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C.B.S.E. School No.

040(D
School Leaving Certificate

BookNo. 2l sr. No. iooi Admission No' ............'.......

l. Name of PuPil

2. Father's/Guardian's Name

3. Nationality
Caste or Schedule Tribe
4. Whether the Candidate belongs to the Schedule

5. Date of First a<lmission in the School with Class


Register (in figures
6. Date of Birth (in Christian era) according to Admission

1in words)
Class in which the pupil last studied
(in figures)
1.

School/Board Annual Examination last taken


with result
8.

9. Whether failed, if so once /twice in the same class

10. SUBJECTS OFFERED

6.
4.

1 l. Whether qualified for promotion to higher class


(in u'ords
If so, to which claSs (in figures)

12. Month up to which the (pupil has paid) school dues/

13. Any fee concession availed oi if, so the nature of such concession

14. Total no. of working daYs


15. Total no. of working daYS attended
be given)
16. Whether N.C.C Cadet Boy/ Scout Girl Guide (Details may

17. GamesplayedorextlacurTiculafactivitiesinwhichthepupilusuallytookpafi(mentionachievementtherein)

18. General conduct

19. Date of application for certificate

20. Date of issue of Certificate


21. Reasons for leaving the School
22. Any other remarks

Checked bY Principal
Class Teacher Office Supdtt.

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