STATE/UT/UNIT : COMMISSIONER FOR SCHOOL EDUCATION

BENGALURU, KARNATAKA
National School Games 2025-26
Under the aegis of School Games Federation of India

CERTIFICATE OF ELIGIBILITY

Under - 17 Boy

UDISE Code: 29280503904 SATS No: 075295165 VaultRef No: XXXXXXXX3812

1 Sports Player ID PE25075295165

2 Name Of The Participant MOHAMED ARFAT
3 Father Name GHUDUSAHEB
4 Mother Name AFSANA
5 Home Address 256, GANESHA SA MIIL ROAD
6 Date Of Birth 18/05/2010
7 Age 15 Years, 7 Months, 13 Days
8 Admission No. & Year 2023
9 Date Of Joining School 05/06/2025
JYOTHI ENGLISH SCHOOL YASHWANTAPURA, No24 6th Cross 1st
Institution Name And Address And
10 Main Road, 560022
Phone No
Ph.No: 23573167

Games:
11 Discipline (Games)
1. Cricket

12 Standard Studying 10
13 Standard Studied Last Year 9
14 Personal Identification Marks No
15 Track Suit Size 38
16 Shoe Size 8
Bank Account No: XXXXXXXX4901
17 Bank Details: IFSC Code: KARB0000017
Bank Name:
18 2025-26 VKN & Affiliation Fee Paid By School, Receipt No. & Date

19 Signature Of The Participant

CERTIFICATE:

1. Certified that the above participant is a bonafide student of this institution for the acadamic year>
2. Certified that I have verified the admission records maintained in the school
3. Certified that it is understood in the event of information furnished above found to be partly or wholly untrue,
the above student is liable to be disqualified for a period of two years. In case the student is a member of the team,
then the participant is liable to be disqualified as a whole

Signature of Competent Signature With Seal of

Signature With
Authority the
Seal
Of State /UT/unit With Head of
manger/Coach
Seal Institution/Principal
cds#

software development centre, e-governance, CPI office, Nrupatunga Road, Bangalore

Printed on: 16-08-2025

 -- 2 --

ELIGIBILITY CERTIFICATE

1. The Eligibility certificate holds good from Taluk Level to National Level Sports Competition for the academic year
in which it is issued, hence this should be preserved carefully in good condition.
2. All the columns in this form should be filled in legibly, and no column should be left blank. Paste Passport size
recent Photograph duly attested by the Principal/Head Master with Seal in the space provided for it.
3. The Participant selected for Division/State/Nationals should participate in all Levels without fail. If they fail, he/she
will not be eligible to participate in any Departmental Sports and Games competition for the next 2 years.
4. In the event of any impersonation/misleading information regarding Date of Birth, Admission No. etc., the
participant will be debarred for a period of two years from the competitions. Further, if it is found to be true upon
inquiry, action will be taken against the Head of the Institution and the Manager of the team concerned as per
KCSR and CCA rules. In the case of unaided institutions, action will be taken to derecognize the institution.
5. D.D.P.I [Phy. Edn] with respect to National Level Competition.

DECLARATION BY PARENTS/GUARDIAN

My Son/Daughter, MOHAMED ARFAT, who is participating in the Cricket at competition, is willingly permitted by us to
compete in the above sports and games. We agree to take full responsibility for any eventuality. We also declare that
he/she is not suffering from any major disorders.

Competitor Signature

Date: Signature of Parent/Guardian

Place: Address of the Parents:

Ph:

Signature of the P.E.T with seal Signature of the T.P.E.I with seal Signature of the D.P.E.O with seal

cds#
software development centre, e-governance, CPI office, Nrupatunga Road, Bangalore

Printed on: 16-08-2025

 Handler1.ashx

Open

cds#

software development centre, e-governance, CPI office, Nrupatunga Road, Bangalore

Printed on: 16-08-2025