Sathya Ammaiyar Ninaivu Government Orphanage Application form 1. Name of the Child .. 2. Name of the Father & Mother .. 3. Address of Father & Mother .. 4. Guardian's name & address .. 5. Bus / Train route & Telephone No... 6. Parents alive (or) separated, with .. whom the child is living 7. Parents annual income .. 8. Religion, Cast .. 9. Is the school Transfer certificate .. enclosed? Otherwise the age certificate certified by the Government doctor is enclosed? 10. Identification marks of the child .. 11. Height of the child .. 12. Date of birth of the child .. 13. Which class the child is studying .. now ? 14. Details of the recommending .. person I assure that the above details are true to the best of my knowledge. I will obey the rules and regulations of the Orphanage. I will take full responsibility if my child is when absconding from the Orphanage. Superintendent Parent / Guardian signature District Social Welfare Officer Certificates to be enclosed: 1. Destitute / Widow / deserted certificate ( from Tahsildar) 2. Income certificate (from Tahsildhar) 3. Date of birth certificate (or) School Transfer certificate 4. Physical fitness certificate from Government doctor 5. Passport size photo - 2 copies
