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The Principal

Apeejay School
Faridabad

Subject: Issue of School Leaving Certificate

Please issue School Leaving Certificate to my ward whose particulars are as given below as he/she will not be
continue his/her studies in your school.

1. Admission No. ________________________________


2. Name of Student ________________________________
3. Father’s Name ________________________________
4. Last Class/Section attended ________________________________
5. Annual Board Examination Last Taken ________________________________
6. Year of Examination ________________________________
7. Present Class/ Section attended ________________________________
8. Games Played ________________________________
9. Participation Extra Curricular activities if any ________________________________
10. Achievement level therein ________________________________
11. NCC Cadet/Boy Scout/Girl Guides
(Details to be given) ________________________________
12. Date of application for School Leaving Certificate ________________________________
13. Reason of Leaving ________________________________

I hereby declare that all the above given particulars are correct.
Date: ________________ (Signature of Parent)
Name: _______________________
Telephone No.: ________________
(To be filled by Class Teacher)
Class & Section _____________________ Total Attendance as on date ___________out of __________
Subjects offered 1. _________________ 2. ___________________ 3. _______________________
4. _________________ 5. ____________________ 6. _______________________
Date: _____________________ Signature of Class Teacher
Name : ________________

(Clearance Certificate)
Accounts Deptartment: Fees paid upto _________________________ Transport ____________________
Library _______________Games & Sports ________________ Band _____________NCC _______________
Science Deptartment Physics ____________ Chemistry _________ Bio __________ Comp Sci. __________
Art _________Music __________Home Sci. __________ Medical ___________ Electronics _____________

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