3.
Father's/Guardian's Name
4.
Date of Birth(in Christian Era) according to Admission & Withdrawl Register
6.
Whether the candidate belongs to Schedule Caste or Schedule Tribe or OBC
9.
School/Board Annual Examination last taken with result
10.
Whether failed, if so once/twice in the same class
12.
Whether qualified for promotion to the higher class
13.
Month upto which the pupil has paid school dues
14.
Any fee concession availed. If so, the nature of such concession
15.
Total No. of working days in the academic session
16.
Total No. of working days pupil present in the school
17.
Whether NCC Cadet/Boy Scout/Girl Guide (details may be given)
18.
Games played or extra curricular activities in which the pupil took part (mention achievement level therein)
20.
Date of Application for Certificate
21.
Date of Issue for Certificate
22.
Reasons for Leaving the school
Signature of
Checked by
Sign of Principal
Class Teacher
(With full name and designation)
(With Date & School SEAL)