SCHOOL GAMESFEDERATION OF INDIA

01 Name of the participants(In Block letters)

M.POUNRAJ

02 Father s name (In Block letters)

M.MURUGAN

03 Name of the institution (In Block letters)

KENDRIYA VIDHYALA

04 Institution full Address(In Block letters)

P.T.RAJAN ROAD NARIMEDU MADURAI

05 Institution phone no. with Code No.06 Last year registration No . SGFI07 DATE of Birth (i)in FIG

(ii) in words31/01/2002

08 Disclpline GOOD09 Pass port NO. (IF AVALABLE) NO

10 Age in Completed Years as on 31 December 13

11 Home Address in Full & phone / Mob.No. (in Block letter

2/742 AATHI NAGAR Y.OTHAKKADAI MADURAI-625107 CELL NO; 9367702323

12 Admission No. & Year 8876 2007

13 Date of Joining the school

14 Standard & Section Studying this year 8 B

15 Standard Studying last year 7 B

16 Personal identification marks A MOLE ON RIGHT HANDA SEARE ON LEFT HAND

17 Singnature of the Participants

Certutucate.1.certified that the abive particuoant is a bonalide student of the institution for the academic year.2.certified that the I have personally verified the admission recirads maintained in the school andfound correct.3. certificate that it is understood in the event if information fumshed above fount to be party or wholly dune the above student is liable to be disqvalified for a period of two years in case the stutaints is a member of the team then the participant is to be disqualified as a whole

Singnature of competent authority Singnature with Seal Singnature with Seal of theOf State/UT/Unit with Seal manager/ Coach Head of institution/principal

For office use only .name of invigftator -------------------------------- sign of invigilator ---------------------------

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