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Signature of Class Teacher Checked By Principal Seal Sl No.: 38 Admission No.:5230 _________________________________________________________________________________________________ 1. Name of Pupil : KEVAL MODI _________________________________________________________________________________________________ 2.Mother's Name : NAYANA NATHALAL JASANI _________________________________________________________________________________________________ 3. Father's Name : RAJESH MODI _________________________________________________________________________________________________ 4. Nationality: INDIAN _________________________________________________________________________________________________ 5. Whether the Candidate belongs to Schedule Caste or Schedule Tribe: GEN _________________________________________________________________________________________________ 6. Date of First Admission in the school with class: XI Science _________________________________________________________________________________________________ 7. Date of Birth (In Christian Era) according to Admission Register [in figures] : 15/03/2000 _________________________________________________________________________________________________ 8. Date of Birth according to Admission Register [in Word] : March Fifteenth Two Thousand _________________________________________________________________________________________________ 9. Class in which the pupil last studied (in figures) : XI Science _________________________________________________________________________________________________ 10. School/ Board's Annual Examination last taken with result : - _________________________________________________________________________________________________ 11. Whether failed, if so once/twice in the same class : - _________________________________________________________________________________________________ 12. Subject Studied : English,Mathematics,Physics,Chemistry,Computer, _________________________________________________________________________________________________ 13. Whether qualified for promotion to the higher class. If so, to which class [in Figure] : _________________________________________________________________________________________________ 14. Month upto which the pupil has paid school dues/paid : PAID _________________________________________________________________________________________________ 15. Any fee concession availed of, if so the nature of such concession : _________________________________________________________________________________________________ 16. Total number of working days : 106 _________________________________________________________________________________________________ 17.Total number of working days present : 076 _________________________________________________________________________________________________ 18.Whether NCC Cadet/Boy scout/Girl Guide : - _________________________________________________________________________________________________ 19.Gamed played or extra-curricular activities in which the pupil usually took part : - _________________________________________________________________________________________________ 20.General Conduct : GOOD _________________________________________________________________________________________________ 21.Date of application for certificate : 20/12/2016 _________________________________________________________________________________________________ 22.Date of issue of certificate : 20/12/2016 _________________________________________________________________________________________________ 23.Reason for leaving the school: Going Abroad _________________________________________________________________________________________________ 24.Any other remarks : Reg. No. A/2/18/13088/0104 _________________________________________________________________________________________________ _______________
