Application for Leaving Certificate

Full Name in English

National Identity Card No

Index No

Present Address

Permanent Address

Date of Birth

Year of Admission

Grade Admitted

Last Class Attended

Reason for Leaving

Date of Leaving

Special position or ranks you hold

Extracurricular activities you took part in

Special Achievements

Guardian Full Name

Guardian Permanent Address

Guardian NIC No

Relation to Student

Guardian Phone No

Father Full Name

Father Permanent Address

Father NIC No

Mother Full Name

Mother Permanent Address

Mother National Identity Card No

Guardian Name

Date

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