Directorate of Government Examinations Chennai 6

S.S.L.C EXAMINATIONS APRIL 2023

216GDLR0018 - GOVERNMENT HIGH SCHOOL DHARMAGIRI

, -.

Student Declaration Form

Name in English VASANTH V

Name in TAMIL வசந்த் வே

Date of Birth 13-09-2006

Gender MALE

Class with Section SSLC A EMIS No 1015905035

Religion Hindu Community SC - Others

Specific learning disabilities

Physically Challenged
National ID Number
Mobile 9488457078

Father's Name(In English) Mother's Name(In SASIKALA

VELAN
English)
Father's Name(In Tamil) வேலன்
Mother's Name(In சசிகலா
Tamil)
Guardian's Name(In Guardian's Name(In -
-
English) Tamil)

Address 10/61, GUDALUR INDIRA NAGAR ,NANDHATTY PIN: 643212

Language
Medium of Instruction ENGLISH -
Exemption

Group Code -

Part Subject / Language Medium

PART I Subject : 1 1 - LANGUAGE TAMIL

PART II Subject : 2 3 - ENGLISH ENGLISH

PART III Subject : 3 5 - MATHS ENGLISH

PART III Subject : 4 6 - SCIENCE ENGLISH

PART III Subject : 5 7 - SOCIAL SCIENCE ENGLISH

Fees Exempted
Community Category :SC - Others

I declare that the particulars given above are true and correct. Further, I secure that I will not Claim any
changes in future

Parent's / Guardian's Class teacher's Signature Head master/Principal

Candidate's Signature
Signature Signature