ekSykuk vkt+kn f'k{kk izfr"Bku

MAULANA AZAD EDUCATION FOUNDATION

ekSykuk vkt+kn jk"Vh; Nk=o`fr ;kstuk

vYial[;dksa ls lacfa /kr es/kkoh Nk=kvksa ds fy,
MAULANA AZAD NATIONAL SCHOLARSHIP
FOR MERITORIOUS GIRL STUDENTS SCHEME
BELONGING TO MINORITIES

ekSykuk vkt+kn f'k{kk izfr"Bku

MAULANA AZAD EDUCATION FOUNDATION
vYila[;d dk;Z ea=ky;] Hkkjr ljdkj
(MINISTRY OF MINORITY AFFAIRS, GOVT. OF INDIA)

lkekftd U;k; lsok dsUnz] psElQksMZ jksM] ubZ fnYyh - 110055

Social Justice Service Centre, Chelmsford Road, New Delhi - 110055

Qksu/Phone : 23583788, 23583789 QSDl@Fax : 011-23561945

osclkbV/Website : www.maef.nic.in

ekSykuk vkt+kn jk"Vh; Nk=o`fr ;kstuk

vYila[;dksa ls lacfa /kr es/kkoh Nk=kvksa ds fy,
MAULANA AZAD NATIONAL SCHOLARSHIP SCHEME
FOR MERITORIOUS GIRL STUDENTS BELONGING TO MINORITIES

ekSykuk vkt+kn f'k{kk izfr"Bku dh LFkkiuk ekSykuk vcqy dyke vkt+kn ds tUe 'krkCnh lekjksg ds volj ij dh
xbZ FkhA bldk iathdj.k lkslk;Vh iathdj.k vf/kfu;e 1860 ds rgr 06 tqykbZ 1989 dks fd;k x;k FkkA ;g izfr"Bku]
,d LoSfPNd] vjktuSfrd] ykHk u dekus okyk lkekftd lsok laxBu gS ftldh LFkkiuk lkekt ds 'kSf{kd :i ls fiNM+s oxksaZ
esa f'k{kk dks c<+kok nsus ds fy, dh xbZ FkhA ;s vYila[;d dk;Z ea=ky;] Hkkjr ljdkj }kjk fokiksf"kr gSA ekuuh; vYila[;d
dk;Z ea=h bl izfr"Bku ds insu v/;{k gSAa izfr"Bku dk m}s';] 'kSf{kd :i ls fiNM+s oxks]aZ fo'ks"kr% vYila[;dks esa vkSj
lkekU;r%a detksj oxksaZ ds ykHk ds fy, 'kSf{kd ;kstukvksa dks rS;kj o dk;kZfUor djuk gSA
Maulana Azad Education Foundation was established on the occasion of Maulana Abul Kalam
Azads birth centenary. The Foundation was registered under the Societies Registration Act
1860, on 6th July, 1989. The Foundation is a voluntary non-political, non-profit marking social
service organization established to promote education amongst the educationally backward
sections of the society. It is funded by the Ministry of Minority Affairs, Government of India.
The Honble Minister of Minority Affairs is its Ex-officio President. The aim of the Foundation is
to formulate and implement educational schemes and plans for the benefit of the educationally
backward minorities in particular and weaker sections in general.

;kstuk dk 'kh"kZd %
TITLE OF SCHEME

^^vYila[;d es/kkoh Nk=kvksa ds fy, ekSykuk vkt+kn jk"Vh; Nk=o`fr ;kstuk**

Maulana Azad National Scholarship Scheme for Girls belonging to Minorities

;kstuk dk m}s'; %
OBJECTIVE OF THE SCHEME

jk"Vh; vYila[;dksa ls lacfU/kr mu es/kkoh Nk=kvkssa dh igpku djuk] c<+kok rFkk lgk;rk nsuk tks fokh; lgk;rk ds fcuk
viuh f'k{kk tkjh ugha j[k ldrh gSA
To recognize, promote and assist meritorious Girl students belonging to National Minorities
who can not continue their education without financial support.

Nk=o`fk dk iz;kstu%
PURPOSE OF SCHOLARSHIP

;g Nk=o`fr] Ldwy@dkWyts Qhl] ikB;e dh iqLrdks]a ikB;e ds fy, visf{kr ys[ku lkexzh@midj.kksa dh [kjhn rFkk vkokl
,oa Hkkstu izHkkjksa ds Hkqxrku ij gksus okys [kps Z a ds fy, ns; gksxhA
Scholarship will be admissible for expenditure on payment of School/College Fee, purchase
of syllabus books, purchase of stationery/equipments required for the course & payment of
Boarding/Lodging charges.

(1)

egoiw.kZ %
IMPORTANT
1.

vkosnu i=@QkZe osclkbV : www.maef.nic.in ls MkmuyksM fd;k tk ldrk gSA vkosnu i= dh QksVksdkWih
Hkh mi;ksx dh tk ldrh gSA vkosnu ds fy, Qhl@fdlh vU; jkf'k dk Hkqxrku ugha fd;k tkuk gSA
Application can be downloaded from the web site www.maef.nic.in Photocopy of the
application form can be used freely. No fee/any other amount is to be paid for application.

2.

vkosnu i= izfr"Bku dks lh/ks Mkd }kjk Hkstk tk ldrk gS ;k izfr"Bku dk;kZy; esa
rd lHkh dk;Z fnol esa nLrh tek fd;k tk ldrk gSA

10.00

cts ls lk;a

5.00

cts

Application form can be sent by the student directly to the Foundation by post or can be
submitted by hand from 10.00 a.m. to 5.00 p.m.on all working days in the office of the
Foundation.
3.

fdlh lsok ds fy, fdlh dks Hkh dksbZ izHkkj@Qhl vkfn dk Hkqxrku ugha djuk gksrk gSA
No charges/fee is to be paid to any one for any services.

4.

fu/kkZfjr dkx+t i=ks@a vkSipkfjdrkvksa ds iwjk gksus ij Nk=o`fr eatjw h i=@pSd] lQy mEehnokj ds irs ij jftLVMZ
Mkd }kjk lh/ks gh Hkstk tk,xkA
Sanction letter/cheque for scholarship will sent by Regd. Post directly to the address of
successful candidate on completion of prescribed papers/formalities.

5.

fdlh iz'u@lwpuk ds fy, lfpo] ekSykuk vkt+kn f'k{kk izfr"Bku dks lh/ks gh laidZ fd;k tkuk pkfg,A
For any query/information, only Secretary, MAEF should be contacted directly.

ik=rk ekunaM@dkSu vkosnu dj ldrk gS

ELIGIBILITY CRITERION / WHO CAN APPLY
1.

jk"Vh; vYila[;dksa vFkkZr eqfLye] bZlkbZ] ckS)] fl[k] ikjlh ls lacfU/kr dsoy yM+fd;ka gh vkosnu dj ldrh gaAS
Only Girl Students belonging to National Minorities, (i.e. Muslims, Christians, Buddhists,
Sikhs, Parsis) can apply :

2.

fdlh ekU;rk izkIr dsUnzh;@jkT; ek/;fed f'k{kk cksMZ }kjk vk;ksftr ek/;fed Ldwy nloha d{kk ijh{kk esa de ls
de 55% vad ,xzhxsV esa izkIr fd, gq, gksus pkfg,A ekU;rk izkIr 33 cksMks@aZ ifj"knksa dh lwph layXud&AAA esa nh
xbZ gSA ;g vkosnu djus ds fy, dsoy ;ksX;rk fu/kkZj.k gsrq gS vkSj Nk=o`fr iznku djus dh dksbZ xkjaVh ugha nsrk gS
;s jkT; ls izkIr ik= vkosnuksa esa ls lacfa /kr jkT; ds fy, fu;r dksVs ds vk/kkj ij mPp Js.kh ds vkosndksa dks ;s
Nk=o`fr iznku dh tkrh gSA
Should have secured not less than 55% marks (in aggregate) in the secondary school
certificate examination (Class xth) conducted by any recognized Centre/State Board of
Secondary Education. The List of 33 recognized Boards/Councils is given in
Annexure-III. This is only qualifying percentage for applying and does not guarantee
grant of scholarship which is given to the top eligible applicant based on the quota fixed
for the concerned state from amongst the eligible application received from the state.

(2)

3.

fiNys fok o"kZ esa Nk= ds ifjokj dh lHkh Lkzkrs ksa lfgr dqy vk; 1,00,000/- :i, dsoy ,d yk[k :i, ls de
gksuh pkfg,A
Family income of the student from all sources should be less than Rs. 1,00,000/- (Rupees
one lakh only) in the preceding financial year:

osru Hkksxh oxZ ds ekeys esa Nk=k dks vius ekrk&firk@vfHkHkkod dk inuke] osrueku] ewyosru rFkk dqy ,oa
?kj ij yk, tkus okys osru lfgr iwjk fooj.k nsuk pkfg,A dsoy ^^lfoZl** fy[k nsuk Lohdk;Z ugha gksxkA Nk=k
dks vkosnu ds lkFk vius ekrk&firk@vfHkHkkod ds fu;a=d izkf/kdkjh }kjk lka{;fdr osru izek.ki= vFkok
is'a ku izek.ki= lsokfuo`k O;fDk;ksa ds ekeys esa layXu djuk gksxkA
In case of salaried class, the student must indicate the designation, pay-scale,
basic pay and other allowances alongwith total gross & take home emoluments of
the parent/guardian. A mere statement saying Service will not be acceptable.
The student must attach a Salary Certificate or Pension Certificate (in case of
retired persons), duly authenticated by controlling authority, of her parent/guardian
alongwith the application.

d`f"k@ckxokuh ds ekeys esa Nk=k dks flafpr vkSj vflafpr rFkk mlds ifjokj }kjk vU; Hkwfe laink ds C;kSjs ,oa
ifjokj dh dqy vk; lfgr dqy Hkwfe gksfYMax dk mYys[k djuk gksxkA ekrk&firk@vfHkHkkod }kjk fn, tkus okys
'kiFk i= layXud&II ds lkFk&lkFk jkTkLo izkf/kdkjh ls izek.k i= esa bu C;kSjksa dk mYys[k Hkh fd;k tk,xkA
In case of agriculture/horticulture etc., the students has to mention total land holding
with details of irrigated and non-irrigated and other landed property owned by her
family alongwith total income of the family. These details will also be mentioned in
the affidavit of the parent/guardian (Annexure-II) as well as in the certificate from
Revenue authority.

O;kikjh oxZ ds ekeys esa Nk=k dks ifjokj ds dqy djksckj vkSj dqy vk; lfgr Li"V :i ls fctusl dk uke
vkSj fdLe crkuk gksxkA bu C;kSjksa dk muds ekrk&firk@vfHkHkkod }kjk fn, tkus okys 'kiFk i= layXud&II
esa Hkh mYys[k djuk gksxkA
In case of business class, the student must categorically state the name & type of
the business alongwith the total turn over and the total income of family. The
same details will also be stated in the Affidavit (Annexure-II) from her parent/
guardian.

vU; lHkh lzkrs ksa ls gqbZ vk; dk Hkh mYys[k fd;k tkuk pkfg,] fo'ks"kdj ;fn Nk=k dh ekrk Hkh jkstxkj esa gSAa
Income form all other sources must also be mentioned, specially if mother is also
employed.

(3)

;g uksV fd;k tk, fd Nk=k }kjk vkosnu esa fn, x, lHkh vk; izek.ki= ,oa fooj.kksa dh ekSykuk vktkn f'k{kk
izfr"Bku }kjk vkxs tkap dh tk ldrh gSA rF;ksa esa tkucw> dj dh xbZ xyrh@rF;ksa dks Nqik, tkus ds ekeys
esa ;g izfr"Bku] Nk=o`fr dks jn~n@igys ls iznku@tkjh dh xbZ Nk=o`fr dh olwyh djus ds lkFk&lkFk dkuwu
ds vuqlkj vko';d dkjokbZ 'kq: dj ldrk gSA
It must be noted that all income certificate and statements made by the students
in the application is subject to further verification of Maulana Azad Education
Foundation. In case of any deliberate discrepancy/concealment of facts, the MAEF
may cancel/recover the scholarship granted/released as well as initiate necessary
action as per law.

vk; izek.ki=@'kiFk i= layXud&II vo'; gh ekrk&firk@vfHkHkkod dh rjQ ls gksus pkfg, rFkk ;s

lacfa /kr gkse LVs'ku ls tkjh gq, gkus pkfg,A gkse LVs'ku ds vykok tgka Nk=k i<+ jgh gS ml LFkku ls tkjh
fd;k x;k vk; izek.ki= vFkok 'kiFk i=] Lohdk;Z ugha gksxk QksVkdkWih ds ekeys es]a ;g jktif=r vf/kdkjh
;k laLFkku ize[q k }kjk izekf.kr fd;k tkuk pkfg,A
The income certificate/affidavit (Annexure-II) must be from the parents/guardians
side and should have been issued from the respective home station. The income
certificate issued or affidavit made from the place where the student is studying,
as against the home station, will NOT be acceptable (in case of photocopy, it
should be attested by Gazetted Officer or Head of Institution).

4.

Nk=k dk d{kk & XI esa nkf[kyk iDdk dUQeZ gksuk pkfg,A dkWyts @Ldwy }kjk tkjh dh xbZ nkf[kyk fLyi tgka bl
le; i<+ jgh gS] vkSj fu/kkZfjr izi= layXud&I esa iz/kkukpk;Z }kjk dh xbZ tkap Hkh vkosnu i= ds lkFk vo'; Hksth
tkuh pkfg,A
Should have Confirmed admission in class-XI. Admission Slip issued by the college/
school where the student is presently studying and verification of the principal
(Annexure-I), in the prescribed proforma must be sent with the application.

5.

nkf[kyk nsus okyk fo'ofo|ky;@dkWyts @laLFkku] ljdkj }kjk dsUnzh; ;k jkT; Lrj vFkok fdlh vU; l{ke inkf/kdkjh
}kjk ekU;rk izkIr gksuk pkfg,A
The University/College/Institute offering admission should be recognized by the
Government at the Central or State level or any other competent authority.

6.

;g dsoy ,d ckj ouVkbe feyus okyh Nk=o`fr gS vkSj LFkk;h ykHkxzkgh ds :i esa dksbZ nkok Lohdkj ugha fd;k
tk,xkA Nk=o`fr ds fy, ,d ckj p;u dh xbZ Nk=k] dks nqckjk ;g Nk=o`fr iznku ugha fd;k tk;sxkA
It is one time scholarship, and no claim as permanent beneficiary will be entertained.
Student once selected for scholarship can not avail the same again.

7.

tks Nk=k fdlh vU; lzkrs ls Nk=o`fr izkIr dj jgh gSa og bl Nk=o`fr ds fy, ik= ugha gksxhA
A student getting a scholarship from any other source would not be eligible for this
Scholarship.

(4)

8.

ekSykuk vkt+kn f'k{kk izfr"Bku ds dk;kZy; esa vkosnu i= tek djus dh vafre frfFk 30 flrEcj gS] ftldk vo';
gh ikyu fd;k tkuk pkfg,A 30 flrEcj ds ckn izkIr gq, Nk=o`fr ds vkosnu dks fdlh Hkh gkyr esa Lohdkj ugh
fd;k tk,xkA ;s izfr"Bku bl ekeys esa Mkd esa gqbZ nsjh ds fy, ftEesnkj ugha gksXkkA
The last date for receipt of application in the office of the Maulana Azad Education
Foundation is September 30th which must be adhered to. The application of the
scholarship received after 30th September, will not be entertained under any
circumstances. MAEF will not be responsible for postal delay in the matter.

9.

Nk=o`fr dh dqy jkf'k : 12,000/- :i, ckjg gtkj :i, ek= gksxh ftls : 6,000/- :i;s Ng gt+kj dsoy
dh nks fdLrksa esa tkjh fd;k tk;sxkA igyh fdLr dk psd Nk=o`fr ds Lohd`fr ds ckn fn;k tk;sxk rFkk nwljh fdLr
d{kk XI esa ikl dj d{kk XII esa izo's k ikus ds izek.k dks izfr"Bku ds dk;kZy; esa tek djkus ds ckn fn;k tk;sxkA
The amount of Scholarship will be Rs. 12,000/- (Rupees twelve thousand only) which
will be released in two installments of Rs. 6,000/- each. The first installment will be
released after sanction of scholarship and the second installment will be released when
the student will submit proof of passing class XIth, and admonition to Class XIIth in the
office of the Foundation.

10.

;g Nk=o`fr] d{kk -X dh ijh{kk ikl djus ds ckn ml o"kZ XI oha d{kk esa nkf[kyk ysu]s ij nh tkrh gSs ckn ds o"kksaZ
esa nkf[kyk ysus okyh Nk=kvksa ls izkIr vkosnu i= Lohdkj ugha fd, tk,xsAa
The scholarship is given to student passing X th exam and taking admission in XIth in the
year when result of Xth exam is declared. Applications received in subsequent years will
not be entertained.

(5)

30 flrEcj
Last Date for Receipt of Application Form : 30 th, September

vkosnu i= izkIr djus dh vfUre rkjh[k %

ekSykuk vkt+kn f'k{kk izfr"Bku

MAULANA AZAD EDUCATION FOUNDATION
vYila[;dksa ls lacf/kr es/kkoh Nk=kvksa ds fy, ekSykuk vkt+kn jk"Vh; Nk=o`fr gsrq vkosnu i=
APPLICATION FORM FOR MAULANA AZAD NATIONAL SCHOLARSHIP FOR MERITORIOUS
GIRLS STUDENT BELONGING TO MINORITIES

iathdj.k la-

/Reg. No.a----------------------------------

uksV % lHkh dkWye vo'; gh Hkjs tk,aA tgka vko';d gks ^^ykxw ugha** fy[ksaA v/kwjs ;k lefFkZr nLrkostksa ds fcuk izkIr vkosnuksa dks Lohdkj
ugha fd;k tk,xkA lHkh nLrkost fgUnh@vaxzsth esa nsus gksaxsA Nk=k dk laidZ VsyhQksu la- nsuk vR;ar vko';d gS% orZeku Ldwy@dkWyst dk Qksu
la- Hkh nsuk vko';d gSA
NOTE: All colums must be filled. Write NOT APPLICABLE where necessary. Application received in an incomplete form or
without supporting document will not be entertained. All documents will be required in Hindi/English version. It is absolutely
necessary to give contact telephone number of the student; present School/College Telephone no. must also be given.

1)

uke

Ldwy ds iz/kkukpk;Z ls izekf.kr

gky dh ikliksVZ vkdkj
dh QksVks fpidk,a

Name
2)

tUe LFkku ,oa tUe frfFk

Affix Recent Passport

Size Photograph
attested by the
Principal of the School

Place & date of birth

3)

jk"Vh;rk vkSj jkT; ftlls

vkosnd lacf/kr gS
Nationality &the State to which the applicant belongs

4)

/keZ nLrkosth lcwr

vfuok;Z gS
Religion (compulsory with documentary evidence)

5)

vk/kkj ua-@ Aadhaar No.

6)

iwjk irk % d orZeku

Full Address: (a) Present

fiudksM/Pin Code

ftyk / District
jkT; / State
VsyhQksu ua0 / Telephone No.
;fn vko';d gks rks] ih- ih- uEcj nsa (If necessary, give PP no.)
[k LFkkbZ
(b) Permanent

ftyk / District
jkT; / State

fiudksM/Pin Code

VsyhQksu ua0 / Telephone No.

;fn vko';d gks rks] ih- ih- uEcj nsa (If necessary, give PP no.)

(6)

7)

d firk dk iwjk uke

(a) Fathers Full Name

[k vfHkHkkod dk uke
(b) Guardians Name

x firk@ifr ds laj{kd
u gksus dk dkj.k
(c) Reasons for father/husband Not being the guardian
8)

firk@laj{kd dk O;olk;

Occupation of father/Guardian
d lfoZl ds ekeys esa i) in
(a) In case of Service: i) Designation
ii) dk;kZy; dk irk
ii)

Office Address

iii)

osrueku xzsM

iii)

Pay-Scale (grade)

iv)

ewy osru

iv) Basic Pay

v) Hkks
v) Allowances
vi) dqy ekfld vk;
vi) Total emoluments (monthly)
vii)

vU; lzksrks ls vk;

vii) Income from other sources

v)

ekrk dh vk;] ;fn dksbZ gS

v)

Mothers income, if any

vi)

iSu la- ;fn vk; dj nsrs gSa

vi) PAN No. (if income-tax payee*)

firk / Father
ekrk / Mother
vfHkHkkod / Guardian
[k d`f"k ds ekeys esa
(b) In case of Agriculture:
i)

dqy Hkwfe

i)

Total land holding

ii)

flafpr

ii)

Irrigated

iii)

vflafpr

iii)

Non-irrigated

iv)

LFkku irk

iv) Located at (address)

v)

vU; Hkwfe laifk

v)

Other landed property

vi)

dqy vk; okf"kZd

vi) Total income (Annual)

vii)

iSu la- ;fn vk; dj nsrs gSa

vii) PAN No. (If Income-tax payee*)

(7)

viii)

dqy ifjokfjd vk; okf"kZd

viii) Total family income (annual)

i)
(c) In case of Business:i)
ii)

x fctusl ds ekeys

fdLe
Type:

LokfeRo@Hkkxhnkjh

ii)

Ownership/Partnership

iii)

nwdku@dk;Z'kkyk dk LokfeRo

iii) Ownership of shop/workshop

iv)

irk

iv) Address
v)

Hkwfe okyh lEifk

v)

Landed Property

vi)

dqy vk; okf"kZd

vi) Total income (Annual)

vii)

iSu la- ;fn vk; dj nsrs gSa

vii) PAN No. (If Income-tax payee*)

viii)

dqy ifjokfjd vk; okf"kZd

viii) Total family income (annual)

?k fdlh vU; O;olk; vkfn ds ekeys esa %

(d) In case of any other profession etc.
9

eSfVd ;k lerqY; ds vkjaHk ls ikl dh xbZ lHkh ijh{kkvksa dk fooj.k %

Particulars of all examination passed commencing with the Matriculation or equivalent Examination :

10)

ijh{kk dk uke

fo'ofo|ky;@cksMZ

o"kZ

jksy ua-

Name of Examination

University / Board

Year

Roll No.

(1)

(2)

(3)

(4)

d Ldwy@dkWyts dk uke o iwjk

irk tgka Nk=k vHkh i<+ jgh gS
(a) Name & full address of the
School/College where the
student is Presently enrolled

fiudksM/Pin Code

ftyk / District
jkT; / State
VsyhQksu ua- vfuok;Z gS
Telephone No. (Compulsory)

(8)

izkIr vadks dk
izfr'kr
% Age of
Marks obtained
(5)

[k fo'ofo|ky;@cksMZ dk uke
ftlds lkFk ;s laLFkku lac) gS
(b) Name of the University/Board with
Which the institution is affiliated to

x nkf[kys dh rkjh[k
(c) Date of Admission

?k d{kk@o"kZ ftlesa vkosnd vHkh

i<+ jgh gSa
(d) Class/Year in which the applicant is presently studying

M ikB;e bldh vof/k vkSj

fy, x, fo"k;
(e) Course its duration & and Subjects taken

p nku ds Hkqxrku ;k [kqyh

izfr;ksfxrk@eSfjV ds ek/;e ls
nkf[kyk gqvkA
(f) Admitted through payment of Donation or
through open Competition/merit
11)

;fn vkosnd fdlh dsUnz@jkT; ljdkj ds fo'ofo|ky; ;k fdlh vU; laLFkku@,stlas h O;fDr ls dksbZ vU; Nk=o`fr@_.k@'kSf{kd lgk;rk izkIr
dj jgh gS rks mldh ekfld nj rFkk nsus dh rkjh[k lfgr iwjk fooj.k nsa
If the applicant is in receipt of any other scholarship/loan scholarship / educational aid from Central / State Govt.
University or from any other Institution/Agency/Person, then full particulars should be given including the monthly
rate and the date of award etc.

12)

fgUnh@vaxzsth esa vfuok;Z :i ls layXu fd, tkus okys nLrkostksa dh lwph %

List of documents to be attached compulsorily in Hindi/English version:
d
vk; izek.ki=@'kiFki= layXud&II ds vuqlkj
(a)
Income Certificate/Affidavit (as per Annexure-II)
[k
orZeku Ldwy@dkWyst ds iz/kkukpk;Z }kjk izekf.kr Xth d{kk dh vad lwph
(b)
Mark sheet of class Xth attested by the Principal of present School/College
x
orZeku Ldwy@dkWyst ds iz/kkukpk;Z }kjk tkap layXud&I ds vuqlkj
(c)
Verification by the Principal of present School/College (as per Annexure-I)

13)

?k

orZeku Ldwy@dkWyst ds iz/kkukpk;Z }kjk izekf.kr QksVks

(d)

Photo attested by the Principal of present School/College

M+

orZeku Ldwy@dkWyst ds iz/kkukpk;Z }kjk izekf.kr /keZ@tkfr ds izek.k dk izek.ki=

(e)

Proof of Religion certificate attested by the Principal of present School/College

eSa ,rn}kjk ;g ?kks"k.kk djrh gw fd esjs }kjk bl vkosnu i= esa fn;k x;k fooj.k esjh tkudkjh vkSj fo'okl ds vuqlkj lR; ,oa lgh gSA
eSa ;g tkurh gw fd ;fn mDr vkosnu esa fn;k x;k fooj.k xyr gS rks eq>s tkylkth gsrq Hkkjrh; naM lafgrk ds rgr ltk ds lkFk&lkFk naMkRed
dkjZokbZ dk lkeuk djuk gksxkA ;fn eSa ekSykuk vktkn jk"Vh; Nk=o`fr ds fy, p;fur gksrh gw rks eSa bl Nk=o`fr dh fuca/ku ,oa 'krksZa dk
ikyu d:axhA ;fn mDr lwpuk iw.kZr;k ;k vkaf'kd :i ls xyr ikbZ tkrh gS rks Nk=o`fr dh iwjh jkf'k esjs ls ,deq'r olwyh dh tk ldrh
gSA
I hereby declare that the statements made by me in this application form are true and correct to the best of my
knowledge & belief. I am aware that if there are false statements in the foregoing application, I am liable to be
prosecuted under the Indian Panel Code for forgery as well as any other panel consequences. I further agree to
abide by the terms and conditions of the scholarship if selected for the Maulana Azad National Scholarship. The
entire amount of Scholarship can be recovered in lump sum from me in case the above information is found fully
or partially incorrect.

fnukad / Place---------------------------------------

vkosnd ds grk{kj
(Signature of applicant)

LFkku/Date:--------------------------------------------(9)

layXud &A
Annexure I

Ldwy@dkWyst ds iz/kkukpk;Z }kjk tkap fd;k tkus okyk QkeZ*

VERIFICATION FORM BY PRINCIPAL OF SCHOOL/COLLEGE*

;s QkeZ Ldwy@dkWyt
s ds iz/kkukpk;Z }kjk Hkjk ,oa gLrk{kj fd;k tk,xk tgka bl le; Nk=k@vkosnd i<+ jgh gS
(To be filled and signed by the Principal of the school/college where the student/applicant is presently studying).

(i)

izekf.kr fd;k tkrk gS fd dqekjh -----------------------------------------------------------------------------------------------------lqi=q h Jh-----------------------------------------------------------------------------------------------------------------------------dks bl Ldwy@dkWyst esa fu;fer ,oa iw.kZdkfyd Nk=k ds :i esa **-------------------------------------------------------------------oxZ esa d{kk@ikB;e --------------------------------- esa rkjh[k ----------------------------- dks nkf[kyk fn;k x;k gS vkSj bl le;
og 'kS{kf.kd l= ----------------------------------------- esa d{kk@o"kZ ---------------------------------------esa i<+ jgh gSA
Certified that Miss.........................daughter/ward of ....
has been admitted in the School/College against**.......as a regular and full
time student in Class/course.....on..and is at present
studying in class/ Year..........in the academic session..

(ii)

og dsUnz@jkT; ljdkj@fo'ofo|ky; ;k fdlh vU; laLFkku@,stlas h@O;fDr ls ---------------------------------------- :i;s dh nj ls

-------------------------------------------------- :i;s Nk=o`fr@'kSf{kd _.k lgk;rk izkIr dj jgh@ugha dj jgh gSA
She is/is not in receipt of Scholarship/educational Loan aid from. @ Rs..
(Rupees.only) per month/per annum from Central/State Govt. University
or from any other Institution/Agency/Person.

(iii)

;g vkSj izekf.kr fd;k tkrk gS fd bl laLFkku esa Nk= ds nkf[kyk fjdkMZ esa fyf[kr buds firk@vfHkHkkod dk uke irk rFkk O;olk;
---------------------------------------------------------------------------------------------- gSAa
It is further certified that the name, address & occupation of the Father/Guardian mentioned in the admission
record of the student in this Institution is

(iv)

og ---------------------------------------------------------------------------------------- leqnk; vFkkZr eqfLye@bZlkbZ@fl[k@ckS)@ikjlh

ls lacaf/kr gSA
She belongs to..community (i.e. Muslim/Christian/Sikh/Buddhist/Parsi)

Ldwy@dkWyts ds iz/kkukpk;Z dh eksgj lfgr gLrk{kj ,oa iwjk uke

(Signature and Full Name with Seal of Principal of the School/College)+

LFkku

/Place :....................

rkjh[k

/ Date:....................

uke / Name:...............................................................................
Ldwy@dkWyts / School/College............................................................
iwjk irk / Full Address....................................................................
ftyk /Distt............................................ jkT; /State.......................
Qksu@eksckbZy la- Ph./Mobile No.***(Compulsory)......................................

bl tkap QkeZ dks gLrk{kj djus ls igys Nk=k ds nkf[kyk fjdkMZ ds vuqlkj vkosnu i= dh tkap dj ysAa ;g vo'; gh tkap dh tk, fd
firk@vfHkHkkod ds vk; okys dkWye esa fn, x, fooj.k] O;olk;@/keZ ml laLFkku tgka Nk=k i<+ jgh gS] esa miyC/k fjdkMZ ls feyrk gSA
The application must be scrutinized as per the admission record of the student before signing the verification form.
It must be verified that the statements made in the income column of the father/guardian, the occupation/religion
tallies with the records available if any, in the institution where the student is studying.

**

d`i;k ;gka nkf[kys dk oxZ] fo'ks"k :i ls mYys[k djsa tSls fd isesaV lhV] fu'kqYd lhV] vkjf{kr lhV] lkekU; eSfjV vkfnA
Please specifically mention here the category of admission like against payment seats, free seats, reserved seats,
general merit etc.

***

laidZ VsyhQksu la- ySaMykbu vkSj eksckby nksuksa Hkh vo'; fy[ks tkus pkfg,A
Contact Telephone no. (both landline and Mobile) must be mentioned.

(10)

layXud &AA
Annexure II

vk; ds 'kiFki= ds fy, uewuk

SPECIMEN FOR INCOME AFFIDAVIT
(20 #i;s ds xSj&U;kf;d LVki isij ij Vkbi fd, tkus okyk uewuk
(Specimen to be typed on Rs. 20/- Non-judicial Stamp paper)

eS Jh@Jherh ----------------------------------------------------------------------------- tks---------------------- dk firk@laj{kd

gw rFkk ------------------------------/keZ ls lacfa /kr gwa vkSj iwjk irk --------------------------------------------------------------------------------------------------------------------------------------------------------------------- ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ftyk --------------------------------------------------- fiu
dksM -------------------------------------------------- jkT; ----------------------------------------- tks ekSykuk vkt+kn f'k{kk
izfr"Bku] ubZ fnYyh }kjk izLrkfor ekSykuk vkt+kn jk"Vh; Nk=o`fr ;kstuk ds rgr Nk=o`fr ds fy, ,d mEehnokj gS ,rn }kjk ;g
?kks"k.kk djrk gw fd fiNys o"kZ

31

ekpZ]

20......................

dks lekIr gq, o"kZ esa esjh /keZiRuh dh vk; lfgr esjh dqy vk;

-------------------------------------- #i;s --------------------------------------------- #i;s FkhA vk; dk C;kSjk bl izdkj gSA

I, Shri/Smt..Father/Guardian of
belonging to........ religion, full Address.....................
.....Distt..........
Pin Code. State............ (a candidate for scholarship under
Maulana Azad National Scholarship Scheme offered by Maulana Azad Education Foundation, New Delhi)
hereby declare that my total income including income of my spouse in the preceding year ended on
March, 31st, 20.., was Rs............. (Rupees...................only).
The break-up of the income is as follow:
(1)

d`f"k

(2)

vU; Hkwfe laifk

(3)

fctusl

(4)

dksbZ vU; O;olk; Li"V djsa

Agriculture
:

Other Landed Property

:

Business
:

Any other profession (Specify)

eS vk;dj dk Hkqxrku ugaha djrk gw ;k eSa vk;dj nsrk gw vkSj esjk iSu la- ------------------------------------------------------------ gSA
I am not an Income Tax payee or I am an Income Tax payee and my PAN No. is................

ekrk firk@vfHkHkkod dk uke vkSj gLrk{kj/Name & Signature of the Parent/Guardian)

eftLVsV @ uksVh ifCyd dk uke vkSj gLrk{kj/Signature with seal of Magistrate / Notary Public)
uksV %

(1)
(2)

;fn ekrk vkSj firk nksuksa dk;Zjr gSa rks nksuksa dk osru izek.ki= vko';d gksxkA
vk; vkSj vk; dk lzkrs ds C;ksjs dk mYys[k djuk vko';d gS ftlds fcuk vkosnu i= ij fopkj ugh fd;k tk,xkA

Note: (1) In case both the parents are working, salary certificate of both would be required.
(2) The break-up of Income & Source of Income is necessary to be mentioned, without which application will not
be considered.

(11)

layXud &AAA
Annexure III

cksMksZa @ ifj"knksa dh lwph

LIST OF BOARDS/COUNCILS
(1)

vka/kz izns'k ek/;fed f'k{kk cksMZ] vka/kz izns'kA

Andhra Pradesh Board of Secondary Education, Andhra Pradesh.

(2)

v:.kkpy izns'k ek/;fed f'k{kk cksMZ] v:.kkpy izns'kA

Arunachal Pradesh Board of Secondary Education, Arunachal Pradesh.

(3)

ek/;fed f'k{kk cksMZ] vleA

Board of Secondary Education, Assam.

(4)

fcgkj Ldwy ijh{kk cksMZ] fcgkjA

Bihar School Examination Board, Bihar.

(5)

Nkhlx<+ ek/;fed f'k{kk cksMZ] Nkhlx<+A

Chattisgarh Board of Secondary Education, Chattisgarh.

(6)

xksok ek/;fed ,oa mPprj ek/;fed f'k{kk cksMZ] xksokA

Goa Board of Secondary & Higher Secondary Education, Goa.

(7)

xqtjkr ek/;fed ,oa mPprj ek/;fed f'k{kk cksMZ] xqtjkrA

Gujarat Secondary & Higher Secondary Education, Gujarat.

(8)

gfj;k.kk f'k{kk cksMZ] gfj;k.kkA

Haryana Board of Education, Haryana.

(9)

fgekpy izn's k Ldwy f'k{kk cksM]Z fgekpy izn's kA

Himachal Pradesh Board of School Education, Himachal Pradesh.

(10)

tEew ,.M d'ehj jkT; Ldwy f'k{kk cksMZ] tEew ,.M d'ehjA
J. & K State Board of School Education, Jammu & Kashmir.

(11)

>kj[kaM ek/;fed f'k{kk cksMZ] >kj[kaMA

Jharkhand Board of Secondary Education, Jharkhand.

(12)

dukZVd ek/;fed f'k{kk cksMZ] dukZVdA

Karnataka Secondary Education Examination Board, Karnataka.

(13)

dsjy ifCyd ijh{kk cksM]Z dsjyA

Kerala Board of Public Examination, Kerala.

(14)

e/; izns'k ek/;fed f'k{kk cksMZ] e/; izns'kA

Madhya Pradesh Board of Secondary Education, Madhya Pradesh

(15)

egkjk"V jkT; ek/;fed ,oa mPprj ek/;fed f'k{kk cksMZ] egkjk"VA

Maharashtra State Board of Secondary & Higher Secondary Education, Maharashtra.

(16)

ef.kiqj Ldwy ijh{kk cksMZ] ef.kiqjA

Manipur Board of School Education, Manipur.

(17)

es?kky; Ldwy f'k{kk cksMZ] es?kky;+A

Meghalaya Board of School Education, Meghalaya.

(12)

(18)

fetksje Ldwy f'k{kk cksMZ] fetksjeA

Mizoram Board of School Education, Mizoram.

(19)

ukxkySaM Ldwy f'k{kk cksMZ] ukxkySaMA

Nagaland Board of School Education, Nagaland.

(20)

mfM+lk ek/;fed Ldwy f'k{kk cksMZ] mfM+lkA

Orissa Board of Secondary Education Orissa.

(21)

iatkc Ldwy f'k{kk cksMZ] iatkcA

Punjab School Education Board, Punjab.

(22)

jktLFkku ek/;fed f'k{kk cksMZ] jktLFkkuA

Rajasthan Board of Secondary Education, Rajasthan.

(23)

flfDde ek/;fed f'k{kk cksMZ] flfDdeA

Sikkim Board of Secondary Education, Sikkim.

(24)

rfeyukMq ek/;fed f'k{kk cksMZ] rfeyukMA

Tamil Nadu Board of Secondary Education, Tamil Nadu.

(25)

f=iqjk ek/;fed f'k{kk cksMZ] f=iqjkA

Tripura Board of Secondary Education, Tripura.

(26)

;w- ih- gkbZ Ldwy ,oa baVjehfM;sV f'k{kk cksMZ] mkj izns'kA
U.P. Board of High School & Intermediate Education, Uttar Pradesh.

(27)

mkjk[kaM ek/;fed f'k{kk cksMZ] mkjk[kaMA

Uttaranchal Board of Secondary Education, Uttranchal.

(28)

if'pe caxky ek/;fed f'k{kk cksMZ] if'pe caxkyA

West Bengal Board of Secondary Education, West Bengal.

vf[ky Hkkjrh; cksMZ@ifj"knsa

ALL INDIA BOARDS / COUNCILS
(1)

vyhx<+ eqfLye fo'ofo|ky;] vyhx<+A

Aligarh Muslim University, Aligarh.

(2)

dsUnzh; ek/;fed f'k{kk cksMZ] fnYyhA

Central Board of Secondary Education, Delhi.

(3)

Hkkjrh; Ldwy izek.ki=k ijh{kk ifj"knA

Council for the Indian School Certificate Examinations.

(4)

tkfe;k fefy;k bLykfe;k] ubZ fnYyhA

Jamia Millia Islamia, New Delhi.

(5)

jk"Vh; vksiu Ldwy] fnYyhA

National Open School, Delhi.

(13)