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Momascholarship - Gov.in Minority Scholarship StudentApplicationRenewal
Momascholarship - Gov.in Minority Scholarship StudentApplicationRenewal
Renewal
Temporary ID :
T2014RmhM02339
Permanent ID :
P2013mhM02738
Admission No :
0038
Year
Course
Whether approved
Affix a self
attested passport
size photograph
1.Student name
SHAKEEL SHAHJAHAN
3.Mother's name
Maharashtra
MUMBAI 400001
District
Mumbai City
State
Maharashtra
Pincode
400001
KUMBHARWADA
District
Raigad
State
Maharashtra
Pincode
402105
19-Oct-1992
Male
9. Religion
Muslim
10. Nationality
Indian
551456494024
NOTE: Scan each page of this application as separate PDF Files for upload after Signing from Institute.
Page 1 of 5
Printed Date: 12-Nov-14
Year
Marks Obtained
Full marks
% of marks
723
1000
72.3000
Item
Annual fee
1.
Tuition Fee
93000.00
2.
Library Fee
0.00
3.
Examination Fee
0.00
4.
12140.00
Total
105140.00
BANK OF MAHARASHTRA
Full address
60075561575
MAHB0000900
NOTE: Scan each page of this application as separate PDF Files for upload after Signing from Institute.
Page 2 of 5
Printed Date: 12-Nov-14
In case the information filled in these columns is not correct, then the institute should indicate that
separately.
NOTE :
NOTE: Scan each page of this application as separate PDF Files for upload after Signing from Institute.
Page 3 of 5
Printed Date: 12-Nov-14
Signature
Residential Address
Date:
(Father/Mother/Guardian)
UBHARE CHWAL
KUMBHARWADA
Raigad
Maharashtra
402105
NOTE: Scan each page of this application as separate PDF Files for upload after Signing from Institute.
Page 4 of 5
Printed Date: 12-Nov-14
(i) I hereby declare that the information given in my application form (From 1 15) is correct.
(ii) I am not availing any other Scholarship for this purpose from Central Govt./State Govt.
sources.
(iii) I shall abide by the terms and conditions for sanction of the Merit cum Means based
Scholarship.
(iv) I have uploaded the desired documents in support of my claim.
(v) I undertake, that if at any stage, it is found to the satisfaction of the sanctioning authority in
the Ministry of Minority Affairs that the information given by me is false or if I violate the terms
and conditions of the scholarship, the scholarship sanctioned to me, may be cancelled and the
entire amount of scholarship will be refunded by me or recovered from me, apart from liability for
such penal action as warranted by law.
Date :
NOTE: Scan each page of this application as separate PDF Files for upload after Signing from Institute.
Page 5 of 5
Printed Date: 12-Nov-14