School Leaving Certificate


RAM PRASAD D.A.V. PUBLIC SCHOOL

                         SHAHABAD MARKAND- 136 135 (HARYANA)   PHONE NO. 01744-242209

(Affiliated to
C.B.S.E. New Delhi)

School Code – 40235                                                                                                                  Affiliation No. – 530251

                             SCHOOL LEAVING CERTIFICATE

                       Sr. No:_______                                            Admission No: _____


1.     Name of Student :                                        ____________________________

2.     Father’s/ Guardian Name:                         ____________________________

3.     Mother’s Name:                                            ____________________________

4.     Nationality:                                                     ____________________________

5.     Whether the candidate belongs to Schedule Caste or Schedule Tribe:   ____

6.     Date of first admission in the school with class: _____________________

7.     Date of Birth (In Christian Era) According to AdmissionRegister

(In figure) ______          (in words) ___________________________________

8.     Class in which the pupil last studied (in figures)____(In words) _________

9.     School/ Board Annual Examination last taken with result:  ___________

10.     Whether failed, if so once/twice in the same class:  _________________

11.     Subject studied: ______________________________________________

12.     Whether qualified for promotion to the higher class:   ___if so, to which class (in figure)________                  (in words)        ______________    

13.     Month upto which the school dues paid:        ______________________

14.     Any fee concession availed of: if so, the nature of such
concession : ____

15.    Total Number of working days:             _________________________

16.     Total no of working days present :       _________________________

17.     Whether NCC Cadet/Boy Scout/ Girl Guide (Details may be given) : _____

18.     Games played or extracurricular activities in which the pupil
usually took part (mention achievement level therein) :  ______________

19.     General Conduct:                                       ______________

20.     Date of application for certificate:        ______________

21.     Date of issue of certificate:                      ______________

22.     Reason for leaving the school :              ______________

23.     Any other remarks:                                   ______________

 

Signature of                                                       Checked by                                                        Principal Signature

            (Class   Teacher)                                         (Name and designation)                                                     (seal)