A List (ARC/CCC/BT )

LIST OF CANDIDATES PRESENTED FOR THE SECONDARY SCHOOL LEAVING CERTIFICATE EXAMINATION, MARCH 20……… Name of School in full …………………………………………....

Name of Post Office……………………..

Pin code………………………

Tel No with STD Code…………………………………..

Name of Educational District ………………………………………………….

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*Regular ®/ Attendance Recouped (ARC)/Betterment(B)/Malayalam only(M)/Hindy only(H) Place……………………………………….. Date………………………………………..

(School Seal)

Name of the Head of Institution: Signature:

Whether physically challenged If yes, specify V.I, H.I, M.R, O.H or L.D (Dyslexic, Dysgraphic Dyscalculia)

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Annual Income of Parents (whether BPL/APL)

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Home Address with Name of Post Office & Pin code

Name of Panchayat/ Muncipality/ Corporation

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Category (SC/ST/OBC/ OEC/Genl

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Caste

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Religion

9

Nationality

8

Name of Father

7

Name of Mother

6

Paper I Paper II

Name of Guaridian with relationship

5

Language 1st Language

Third Language/Hindi/ General knowledge

4

Medium of Instruction

3

Place of birth

2

Date of Birth (in figures)

Number of Chance

Admission Number

1

Name of Pupil ( in Regional Language)

Candidate Type *

Register Number

Name of Pupil with initials after name ( in English Capital Letters)

Boy/Girl

Serial Number

No. of pupils presented: Boys……… Girls……… Total…………… School Code……………Centre Code…………………. Name of Revenue District……………….

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