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.

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

CLEARANCE FORM

1.                  Library                       : _____________________               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