Form-IX

(See Regulation - 13)
School Leaving Certificate

No one shall effect any alteration in any entry of this certificate except the authorized person issuing the certificate and the person infringing this condition, shall be liable for the punishment of dismissal from the school.

( This Certificate shall be filled - in by ink only)

Name of the School
(A) General register number of the student.
(B) Certificate
(1) Full name of the student:
( Begin with surname)
(2) Religion and caste.
(I) Scheduled caste.
(II) Scheduled tribe.
(III) Socially and educationally backward by Baxi Panch)
(2) Place of Birth ( With taluka, district)
(3) Date of Birth, month according to Christian year (Both in words and figures) :
(4) School where last studied :
(5) Date of admission ( With standard ) :
(6) Date of leaving the school :
(7) In which standard and since when he has been studying :
(8) Reasons for leaving the School :
(9) Progress :
(10) Behavior :
(11) Remarks :

This is to certify that the above information is according to the school register :

Date:
Place:
Head of the school.

Note :- If the student belongs to scheduled caste, schedule tribe or socially and educationally back-ward classes.
( Castes - classes - groups recommended by baxi panch ), mention in column - 2.