FORM IX
[Rules 27(17) and 79(2)]
UNDERTAKING BY THE PARENT OR ‘FIT PERSON’ TO WHOM
CHILD IS RESTORED
I
___________________________________________ resident of House no. _________
Street
_________________ Village/Town
__________________ District ___________________ State
_____________________
do hereby declare that I am willing to take charge of (name of the child)
_________________________________________
Aged _______ under the orders of the Child
Welfare Committee___________________________________
subject to the following terms and
Conditions:
I.
If his/her conduct is unsatisfactory I shall at
once inform the Committee.
II.
I shall do my best for the welfare and education
of the said child as long as he/ she remains in my charge and shall make proper
provision for his/her maintenance.
III.
In the event of his/her illness, he/she shall
have proper medical attention in the nearest hospital.
IV.
I undertake to produce him/her before the
competent authority as and when required.
Date this ………………day of
………………..
Signature
Signature and
address of witness (es)
(Signed before me)
Chairperson, Child
Welfare Committee
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