Kidzee…….
Address….
SCHOOL LEAVING CERTIFICATE
Serial No.__________ Date of Issue ________________
Name of Child:
_______________________________________________________________________
Father’s Name:
_______________________________________________________________________
Mother’s / Guardian’s Name:
___________________________________________________________
Date of Birth: _____________________
In words:
Date of Admission: _____________________ Class (on admission): _____________________
Nationality: Indian / _________________
RESIDENTIAL ADDRESS
Flat / House No.: _____________________ Building Name
____________________________________ Street / Road
_________________________________________ Town / Locality___________________ City
_______________________________ State ____________________________ PIN _____________
Class in which presently studying: ____________________
Sports / Games Co-curricular
Participated activities participated
Participation in Total school Number of Session
other Activities working days days present
General Conduct: Excellent / Very Good / Good / Average School fee
paid up to month
Any other Remarks
____________________________________________________________________
Reasons for leaving school ________________________________________________________
____________________________________
Countersigned by Signed b
Prepared & Checked by: __________________
(Centre Coordinator)
