

T. C. Form
APPLICATION FOR WITHDRAWAL/SCHOOL LEAVING CERTIFICATE/ TRANSFER CERTICATE
(*All fields are mandatory)
Cheque to make in favor of: ____________________________________________________________________________________
(Parent to write their name as per their bank records)
CLASS: _______________ SECTION: ___________________ ADM NO. ________________
1. Name of student (IN BLOCK LETTERS) : __________________________________________________________
2. Date of Birth : __________________________________________________________
3. Father’s Name : __________________________________________________________
4. Mother’s Name : __________________________________________________________
5. Caste : __________________________________________________________
6. Fees paid up to : __________________________________________________________
7. Reason for leaving : __________________________________________________________
8. Date of pupil’s last attended at school : __________________________________________________________
9. Residential add. With mobile no (in full) : __________________________________________________________
__________________________________________________________
Certify that the above statement is correct.
Date: _________________ Parents Signature
FOR CLASS TEACHER USE ONLY
Certified that fee is paid up to the month of _____________________. Dues left for the month of ____________.
The transfer certificate may be issued after recovery of dues.
1. Admission no. : _________________________________
2. Date of Admission : _________________________________
3. Date of Birth : _________________________________
4. Name of House : _________________________________
5. Whether Passed or Detained : _________________________________
6. Total No. of school days up to the date : _________________________________
7. No. of school days the pupil attended : _________________________________
8. Date of pupil’s last attendance at school : _________________________________
9. Date on which pupil struck off the school : _________________________________
10. Date of application received from office : _________________________________
11. Fee category : _________________________________
12. Subject studied : 1. _______ 2. _______ 3. ______ 4. _______ 5. ______6. ________
· Certify that the above information is correct
Date: Class teacher’s Signature
CLEARANCE FORM
1. Library : _____________________ Date of application received: _____________________
2. Science Lab : _____________________ Date of application received: _____________________
3. Sports : _____________________ Date of application received: _____________________
4. Computer Lab : _____________________ Date of application received: _____________________
FOR OFFICE USE ONLY
1. Date of application received/back to office : _________________________________.
2. Date of issue of the Transfer Certificate with TC no. : Date: _________________ TC No. ________________.
Date: Signature of Clerk