State / UT / UNIT : TAMIL NADU.

ELIGIBLE CERTIFICATE FOR S.G.F.I. NATIONAL COMPETITION Passport Size

Photograph dully
NATIONAL SCHOOL GAMES : 2011 - 2012 Attested by the Principal
(Under the aegis of School Games Federation of India) / Headmaster with
Stamp
CERTIFICATE OF ELIGIBILITY (Under - 14 / 17 / 19 - Boys / Girls)

1 Name of the Institution

2 Name of the Participant (In Block Letters)

3 Father's Name
i) In Figure
4 Date of Birth
ii) In Words
5 Discipline
Year Month Days
6 Age in completed years as on 31st December 2011

Residential Address in Full & Phone No. / Mobile No.

7
Phone Number :
Mobile Number :
8 Admission No. & Year
9 Date of Joining the School
10 Standard & Section studying in this year
11 Standard studying last year
12 Name of the Educational District
13 Name of the Revenue District
1)
14 Personal Identification Marks
2)
i) In Tamil
15 Signature of the Student
ii) In English
CERTIFICATE
1) Certified that the above participant is a bonafide student of the institution for the academic year.
2) Certified that I have personally verified the admission records maintained in the school and found correct.
3) Certified that it is understood in the event of information furnished above found to be partly or wholly untrue, the above students is
liable to be disqualified for a period of two years in case the students is member of the team, then the participant is liable to be
disqualified for a period of two years in case the students is a member of the team, then the participant is liable to be disqualified as a
whole.

Signature of the Parent / Guardian : __________________________________

Signature with Seal of Chief Inspector of Signature with Seal of the Head of Institution /
Signature of the PET / PD
Physical Education Principal / Headmaster