T.C. No /09-10 dt Admission No T.C.

No /09-10 dt Admission No
Std - Std -
FORM 5 ( See Rule VI-17(1) ) FORM 5 ( See Rule VI-17(1) )
TRANSFER CERTIFICATE TRANSFER CERTIFICATE
1.Name of School A L P S Amayur 1.Name of School A L P S Amayur
2.Whether the school is a Govt , Aided , or 2.Whether the school is a Govt , Aided , or
recognized school Aided recognized school Aided
3.Name of pupil 3.Name of pupil
4.Name of parent / Guardian & Relationship 4.Name of parent / Guardian & Relationship
Of the pupil to the guardian (Father) Of the pupil to the guardian (Father)
5. Identification marks , if any of the pupil 5. Identification marks , if any of the pupil

6.Nationality
7.Religion
8.Whether the candidate belongs SC/ST/OBC -
Or Whether he is a convert from the SC
9.Date of birth according to Admission Register
(In words)
10.Std in which the pupil was last enrolled(in words)
11.Date of admission or promotion to that Std
12.Whether qualified for promotion to a higher Std
13 Whether the pupil has paid all the fees due
to the school
14.Whether the pupil was in receipt of fee concession -
15.Date of the pupil's last attendance at school
16.Date on which the name was removed from rolls
17. Date of application for Certificate
18.Date of issue of the Certificate
19. Reason for leaving
20.School to which the pupil intents proceeding
…………………………………………………………………………………………………….
6.Nationality
7.Religion
8.Whether the candidate belongs SC/ST/OBC -
Or Whether he is a convert from the SC
- 9.Date of birth according to Admission Register -
(In words)
10.Std in which the pupil was last enrolled(in words)
11.Date of admission or promotion to that Std
12.Whether qualified for promotion to a higher Std
N.A 13 Whether the pupil has paid all the fees due N.A
to the school
N.A 14.Whether the pupil was in receipt of fee concession - N.A
15.Date of the pupil's last attendance at school
16.Date on which the name was removed from rolls
17. Date of application for Certificate
18.Date of issue of the Certificate
Change of residence 19. Reason for leaving Change of residence
20.School to which the pupil intents proceeding
…………………………………………………………………………………………………….

21.Date of last successful vaccination - 21.Date of last successful vaccination -

22.No of school days up to the date 22.No of school days up to the date
23.No of school days the pupil attended 23.No of school days the pupil attended

Signature of Head Master Signature of Head Master

NB 1.fee concession/scholarship history of the pupil may be entered below NB 1.fee concession/scholarship history of the pupil may be entered below
2.in the case of pupils of higher stds details of the studies should be furnished below 2.in the case of pupils of higher stds details of the studies should be furnished below
 Application for T.C
1. Name of school :- A L P S Amayur

2. Name of pupil :-
3. Std in which the pupil was last
enrolled :-
4. Weather qualified for promotion to
a higher std :-

5. Date of application for T.C :-

6. Reason for leaving :- Change of residence

7. School to which the pupil intents

proceeding
8. Date oflast successful _
vaccination :-

Name & Signature of parent

Place :- Amayur
Date :-

Admission No :- T.C. No /09-10 dt

Date of issue :-
Signature of Head Master

Received the T.C of

Date :-

Name & Signature of parent or guardian