D. M. S. Mandal’s Jyoti Central School GLR/Sy. No. 251/858, Old Post Office Road, Belgaum – 590001 DISE No: 29010305947 Transfer Certificate No. 01

Admission No: _______________ Book No. _______________ Sr. No. __________________

1. Name of the Pupil: _______________________________________________________
2. Father’s /Guardian’s Name: ________________________________________________
3. Mother’s Name: _________________________________________________________
4. Place of Birth: ___________________________________________________________
5. Date of Birth (in Christian Era) according to Admission Register (in Figures) _____________ (in words) _________________________________________________
6. Nationality: ____________________ Religion & Caste: __________________________
7. Whether candidate belong to SC, ST or OBC: __________________________________
8. Date of first admission in school with class: ____________________________________
9. Last School attended: _____________________________________________________
10. Class in which the pupil last studied in words and figures and since when: _____________

______________________________________________________________________

11. School/ Board Annual Examination last taken with result: ___________________________
12. Whether Failed: if so once/twice in the same class: _________________________________
13. Subject Studied: 1. _________________ 2. __________________3. ___________________ 4. ________________ 5. _________________ 6. ________________ 7. _______________
14. Whether qualified for promotion: ______________to which class: _____________________
15. Total No of Working Days ________ Total No of working days present: _____________
16. Month up to which the pupil has paid school dues: _________________________________
17. Games played or extracurricular activities participated in: ____________________________

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18. General conduct ___________________________________________________________
19. Date of application for certificate: ______________________________________________
20. Date of issue of certificate: ___________________________________________________
21. Reasons for leaving the school: ________________________________________________
22. Any other remarks: _________________________________________________________

Certified that the above information is in accordance with the school records.

Date: _______________