Merry Land Convent Middle School

Rania Road, Mandi Dabwali, District Sirsa, Haryana – 125104

Phone: 01668-227404

Affiliated to C.B.S.E., New Delhi

School Leaving Certificate

Book No.

Serial No.

Admission No.

Name of Pupil

Father’s / Guardian’s Name

Mother’s Name

Nationality

Whether the candidate belongs to Scheduled Caste or Scheduled Tribe

Date of First Admission

Date of Birth in Figures

Date of Birth in Words

Class in Which the Pupil Last Studied

School / Board Annual Examination Last Taken with Result

Whether Failed, and if so, Once or Twice in the Same Class

Subjects Studied

English

Hindi

Maths

Science

Social Science

Punjabi

Other Subject

Whether Qualified for Promotion to the Higher Class

If Yes, Higher Class in Figures

Higher Class in Words

Any Fee Concession Availed; if so, the Nature of Such Concession

Month up to Which the Pupil Has Paid School Dues

Total Number of Working Days

Total Number of Working Days Present

Whether NCC Cadet / Boy Scout / Girl Guide

Games Played or Extra-Curricular Activities in Which the Pupil Usually Took Part

General Conduct

Date of Application for Certificate

Date of Issue of Certificate

Reason for Leaving the School

Any Other Remarks