(see Regulation 35)

Form of Discharge Certificate

This is to certify that services of Shri/Smt/Kum. _________________________________
__________________________ who was a teacher in _________________________________
school, teaching _______________subject in ________________________ Class have been terminated with effect on and from ______________________________.

1. Name and address of the school issuing the certificate:
2. Full name of the teacher :
3. Qualifications:
Degree / Diploma
Class
Years
University
4. Whether temporary / permanent :
5. Service rendered (inclusive
from __________ to ____________
6. Pay drawn ___________________________________________
(a) Rs. __________________________ in the scale of Rs.____________________
(b) Allowances, if any
(c) Date of next increment :
7. Whether due notice by either party was given of not.*
8. (a) Whether subscribing to the government provident Fund.
(b) Postal Savings Bank Account No._______.
9. Whether he / she has returned all school money and books etc.
10. Remarks.

Place:
Date: Signature of the Head of the School
· In the case of removal or dismissal it should be stated whether a regular enquiry was held into the charges framed against him.