LC No.: 1223 GR No.

: 2923 STUDENT ID-NO: 0000000000000000000

Name of Pupil in full : Leiyalan Chinmi Woleng

Father’s Name : Chinmi Woleng
Mother’s Name : Chui Chui Woleng
30-08-2015 ( Thirty August Two Thousand
Date of Birth :
Fifteen)
Place of Birth : Phungreitang West (Ukhrul)
Proof of DOB Submitted at the time of Admission : Birth Certificate
Mother Tongue : Tangkhul
Nationality : Indian
Religion & Caste (with Sub Caste) : Christian
Date of admission with Class : 01-04-2021 / Class-I
Previous School Attended :
Class in which last studied in : I
School/ Board Annual Exam last taken with result : UKG
Subjects Studied : English, Hindi, Mathematics, EVS
Promoted to : -
Attendance : NA
Month upto which the pupil/student has paid school fees : Whole year (2020-2021)
Whether Part of(NCC Cadet, Boy Scout, Girl Guide) : N.A
Games played as extra curricular Activities :
Date of application for Certificate : 10-07-2021
Date of Leaving school : 12-07-2021
Conduct : Good
Reason for leaving school : Parents Request
Any other Remarks : Taking admission in Other School

I hereby declare that the above information including Name of the Candidate, Father’s/ guardian Name, Mother’s
Name and Date of Birth furnished above is correct as per school records.

Date : 12-07-2021 Signature of Principal