State Unit: TAMILNADU - Game : _______________________ Passport size

Photograph dully
Attested by the
National School Games 2017 2018 Principal /
Headmaster with
Under the aegis of School Games Federation of India Stamp
Certificate of Eligibility
Age Group ____________________________

1 Name of the Institute

Name of the Participant

2
[In Block letters]
3 Father Name

Date of Birth _ _
(i) In Figure
4 In School
Record (ii) In words

5 Discipline
Age in completed years as on 31st
6
December of the Academic year

Home Address in full &

7
Phone No. / Mob. No. Cell Number

8 EMIS No. & Year

9 Previews year SGFI Reg. No. ( If Opp.)
10 Date of joining the School
11 Std. & Sec. studying in this year
12 Standard studied in the last year

13 Personal Identification Marks

14 Signature of the Student

1. I certify that the particulars furnished above have been verified with reference to the
information registered in the school records and found correct.
2. It is understood that in the event of the information furnished by the pupil being found untrue,
partly or wholly, the above student is liable to be disqualified for a period of two years.
3. In case the student is a member of a team, such a team is liable to be disqualified as a whole.

Chief Inspector of Signature of Signature of Signature of Headmaster / Principal

Physical Education SGFI Coach PET / PD [With school seal and date]

Note: 3 Attested copies of Birth Certificate for up to Std X / or / X mark sheet (For under 19) to be
enclosed along with the Eligibility Form.

For Office use only Name of Checker. Sign. Of Checker..