Passport size

SCHOOL GAMES FEDERATION OF INDIA Photograph

CERTIFICATE OF ELIGIBILITY
Photograph duly attested
District: Dibrugarh by the
Principal/Headmaster
sports officer with

01 Name of the Participant (In Block Letters)

02 Father’s Name (In Block Letters)
03 Name of the Institution (In Block Letters)
Full Address of the Institution (In Block
04
Letters)
05 Institution Phone No. with Code No.
DD MM YYYY
06 Date of Birth (i) In Fig. (ii) In Words

07 Discipline
08 Identity Card No.
Age in completed years as on 31st
09 Dec/2022, as per Birth certificate or
Admit Card.
Home Address in Full & Phone No.
10
/Mobile No. (In Block Letters)
11 Admission No. & Year
12 Date of Joining in the School
13 Standard & Section Studying this year
14 Standard Studying last year
15 Visible Identification mark
16 Signature of the Participant

Certificate:-

a. Certified that the above participant is a bonafide student of this Institution for the
academic year.
b. Certified that I have personally verified the admission records maintained in the School
and found correct.
c. Certified that it is understood in the event of information furnished above found to be
partly or wholly untrue, the above student is liable to be disqualified for a period of two
years in case the student is a member of them, then the participant is liable to be
disqualified as a whole.

Principal/Headmaster
Signature and seal