Signature of Class Teacher Checked By Principal Seal Sl No.: 934 Admission No.:6159 DISE No.: _________________________________________________________________________________________________ 1. Name of Pupil : MEHA DHARMENDRA PATEL _________________________________________________________________________________________________ 2.Mother's Name : NAYANA PATEL _________________________________________________________________________________________________ 3. Father's Name : DHARMENDRA J PATEL _________________________________________________________________________________________________ 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] : 07/09/2002 _________________________________________________________________________________________________ 8. Date of Birth according to Admission Register [in Word] : Seventh of September Two Thousand and Two _________________________________________________________________________________________________ 9. Class in which the pupil last studied (in figures) : XI 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 : Biology ,Chemistry,English,Physics,Psychology _________________________________________________________________________________________________ 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 : 44 _________________________________________________________________________________________________ 17.Total number of working days present : 29 _________________________________________________________________________________________________ 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 : 05/09/2018 _________________________________________________________________________________________________ 22.Date of issue of certificate : 07/09/2018 _________________________________________________________________________________________________ 23.Reason for leaving the school: PARENT'S REQUEST _________________________________________________________________________________________________ 24.Any other remarks : ---- _________________________________________________________________________________________________