School Games Federation of India

SCHOOL GAMES FEDERATION OF INDIA

State/UT/Unit - KVS

NATIONAL SCHOOL GAMES 2014-15

Under the aegis of School Games Federation of India

Certificate of Eligibility

Under-11/14/16/17/19 Boys/Girls

Signature of student

1. / Name of the Institution/KV
(In Block Letters)
2. / Name of the Participants
(In Block Letters)
3(a) / Father’s Name
(b) / Mother’s Name
4. / Date of Birth / (i) In figures / D / D / M / M / Y / Y / Y / Y
(ii) In words
5. / Discipline
6. / Age in Completed Years as on 31st December 2014 / YEARS / MONTHS / DAYS
7. / Home address in full and phone No./Mobile no
8. / Admission No. & Year
9. / Standard and Section studying in this Year
10. / Standard and Section studied in last Year
11. / Personal Identification marks / 1.  1. / 2.  2.
12. / Signature of Participant

Certificate:

1.  Certified that the above participant is a bonafied student of this institution for the academic year.

2.  Certified that I have Personally verified the admission records maintained in the school and found correct.

3.  Certified that it is understood in the event of information furnished above found to be partly or wholly untrue, the above student is liable to be disqualified for a period of two years in case the student is a member of the team, then the participant is liable to be disqualified as a whole.

Signature of competent Signature with seal Signature of Class Signature with seal of the head

authority of Manager/Coach Teacher/ PET of Institute/Principal/Head

State/UT/Unit with seal Master