FO RM 5

[SEE RULE VI 17 )(1))

TRANS FER CERTI FICAT E
Ad. No : Lf-3<2;}
TC No. 5 / 2021 - 22
Name of School : GOYr H SS, K.UITIPURAM,M AIAPPURAM, Pln-679571
Whether t he School is } GOVT
Govt, Aided or Recognised
Name of the Pupil .. ...... .. .. .. : AJAYRAJ.K
Name of pare nt/guardian
and relationship of t he } RAJEEVK
pupil to the guardia n
Nationality ... .. ... ... .. .. ... .. .. .. : INDIAN
Religion ..... ... .. .. .. ......... .. .. ..: Hindu
Whether the pupil belongs to }
SC/ ST/ OBC or whet he r h e/she
is a convert from the SC/ ST
Date of Birth according to } 22/ 01/ 2005
Admission Register ( Twen ty Two Janu a ry Two Th o u sand an d Five )
~°1 "~- Standard in which pupil was last e nrolled .... .. .. .... .. :
Date of admission or promotio n to t ha t sta nda rd .. .. :
PLUS T\VO
+I i/202..2 Whether qualified fo r promotion to a higher std ..
01/0 6 /2021
e f ves D No
Yes
r the pupil wa s in rece ipt of fee concession D Yes ~No
~}1upil' s last a tte nd ance at school... .. .. .... ...... : 31/03/2022
n which the name was removed from roll .. ... : 31/03/2022
ate of application for ce rtificate ..... ..... ........... .... .. :
Date of issue of certificate .. ... ...... ... ..... ..... .... .. ... .. .. :
Reason for leaving .. .. ... .. .. ..... ... ....... ..... ........ .... ...... : H igher S tudies{ As
. . \ per• r e quest
princ i . ,_al
Govt. ~ ~ T \ PPU RAM
· 1 c ode: \ \034)