Name Of the Student

Admission No
Date of Birth as Entered in the Admission Register

Date of Admission

Date of Leaving

Class in which the student was studying at the time of leaving

Subject studied

Reason for Leaving

Name of university examination for which the student was last presented from the college

Register No of student and Month & Year Of Exam

Whether the student has appeared for the Examination

Whether the student has paid al the fees or other money due to the college in respect to the last term in which student was enrolled

Certificate Required
YesNo

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