarantorbeenselectedforadmissiontotheSainjkSchool interalia,ontheterms and conditions hereinafter appearing for the purpose of receiving education in a Sainik School.

NOWITISHEHEBYAGREEDbyandbetweenthe partieshereto asfollows:-Thatinconsiderationofthestudentbeingadmittedbythegovernorsto theSainikSchoolforthepurposeoftheaforesaid

educationat therequestof theguarantor,he,theguarantor,covenantswiththeGoverru>rsthatthestudentwillattendtheSainikSchoolregularlyandwillobservethecomplywithall therulesandregulationsthereoffor theprescribedperiodandthathe,theguarantor,shall'paytotheGovernorsregularfyandwhenevercalledupontodosoallthefees prescribed,foreducationintheSainikSchool.

Thatthe Governorswillnotbe liableforanydamages/chargesonaccountof injuries(includingfatal)whichmaybesustainedbythestudentanytimeduringhisstayintheschoolwhiletakingpartinsportsorotherextracurricularactivitiesoftheschooloronaccountofanyotherreasondirectlyor indirectlyrelatedtohisstayas1:1studentin theschool.Allexpensesthatmaybeincurredinthe treatmentofsuchinjurieswillbebornebytheparent/guardianasprovidedintherulesofthesaidschool.

Andthatifthereisanydisputeasto theeffectormeaningofthesepresentsor inanywaytouchingorarisingoutofthesepresents,thesameshallbe referredtothesolearbitrationof theBoardofGovernors,SainikSchools,whosedecisionshallbefinal.

InWITNESSWHEREOF hasset his handand ;0 byorderanddirectionoftheBoardof Governorshassethishandthedayandtheyearfirstwrittenabove.

(Agreement form

Appendix' J'

to be executed by parents/guardians of "Full Fee" paying students withBoard of Governors at Sainik Schools)

(to be typed on non-judicial stamp paper worth Rs. 15/-)

Signedbytheparent(FATHER)

Inthepresenceof #(Seenote(b)below)

SignedbyPrincipal

(forandonbehalfoftheBoardof Governors,SainikSchoolsin the

~presenceof)

ATTESTEDBY

....

'1,(

1stClassMagistrateOR AnyGazettedOf!icer .NOTE:

(a) Theagreementformis tobedulystamped.ThenecessarystampedpaperforRS.5.00orofsuchvalueasprescribedforthispurposeis tobepurchasedbytheguarantorfromthetocal RevenueOfficer. -

Governmentservantof Gazettedstatuswhoshouldsigntogetherwithhissealofofficeintokenofhavingwitnessedthesignatureof theguarantor.

Thespaceprovidedforthedatein the1stparaof theAgreementformshouldnotbefilledin by-theguarantor.T.hiswillbefilledinonthedateonwhichtheAgreementwillbesignedbythePrincipal,SainikSchool,Kapurthala.

(b)

(c)

37

Appendix 'I('AFFIDAVIT BY THE PARENTREGARDING

RULESAND REGULATIONS OF SAINIK SCHOOLS SOCIETY

(to be typed on non-judicial stamp paper worth Rs. 15/-)

1. Certified that I, , father/guardianof CadetSchool No. /KP hereby declare and undertake that I have gone through the rules andregulations as laid down in the School Prospectus/Admission Form/SainikSchools Society Rules andRegulations and accept the same.2. I, hereby, undertake that the rules and regulations presently in force and any furtherchange/amendment in these rules and regulations made by Sainik School, Kapurthala and the SainikSchools Society from time to time will be acceptable to me.

Signature of ParentPERMANENT HOUSE ADDRESS:

Viii: Post: Teh:

Distt State Pin:

Phone No.

CORRESPONDENCEADDRESS:

Viii: Post: Teh:

Distt ;f;. State Pin:':<

Phone No.tC

SPECIMEN SIGNATURES:

1.

'~2. ....

3.....

ATTESTED BY

(1st Class Magistrate)

38

IAppendix cL'

AFFIDAVIT REGARDING REALIZATION OF FEE(to be typedon non-judicial stamp paper worth Rs. 15/-)

I, S/oSh Residentof

Village Post Tehsil Distt

FatherofnaturalguardianofCadet . ' SchoolNo. Class-SainikSchool,Kapurthaladuringthesession herebysolemnlydeclareandundertakeasunderthat:-

(a) I ampreparedtopaytheincreaseinthefeefromtimetotimeinrespectofmysonlwardadmittedintheschool.

(b) I furtherundertakethatI willcontinuetopaytheincreaseinthefeeif anyinfuture,ietillthestayoftheboyintheschool.

admittedin

J;II

(Signatureof Father)

Name:

Address:

ATTESTED BY~

(1st Class Magistrate)

INDEMNITY BOND'" Appendix 'M'

(to be typed on non-judicial stamp paper worth Rs. 15/-)In consideration of my ward being nominated at my request to undergo any"type of training like games, swimming,sports, obstacles etc and also participation in any camp, I undertake and agree that neither I nor myexecutor/administrator will make any claim from the Govt of India or against.any Officer/JCO or Civilian MT Driver oragainst any person in the service of Govt of India in respect of any loss or injury to the property or ward (including aninjurY resylting in death~which my ward may suffer while or in consequence of any activity being participated and Iunderstand that no compensation will be paid by the Govt of India or any Officer/JCO/or Civilian, MT Driver and inrespect of any such loss or injury I agree to bind myself, executors and administrators to indemnity to Govt of India,Officers, JCOs/or Civilians, MT Drivers in the service of Govt of India against any clairrfJWhich may be made by the thirdparty against them or any of them arising out of any act of default on any Wardpart during orin connection with said ~

training and injury.

Signature of the student

.~Signature of the ParentFull Name and Address

"Signature of applicant inPresence of witness

1.Signature with Date, Name in Block-Lettersand Address

2.Signature with Date, Name in Block Lettersand Address

ATTESTED BY

(1st Class Magistrate)39

-

=====

Appendix ~N'

Cadet

School

FAMilY DETAilS(to be typed on pucka paper worth Re.1)

Roll No. IKP

Blood Group

" Telephone Numberwith STD Code

't?: Office

Residence-~ ~ .~,

jII

f

II.

Contact

Signature of Father Signature of Mother

Note: If no telephone is available at home/office, some telephone number may be given by each parent of his/her

nearby residence/place where the parent can be contacted or given a message.

I-. 40

-M - M__-

FATHER MOTHER

Name

Age

Height

Weight

Blood Group

Vision

Family history of epilepsy,night blindness, diabetes

BROTHERS SISTERS

Name

Age

Heigflt

Weight

Blood Group

Vision

F.amilyhistory of epilepsy,night b!indness, diabetes -