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 :

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.