+91-88180-28717 
SHRI VIDYA SAGAR BAL BHARTI HIGH SCHOOL
Durga Nagar, Ambala City – 134003
Phone: 8818028717, 9466662478
Email: svsbalbhartischool@gmail.com
SCHOOL LEAVING CERTIFICATE
SLC No.: __________ Admission No.: ____
1. Name of the Pupil: _________________________________________________________________________________________________________________________________________
2. Mother’s Name: ____________________________________________________________________________________________________________________________________________
3. Father’s / Guardian’s Name: __________________________________________________________________________________________________________________________________
4. Nationality: _________________________________________________________________________________________________________________________________________________
5. Whether the candidate belongs to SC/ST/OBC: ______________________________________________________________________________________________________________
6. Date of first admission in the school with class: _____________________________________________________________________________________________________________
7. Date of Birth (in figures): ____ ___ / ____ ____ / ____ ____
(In words): ____________________
8. Class in which the pupil last studied (in figures): ____________________________________________________________________________________________________________
(in words): ________________________________________________________________________________________________________________________________________________
9. School / Board Annual Examination last taken with result: __________________________________________________________________________________________________
10. Whether failed, if so once/twice in the same class: ________________________________________________________________________________________________________
11. Subjects Studied:
1. _______________ 2. ________________ 3. ______________ 4. _______________ 5. ________________
Additional Subjects (if applicable)
6. _______________ 7. ________________
12. Month up to which the pupil has paid school dues: ________________________________________________________________________________________________________
13. Any fee concession availed, if so, the nature of such concession: __________________________________________________________________________________________
14. Total number of working days: ___________________________________________________________________________________________________________________________
15. Total number of working days present: ___________________________________________________________________________________________________________________
16. Games played or extra-curricular activities: _______________________________________________________________________________________________________________
17. General Conduct: _______________________________________________________________________________________________________________________________________
18. Date of application for certificate: _______________________________________________________________________________________________________________________
20. Date of issue of certificate: _____________________________________________________________________________________________________________________________
21. Reasons for leaving the school: _________________________________________________________________________________________________________________________
22. Any other remarks: _____________________________________________________________________________________________________________________________________
Class Teacher Checked by Principal
(Signature) (Signature) (Signature with School Seal)