Name of Pupil

Mother's Name

Father's Name

Nationality

Whether the candidate belongs to scheduled caste or scheduled tribes
Schedule castSchedule tribenone

Date of first admission in the School with class

Date of birth (in Christian Era) according to Admission Register (in figures)

Class in which the pupil last studied (in figures)

Whether failed, if so once / twice in the same class

Subjects studied

Whether qualified for promotion to higher class
yesno
If so to which class

Month upto which the (pupil has paid) school dues / paid

Any fee concession availed of : If so, the nature of such concession

Total number of working days

Total number of working days present

Whether NCC Cadet / Boy Scout / Girl Guide (details may be given)

Games played or extra curricular activites in which the pupil usually took part (mention achievement level therein)

General conduct

Date of application for certificate

Date of issue of certificate

Reasons for leaving the School

Any other remarks

Your message (optional)

Δ