| Students Name : * |
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| Father's Name : * |
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| Nationality : * |
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| Class : * |
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| Date of Birth : * |
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| Gender (Male/Female/Others) : * |
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| Whether student belongs to SC/ ST : * |
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| Date of First Admission in School : * |
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| Class in which Admisison Taken (First Time) : * |
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| School/ Board Annual Examination last taken with result * |
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| Whether failed, if so once/twice in the same class * |
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| Subjects studied :* |
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| Whether qualified, if so then promoted to class : * |
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| Month upto which pupil has paid the school dues : * |
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| Any fee concession availed of: if so, the nature of such concession * |
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| Total no. of working day * |
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| Total no. of working day present * |
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| Whether NCC cadet/Boy Scout/Girl Guide * |
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| Games played or extra/curricular activities in which the pupil usually took part * |
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| General Conduct * |
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| Date of application for certificate * |
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| Date of issue of certificate * |
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| Reason for leaving the school * |
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| Any other remarks * |
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