Signature of Class Teacher Checked By Principal Seal Sl No.: 153 Admission No.:599 _________________________________________________________________________________________________ 1. Name of Pupil : JUI SHAH _________________________________________________________________________________________________ 2.Mother's Name : SHIPRA SHAH _________________________________________________________________________________________________ 3. Father's Name : BHAVESH SHAH _________________________________________________________________________________________________ 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: STD. III (THIRD) 07/06/2007 _________________________________________________________________________________________________ 7. Date of Birth (In Christian Era) according to Admission Register [in figures] : 19/06/2000 _________________________________________________________________________________________________ 8. Date of Birth according to Admission Register [in Word] : Nineteenth of June Two Thousand _________________________________________________________________________________________________ 9. Class in which the pupil last studied (in figures) : XII Science _________________________________________________________________________________________________ 10. School/ Board's Annual Examination last taken with result : CBSE _________________________________________________________________________________________________ 11. Whether failed, if so once/twice in the same class : - _________________________________________________________________________________________________ 12. Subject Studied : Chemistry,Computer,English,Mathematics,Physics _________________________________________________________________________________________________ 13. Whether qualified for promotion to the higher class. If so, to which class [in Figure] : YES _________________________________________________________________________________________________ 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 : 207 _________________________________________________________________________________________________ 17.Total number of working days present : 171 _________________________________________________________________________________________________ 18.Whether NCC Cadet/Boy scout/Girl Guide : - _________________________________________________________________________________________________ 19.Games played or extra-curricular activities in which the pupil usually took part : - _________________________________________________________________________________________________ 20.General Conduct : GOOD _________________________________________________________________________________________________ 21.Date of application for certificate : 27/04/2017 _________________________________________________________________________________________________ 22.Date of issue of certificate : 31/05/2017 _________________________________________________________________________________________________ 23.Reason for leaving the school: PASSED AISSCE(SCI.)-2017 _________________________________________________________________________________________________ 24.Any other remarks : SEAT NO. 1600550 _________________________________________________________________________________________________