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(Recognised by the Director of school Education)

: Admission No

Serial No.
1. gs;spapd; ngah;
(a)Name of the School
(b) fy;tp khtl;lg; ngah;
Name of the Educational Dist.
(c) tUtha; khtl;lg; ngah;
Name of the Revenue Dist.
2. khzth; ngah; ( jdp vOj;Jf;fspy;)
Name of the Pupil ( in block letter)
3. je;;ij my;yJ jhahhpd; ngah;
Name of the Father or Mother of the Pupil
4. Njrpa ,dk;, rkak;, rhjp
Nationality, Religion and Caste
5 ,dk; /Community mtd;/ mts; gpd;tUk;
Ie;J gphpTfspy; vitNaDk; xd;iwr; rhh;e;jtuh
vd;gJ Whether he/she belongs to

TMR Code No.


(a) Mjp jpuhtplh; my;yJ goq;Fb

Adi Dravidar(Scheduled Caste) or Scheduled tribe
---------------------------------------------------------------(b) gpd; jq;fpa tFg;G
Backward Class
------------------------------------------------------------(c ) kpfTk; gpd; jq;fpa tFg;G
Most Backword Class
------------------------------------------------------------(d)Mjpjpuhtplh; ,djpjpypUe;J fpUj;Jt
kjj;jpw;F khwpath; my;yJ
Convert to Christiantity from Scheduled Caste
------------------------------------------------------------(e) ml;ltizapypUe;J ePf;fg;gl;l ,dk;
Denotified Communities
-------------------------------------------------------------khzth; / khztpah; Nkw;Fwpg;gpl;l Ie;J gphpTfspy; VjhtJ xd;iwr; rhh;e;jtuhf ,Ue;jhy; me;j gphpTf;F vjphpy; Mk;
vd;E vOj Ntz;Lk;. mj;Jld; mth; / mts; Fwpg;ghf ve;j ,dj;ijr; rhh;e;jth; vd;W Fwpg;gpl Ntz;Lk;
If the Pupil belongs to any of the five categories mentioned above,write Yes against the relevant item and also indicate
the particular community to which he/she/belongs.
6 . ghypdk; Sex
7. gpwe;j Njjp vz;zpYk;, vOj;jpYk;, (khzth;
Nrh;f;ifg; gjpNtl;by; cs;sgb)
Date of birth as entered in the admission register
In figures and words.
8. clypy; mike;j, milahsf; Fwpfs;
Personal Marks of identification
3. Blood Group ,uj;j tif
9. gs;spapy; Nrh;f;fg;gl;l Njjp kw;Wk; Nrh;f;fg; gl;l
tFg;G (tUlj;ij vOj;jhy; vOjTk;)
Date of admission and Standard in which admitted
( the year to be entered in words)
10. (m) khzth; gs;spia tpl;Lr; nry;Yk;
Neuj;jpy; gapd;W te;j tFg;G (vOj;jhy;)
Standard in which the Pupil was studying at the
time of leaving (in words)





11. Nky; tFg;Gf;F cah;T ngwj; jFjpAilatuh

Whether qualified for promotion of higher standard
----------------------------------------------------------12. khzth; gbg;G cjtpj;njhif VJk; ngw;wtuh?
(mjd; tpguj;ijf; Fwpg;gpLf)
Whether the Pupil was in receipt of any scholarship
(Name of the scholarship to be specified)
----------------------------------------------------------13. khzth; filrp tUlj;jpy; kUj;Jt
Ma;Tf;Fr; nrd;wduh (Kjy; jlit my;yJ
Mjw;F Nky; Fwpg;gpl;L vOjTk;)
Whether the Pupil has undergone Medical
Inspection if any during the last academic year
(first or repeat to be specified)
----------------------------------------------------------14. khzth; gs;spia tpl;Lr; nrd;w Njjp
Date on which the Pupil actually left the school
----------------------------------------------------------15. khzthpd; xOf;fKk; gz;Gk;
The Pupils conduct and character
----------------------------------------------------------16. ngw;Nwhh; my;yJ fhg;ghsh; khzthpd; khw;Wr;
rhd;wpjo; Nfhhp tpz;zg;gpj;j Njjp
Date on which the application for transfer certificate
Was made on behalf of the pupil by parent or guardian.
----------------------------------------------------------17. khw;Wr; rhd;wpjo; Njjp
Date of the Transfer Certificate
----------------------------------------------------------18. gbg;Gf; fhyk;
Course of study
Name of the
gs;spapd; ngah;

fy;tp Mz;L

gbj;j tFg;G

Kjy; nkhop

Medium of
gapw;W nkhop

19. gs;sp jiyik Mrphpahpd; ifnahg;gk;

Signature of the Headmaster with date and school seal:

1. ,r;rhd;wpjopy; mopj;jy;fs; kw;Wk; ek;gfkw;w my;yJ Nkhrbahd jpUj;jq;fs; nra;tJ rhd;wpjio uj;J nra;a
top tFg;gjhFk;.

Erasures and unauthenticated or Fraudulent alteration, in the certificate will lead

to its cancellation.
2. Gs;spj; jiyikahrphpah; ikapdhy; ifnahg;gkpl Ntz;Lk;. gjpT nra;ag;gl;l tptuq;fs; rhpahdit vd;gjw;F
mtNu nghWg;ghzth;.
Should be signed in ink by the Head of the Institution, who will be held responsible for the
correctness of the entries.

ngw;Nwhh; my;yJ fhg;ghsh; mspf;Fk; cWjpnkhop

Declaration by the Parent or Guardisn.
NkNy 2 Kjy; 7 tiuapyhd ,dq;fSf;nfjpNu gjpT nra;ag;gl;Ls;s tptuq;fs; rhpahdit vd;Wk;, vjph; fhyj;jpy;
mtw;wpy; khw;wk; vJTk; Nfl;fkhl;Nld; vd;Wk; cWjpaspf;fpNwd;.
I hereby declare that the particular recorded against items 2 to 7 are correct and that no change will
be demanded by me in future.
khztu; / khztp ifnahg;gk;
Signature of the Pupil

nghw;Nwhh; my;yJ fhg;ghsu; ifnahg;gk;

Signature of the Parent / Guardian