Shri Tuljabhavani Sevabhavi Shaikshanik Va Samajik Shikshan Sanstha Kothari, Dist Chandrapur.

HI-TECH COLLEGE OF PHARMACY

Padoli Phata, Nagpur Highway, Morwa, Post-Tadali, CHANDRAPUR - 442 406
APPENDIX - "FOUR"
LEAVING CERTIFICATE
( VIDE CHAPTER II, SECTION III, RULE - 17 )

Sr No : ___________

Original / Duplicate / Triplicate

Discharge No : _________

U.I.D. (Aadhar No.):
    
    
    
  1. Ref.No. __________________________________________________________________________

  2. Name of Pupil in full ________________________________________________________________

  3. Mother's Name _____________________________________________________________________

  4. Race & Caste (with sub Caste) _________________________________________________________

  5. Nationality ________________________________________________________________________

  6. Place of Birth ______________________________________________________________________

  7. Date of Birth ( In Figure ) ____________________________________________________________

    8. ( in word ) _________________________________________________________________________

  8. Last College Attended ________________________________________________________________

  9. Date of Admission __________________________________________________________________

  10. Progress __________________________________________________________________________

  11. Conduct __________________________________________________________________________

  12. Date of Leaving College _____________________________________________________________

  13. Standard in which Studying ___________________________________________________________

    14. and since when_____________________________________________________________________

  14. Reason of Leaving College ___________________________________________________________

  15. Remarks : ________________________________________________________________________

    16. Certified that the above information is in accordance with the College Register

Date :

Clerk

Principal

N.B. - No change in any entry in this certificate shall be made except by the authority issuing it and infringment in this requirment is liable to involve the imposition of penalty such as that as restication.