Recog No. N2019/001                                                                                                   Ph:03192-232515


Affiliated to CBSE, Affiliation No. 2530020, School Code No. 56917

Unaided Minority Educational Institution (No. 1152 of 2006)

(Run by Association of Catholic Andaman & Nicobar Islands)

Prem Nagar, P.O. Haddo, Port Blair – 744 102


TC No.                                                                                                                             Admission No.


1. Name of Pupil:
2. Mother’s Name:
3. Father’s/Guardian’s Name:
4. Date of Birth (in Christian Era) according to Admission & Withdrawal Register

(in figure):    /   /                   (in words)

5. Nationality:
6. Whether the candidate belongs to Schedule Caste or Schedule Tribe or OBC:
7. Date of first Admission in the school with class:
8. Class in which the pupil last studied (in figure):
9. School/Board Annual Examination last taken with result:
10. Whether Failed, if so once/twice in the same class:
11. Subject Studied: 1.            2.            3.              4.              5.              6.
12. Whether qualified for promotion to the higher class:
If so, to which class (in figure)               (in words)
13. Month upto which the pupil has paid school dues:
14. Any Fee Concession availed of. If so, nature of Concession:
15. Total No. of working days in the academic session:
16. Total No. of working days pupil present in the school:
17. Whether NCC Cadet/Boys Scout/Girl Guide:
18. Games played or extra-curricular activities in which pupil usually took part (mention achievement level therein):
19. General Conduct:
20. Date of application for certificate:
21. Date of issue of certificate:
22. Reasons for leaving the school:
23. Any other remarks:


Checked by

(with full name & designation



Signature of Principal

with date and School Seal