Address: Arjunpur, Hariharpur (Ramaipatti-Kanaura Road), Mirzapur, Uttar Pradesh- 231001
Ph.: 7985007001, 7985005118 | Visit: [Link]
School Leaving Certificate
Affiliation No._________________ School Code ________________
Book No. ____________________ Sl. No. _______________ Admission No. ________________
Status of School: Secondary / Sr. Secondary
1. Name of Student_________________________________ 2. Aadhaar No. _______________________
3. Mother's Name _______________________________________________________________________
4. Father's/Guardian's Name ______________________________________________________________
5. Date of Birth (according to Admission & Withdrawal Register)
(in figures) _________________________ (in words) __________________________________________
6. Nationality ___________________________________________________________________________
7. Wether the child belongs to Scheduled Caste or Scheduled Tribe or OBC ___________________________
8. Date of admission in the school with class ___________________________________________________
9. Class in which the pupil last studied (in figures) _________ (in words) ______________________________
10. School/Board Examination last appeared and result ___________________________________________
11. Whether failed, if so, once/twice in the same class _____________________________________________
12. Subjects studied ______________________________________________________________________
13. Whether qualified for promotion to the higher class ____________________________________________
if so, to which class (in fig.) ________________ (in words) ______________________________________
14. Month up to which the student has paid school dues ___________________________________________
15. Any Fee Concession availed? If so, the nature of such concession ________________________________
16. Total No. of working days in the academic session _____________________________________________
17. Total No. of working days for which student was present in the school ______________________________
18. Whether NCC Cadet / Boy Scout / Girl Guide (details may be given) _______________________________
19. Games played or extra curricular activities in which the pupil usually took part (mention achievement
level)_______________________________________________________________________________
20. Date on which pupil's name struck off from the rolls of the school __________________________________
21. General conduct ______________________________________________________________________
22. Reasons for leaving the school ___________________________________________________________
23. Any other remarks _____________________________________________________________________
Signature of Checked by Principal
Class Teacher With full Name and Designation With Date & School Seal
