Form No. 42 Form No.

42
Government of Tamil Nadu Government of Tamil Nadu
Department of School Education Department of School Education

ST. MICHAEL’S MATRICULATION SCHOOL ST. MICHAEL’S MATRICULATION SCHOOL

Shanthoor, Ketti - 643 215, The Nilgiris. RC. No. 03-M-0065-0214 Shanthoor, Ketti - 643 215, The Nilgiris. RC. No. 03-M-0065-0214
(Recognised by the Government of Tamilnadu) (Recognised by the Government of Tamilnadu)

Serial No. ..................................... Admission No. ....................................... Serial No. ..................................... Admission No. .......................................

TRANSFER CERTIFICATE TRANSFER CERTIFICATE

1. Name of the School : ST. MICHAEL’S MATRICULATION SCHOOL 1. Name of the School : ST. MICHAEL’S MATRICULATION SCHOOL
: Shanthoor, Ketti - 643 215, The Nilgiris : Shanthoor, Ketti - 643 215, The Nilgiris

2. Name of the Educational, Revenue District The Nilgiris

: .............................................................................................................. 2. Name of the Educational, Revenue District The Nilgiris
: ..............................................................................................................

3. Name of the pupil : .............................................................................................................. 3. Name of the pupil : ..............................................................................................................

4. Name of the father or mother of the pupil : .............................................................................................................. 4. Name of the father or mother of the pupil : ..............................................................................................................

5. Nationality and Religion INDIAN

: .............................................................................................................. 5. Nationality and Religion INDIAN
: ..............................................................................................................

6. Community : .............................................................................................................. 6. Community : ..............................................................................................................

whether he / she belongs to whether he / she belongs to

a) Adi Dravidar (Scheduled Caste or a) Adi Dravidar (Scheduled Caste or

Scheduled Tribe) : .............................................................................................................. Scheduled Tribe) : ..............................................................................................................

b) Backward Class : .............................................................................................................. b) Backward Class : ..............................................................................................................

c) Most Backward Class : .............................................................................................................. c) Most Backward Class : ..............................................................................................................

d) Convert to Christianity from d) Convert to Christianity from

Scheduled Caste or : .............................................................................................................. Scheduled Caste or : ..............................................................................................................

e) Denotified Communities : .............................................................................................................. e) Denotified Communities : ..............................................................................................................

7. Sex Male / Female

: .............................................................................................................. 7. Sex Male / Female
: ..............................................................................................................

8. Date of Birth as entered in the Admission 8. Date of Birth as entered in the Admission
Register in figures and words : .............................................................................................................. Register in figures and words : ..............................................................................................................

: .............................................................................................................. : ..............................................................................................................

9. Personal marks of Identification a) : .............................................................................................................. 9. Personal marks of Identification a) : ..............................................................................................................

b) : .............................................................................................................. b) : ..............................................................................................................

10. Date of admission and standard in which 10. Date of admission and standard in which
admitted the year to be entered in words : .............................................................................................................. admitted the year to be entered in words : ..............................................................................................................

11. Standard in which the pupil was studying 11. Standard in which the pupil was studying
at the time of leaving (in words) : .............................................................................................................. at the time of leaving (in words) : ..............................................................................................................

12. Whether qualified for promotion to a 12. Whether qualified for promotion to a
higher standard under the code of higher standard under the code of
Regulations for Matriculation Schools : .............................................................................................................. Regulations for Matriculation Schools : ..............................................................................................................
[PTO] [PTO]
13. Whether the pupil has paid all the fees 13. Whether the pupil has paid all the fees
due to the school : ......................................................................................................... due to the school : .........................................................................................................

14. Whether the pupil was in receipt of any 14. Whether the pupil was in receipt of any
scholarship [nature of the scholarship to scholarship [nature of the scholarship to
be specified] or any Educational concessions: ......................................................................................................... be specified] or any Educational concessions: .........................................................................................................

15. Whether the pupil has undergone Medical 15. Whether the pupil has undergone Medical
Inspection, if any during the last academic Inspection, if any during the last academic
year, [First or Repeat to be specified] : ......................................................................................................... year, [First or Repeat to be specified] : .........................................................................................................

16. Date on which the pupil actually left 16. Date on which the pupil actually left
the school : ......................................................................................................... the school : .........................................................................................................

17. The pupil’s conduct and character : ......................................................................................................... 17. The pupil’s conduct and character : .........................................................................................................

18. Date on which application for transfer 18. Date on which application for transfer
certificate was made on behalf of the pupil certificate was made on behalf of the pupil
by the parent or guardian : ......................................................................................................... by the parent or guardian : .........................................................................................................

19. Date of Transfer Certificate : ......................................................................................................... 19. Date of Transfer Certificate : .........................................................................................................

20. Course of Study 20. Course of Study

Academic Standard First Medium of Academic Standard First Medium of

Name of the School Name of the School
Year (s) Studied Language Instruction Year (s) Studied Language Instruction

ST. MICHAEL’S MATRICULATION SCHOOL ST. MICHAEL’S MATRICULATION SCHOOL

Shanthoor, Ketti - 643 215, The Nilgiris Shanthoor, Ketti - 643 215, The Nilgiris

Mark Certificate S.No. Register No. TMR Code No. & Date Mark Certificate S.No. Register No. TMR Code No. & Date

Signature of the Principal with School Seal Signature of the Principal with School Seal
Note : Note :
1. Erasures and unauthenticated or Fraudulent alterations in the certificate will lead to its cancellation. 1. Erasures and unauthenticated or Fraudulent alterations in the certificate will lead to its cancellation.
2. Should be signed in ink by Head of the Institution who will be held responsible for the 2. Should be signed in ink by Head of the Institution who will be held responsible for the
correctness of the entries. correctness of the entries.
Declaration by Parent or Guardian Declaration by Parent or Guardian
I hereby declare that the particulars recorded against items 3 to 8 are correct and that no change I hereby declare that the particulars recorded against items 3 to 8 are correct and that no change
will be demanded by me in future will be demanded by me in future

................................................................................... ................................................................................... ................................................................................... ...................................................................................

Signature of the Pupil Signature of the Parent / Guardian Signature of the Pupil Signature of the Parent / Guardian