UNIVERSAL ACADEMY HIGH  SCHOOL

T.R.PATTINAM MAIN ROAD, NERAVY, KARAIKAL.

Ph: 04368-238926 cell:9942936926

Visit us at : www.universalacademykkl.com Email:universalacademykkl@gmail.com

AFILIATED TO CBSE, NEW DELHI CBSE             Affiliation No: 2930013         School Code:56810

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SI.No.     EMIS              Admission No…………………

ID

  1. Name of the Pupil:………………………………………………………………………......................................................
  2. Name of School which the pupil is leaving: ………………………………………………………………………………..
  3. Father’s/Mother’s Name:……………………………………………………………………................................................
  4. Nationality:        INDIAN/…………………………………………………………………………………………………...
  5. Religion, Caste & Sub-Caste: ………………………………………………………………………………………………
  6. Whether the candidate belongs to Scheduled Caste or Scheduled Tribe or BC or MBC…………………………………...
  7. Date of birth (in Christian Era) according to Admission Register (in figures): …………………………………………………………………..

(In Words)………………………………………………………………………………………………………………………………………………………………………..

  1. Aadhaar No:…………………………………………………………………………………………………………………………………………………………………….
  2. Place of Birth:………………………………………………………………………………………………………………………………………………………………….
  3. Date of Admission in the school with class: …………………………………………………………………………………………………………………….
  4. Class in which the pupil last studies (in figures) ……………………………….(in words)……………………………………………………………..
  5. School/Board’s Annual Examination last taken with result:……………………………………………………………………………………………..
  6. Whether failed, if so once / twice in the same class: NO/YES –ONCE/TWICE/STUDYING IN STD………………………………………
  7. Subjects Studied: Tick (    ) the Subjects
  1. ENG 2.TAMIL/HINDI/FRENCHdownloaddownload

3.MATHS        4.SCI        5.SOCIAL SCIdownloaddownloaddownloaddownload

6.PHYSICS        7.CHEMISTRY         8.BOILOGYdownloaddownload

    9. COMPUTERdownload

  1. Whether qualified for promotion to the higher class: YES/NO/STUDYING IN STD……………………………………………………………
  2. Month upto which the pupil has paid school dues:   I/II/III/IV Term
  3. Any Fee Concession availed of : if so, The nature of such concession YES/NO………………………………………………………………….
  4. Total No. of working days: ………………………………………………………………………………………………………………………………………………
  5. Total No. of working Days Present:………………………………………………………………………………………………………………………………….
  6. Whether NCC Cadet/Boy Scout/Girl Guide (Details may be given):
  7. Games played or Co-curricular activities in which the pupil usually took part(mention achievement level therein) PARTICIPATED IN CO –CURRICULAR ACTIVITIES/& SPORTS,   GAMES…………………………………………………………………………………………………………………………………………………………………………….
  8. General Conduct: ……………………………………………………………………………………………………………………………………………………………
  9. Date of application for certificate: ………………………………………………………………………………………………………………………………….
  10. Date of Issue of Certificate: …………………………………………………………………………………………………………………………………………….
  11. Reason for leaving the school: ………………………………………………………………………………………………………………………………………..
  12. Any other remarks: …………………………………………………………………………………………………………………………………………………………

Signature of Class Teacher                                Checked by                                                         Principal

(State Full Name and designation)