‘S

SRINIVASA au

_ POLYTECHNIC COLLEGE,

**, *******- **.

2212

TRANSFER CERTIFICATE

. Name of the Pupil

Father’s Name

. Admission No. & Date

. Nationality, Religion

(a) Community whether S.C., S.T. B.C., M.B.C or

Converted to Christianity from S.C. Caste

. Date of Birth as entered in the Admission Register

. Year of course in which the pupil was reading at the

time of leaving (in words)

Bapu i F

cae ZL

Eat SAL MovaMED

BbI5- iss. NF- Qo

INDIAN HAND Mosc

BC

ABRAT

09-03- 4b

FINAL YEAR DIPLOMA COURSE IN

Civit Engg

8

. Date of Admission or Promotion to the Course

. Whether Passed I-Year, Il-Year or II- Wear

: 04 = 0 tL - oh

Refer to Mark Sheet

Examination held by the Board of Technical Education

9. Whether qualified for Promotion to a Higher Class Spos

. Whether the Pupil has under gone medical inspection

during:the years 5 tae ee fe

. Date on which the pupil actually left the institution APRIL

. Reason for leaving the institution

. Date on which application for transher certificate was

made on behalf of the pupil by his Parents or Guardian

COMPLETED THE COURSE

. Date of Transfer Certificate

t is Whether the Student has paid all the Fees due to the ee

@ institution

@lo. Whether the Student has received any Scholarships Yes

C -@ State Loan etc., If so given details

, $B. The Pupil’s Conduct & Character CrpoD

j pe 8. Signature of Principal Oa

® Principal’

Srinivasa Subbaraya Govt. Polytechnic College,

Puttur - 609 108, Sirkali Tk.

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