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									                        APPLICATION FOR CORRECTIONS IN SCHOOL RECORD
                                        G.O(P) No. 38/2012/G.Edn. Dtd. 07/02/2012
                           (Application should be submitted by the Parent/Guardian of the Pupil)

Edl. District:                                                                      Mobile Phone No. of applicant:


                                               i.      Name of Applicant (parent/guardian )........................……..........……...


1. Details of the applicant                    ii.     Address …………………………………………….....………..……

                                                       ...……...……………………………………………PIN…...........................

                                                       District …………….…….....…........................................................

                                               i.      Name of pupil ...............................................................................
                                                       (in block letters)

2. Details of pupil whose date of birth is             Admn. No. ..................................Std .....................Div...................
   to be corrected
                                               ii.     Place of birth……………….........……………….............................

                                               iii. Whether belongs to SC/ST :                                Yes / No

                                                       (certificate to be enclosed)

                                               Existing : .....................................................................................................
3. Date of birth
                                               Proposed : ........................................................(as per documentary evidence)
                                                          Name of Pupil (if clerical error only)
4. Details of other corrections if any
                                                          Name in Regional Language (if clerical error only)
   needed.
                                                          Name of Father                                       Name of Mother
(Existing/correction to be effected should
   be specified)                                          Place of Birth                                      Caste, Category (if clerical error)
                                                          Religion (if clerical error)                        Address

                                               Existing...................................................Proposed..................................................

                                               Existing...................................................Proposed..................................................
                                               Existing...................................................Proposed..................................................
                                               (as per documentary evidence)




5. Documentary evidence produced for No. and Date of issue of the Birth Certificate ...........................................
   correction of date of birth.
   (Original to be enclosed)         Name of Local Body ................................................................................
                                     Name of Revenue District .......................................................................

6. Name and details of the officer who               .............................................................................................................
   attested the copies of the Birth
   Certificate                                         ..........................................................................................................


7. Details of application fee remitted.        Amount ……………… Chalan No………….…….. Date ………………..

                                               Name of Treasury ….………………………………………………………
                                                                       DECLARATION

           I do hereby declare that the details furnished above are true to the best of my knowledge and belief. I am
fully aware that, in case any false information is detected in future at any stage, my application is liable to be rejected
and that it is open to the Department to take appropriate action against me including cancellation of correction
already ordered.


Place :
                                                                                                                Name and Signature of the Guardian
Date :




                                 IDENTIFICATION CERTIFICATE FROM VILLAGE OFFICER/THAHSILDAR
                                       (Only if the name of applicant differs from the Birth Certificate)


 No. ……………

             Certified that Sri/Smt...............................................................................................................................,
 the male/female child born to Shri. ......................................................................................and

 Smt...........................................................................of ............................................................................................
 …………………………………………………..(address) on ……………............…..........…(Date of Birth) and
 whose birth was registered at ……………….....................…...……Grama Panchayat/Municipality/Corporation
 with Register No. .................................... and date of registration ............................................................... is the

 person known as Sri/Smt...........................................................................................................................................
 S/o, D/o..................................................................................................................................................................
 (here enter the full name and address of the person whose date of birth is to be altered) studying in..................Std

 of......................................................................................................................... School with Admission
 No.......................are one and the same person.




 Place:
 Date:                                                                                                                     Signature
                                                 Office Seal                                                       Name and Designation
       INSTRUCTIONS REGARDING CORRECTION OF DATE OF BIRTH IN SCHOOL RECORDS

i)      Application in the prescribed format (downloaded from www.keralapareekshabhavan.in) duly filled up

ii)     Certificate of Birth in original obtained from the Registrar of Births and Deaths of the respective Grama Panchayat/
        Municipality/Corporation in respect of the person whose date of birth is to be altered with two attested copies by
        a Gazetted Officer. The birth certificate should contain the name of child. Birth certificate without the name of
        child will not be accepted under any circumstances.

iii)    Chalan Receipt in original for Rs. 500/- towards application fee remitted at any Government Treasury in the State
        under the Head of Account “0202-01-102-92.” The purpose of remittance and the name of the applicant should
        be clearly indicated in the chalan.

        Applicants belonging to SC/ST communities are exempted from payment of application fee. Caste Certificates
        from Revenue authorities should be submitted to prove the claim.

iv)     Identification Certificate from the local Village Officer/Thahsildar in the form as given in the application form if
        needed.

vi)     Applications should be rejected in the absence of the following documents.

a)      NAME OF PUPIL (Clerical error only)                :        Application submitted in Std I at the time of admission/
                                                                    Admission Register

b)      NAME OF FATHER                                     :        (a) Original Birth Certificate and two copies attested
                                                                        by a Gazetted Officer.
                                                                    (b) Certificate from the Village officer stating one and
                                                                        same

c)      NAME OF MOTHER/ PLACE OF BIRTH                     :        (a) Original Birth Certificate and two copies attested
                                                                        by a Gazetted Officer.

d)      CASTE/ CATEGORY OF CASTE/ (Clerical error only)    :        Caste Certificate of Revenue authorities
e)      ADDRESS                                            :        Original Birth Certificate & two attested copies.


          * Incomplete applications will be rejected.
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