KENDRIYA VIDYALAYA SANGATHAN (HQ)

Photograph duly

State /UT/Unit: K.V.S. Chennai Region. Attested by the

principal with
NATIONAL SCHOOL GAMES 2019 - 2020
(Under the aegis of School Games Federation of India) stamp

Certificate of Eligibility
Age Group Under- 19 (BOYS)
Name of the participants
1. P.LAWRENCE
(In Block Letters)
Father’s Name
2. S.PRABHU KUMAR
(In Block Letters)
Mother’s Name
3. P.ARUL MARY
(In Block Letters)
Name of the Institution /KV
4. KENDRIYA VIDYALAYA NO.I KALPAKKAM- 603 102
(In Block Letters)
Institutional Full Address
5. KV. 1, DAE Township, Kalpakkam- 603102
(In Block Letters)
6. Institutional Phone No. with Code No. 044-27481283 , 1788
7. Last year Registration No. SGFI --
(i) In Fig O 3 0 2 2 0
Date of Birth
8.
THIRD FEBRUARY TWO THOUSAND FOUR
(ii)In Words
9. Discipline Games/ Sports VOLLEYBALL
10. Pass Port No. (if Available) ----
11. Aadhar Card Number
Year Month Days
Age in Completed years as on 31st
12.
December 2019 1 5 1 0 2 8
810, RICE MILLSTREET, RMI
Home address in full and Phone
13. NAGAR,PUDUPATTINAM
No./Mobile No.
9894994617
14. Admission No.&Year 8501 & 2011
15. Date of Joining the school 01.04.2011
Standard and Section Studying in this
16. X-A
year
17. Standard studying last year IX-A
Name : N/A
Bank Details of Participant
Name of the Bank:
18. (if no then mention Mother / Father A/C
A/C No :
No.)
IFSC Code :
1. MOLE ON RIGHT HAND
19. Personal identification marks
2.SCAR ON LEFT CHICK
20. Signature of the participants
Certificate:-
1. Certified that the above participant is a bonafide 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. Certificate that it is understood in the event of information furnished above found to be partly or whole untrue, the above students is liable to be
disqualified for a period of two years in case the students is member of the team, then the participants is liable to be disqualified for a period of two
years in case the students is a member of the team, then the participants us liable to disqualified as a whole.

Signature of competent Signature with seal Signature with seal of the head
authority of state/ UT Manager/Coach of Institute/Principal/HM
with Seal Post/Design. ________

For Office use only Name of Invigilator_______________ Sign of Invigilator ____________________

 KENDRIYA VIDYALAYA SANGATHAN (HQ)
Photograph duly

State /UT/Unit: K.V.S. Chennai Region. Attested by the

principal with
NATIONAL SCHOOL GAMES 2019 - 2020
(Under the aegis of School Games Federation of India) stamp

Certificate of Eligibility
Age Group Under- 14 (BOYS)
Name of the participants
1. B. HARISH
(In Block Letters)
Father’s Name
2. BOOLOGAM
(In Block Letters)
Mother’s Name
3. B.ALLI
(In Block Letters)
Name of the Institution /KV
4. KENDRIYA VIDYALAYA NO.I KALPAKKAM- 603 102
(In Block Letters)
Institutional Full Address
5. KV. 1, DAE Township, Kalpakkam- 603102
(In Block Letters)
6. Institutional Phone No. with Code No. 044-27481283 , 1788
7. Last year Registration No. SGFI --
(i) In Fig 0 1 0 7 0
Date of Birth
8.
FIRST JULY TWO THOUSAND THREE
(ii)In Words
9. Discipline Games/ Sports VOLLEYBALL
10. Pass Port No. (if Available) ----
11. Aadhar Card Number 8681-4573-4478
Year Month Days
Age in Completed years as on 31st
12.
December 2019 1 6 0 5 3 0
Home address in full and Phone
13. 9944726821
No./Mobile No.
14. Admission No.&Year 8454
15. Date of Joining the school 01.04.2011
Standard and Section Studying in this
16. X-A
year
17. Standard studying last year IX-A
Name : N/A
Bank Details of Participant
Name of the Bank:
18. (if no then mention Mother / Father A/C
A/C No :
No.)
IFSC Code :
1. MOLE ON RIGHT LEG
19. Personal identification marks
2.CUT MARK ON FORE HEAD
20. Signature of the participants
Certificate:-
1. Certified that the above participant is a bonafide 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. Certificate that it is understood in the event of information furnished above found to be partly or whole untrue, the above students is liable to be
disqualified for a period of two years in case the students is member of the team, then the participants is liable to be disqualified for a period of two
years in case the students is a member of the team, then the participants us liable to disqualified as a whole.

Signature of competent Signature with seal Signature with seal of the head
authority of state/ UT Manager/Coach of Institute/Principal/HM
with Seal Post/Design. ________

For Office use only Name of Invigilator_______________ Sign of Invigilator ____________________