Bahria University Financial Assistance & Indigent Scholarship (Fall 2011)

Application Form
1. Personal Details:
Name Fathers Name Residential Address Department Registration # Gender Telephone # Mobile No. Email address Enrollment # Date of Birth Program of Study (e.g. MBA, BCE) Campus (Islamabad/Karachi) Semest er Section

2. Family Details:
a. Family members living in the same house (give details below) 1 2 3 4 5 6 7 Relationship with you Age of Family member Occupation of Family Member b. Please indicate the number of your family members studying at Bahria University c. How many of your siblings (brothers and sisters) are studying in other educational institutions d. If Studying at Bahria University, indicate your CGPA up to last semester (Leave the field blank if you are a new student), and your last semester GPA. 8 9 10

GPA

CGP A

3. Statement of Family Assets

a. House(s):
1 2 Owned by Owned by Locality Locality Area Area Plot size Plot size Value Rs. Value Rs. Value Rs. Value Rs. Value Rs. Value Rs. Value Rs. Value Rs. Value Rs.

b. Agricultural Land(s): 1 Owned by 2 Owned by

Locality Locality

Area Area

Type Type

c. Plot(s): 1 Owned by 2 Owned by

Locality Locality

Area Area

Type Type

d. Vehicle(s): 1 Owned by 2 Owned by

Make Make

Mode l Mode l Type

C.C C.C

e. Savings/Investments: 1 Owned by

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Owned by

Type

Value Rs.

4. Statement of Family Income

a. Salary (if employed): per annum 1 Father Rs. 2 Mother Rs. 3 Spouse Rs. 4 Self Rs. 5 Siblings Rs. b. Other income(s) per annum: (e.g. business)

Income Type 1 2

Rupees

Explanation of nature of income

c. How many persons including you depend on your parents income? Please provide the number: d. Any income changes expected next year : per annum income Change Rupees Change Rupees Explanation Increas Decrease: e:

5. Statement of Family expenditures: Total yearly expenses(value in Rupees):

Children Fee Loan (repaid) Telephone Bill Taxes Paid Electric Bill House Rent Medical Expenses Other(s)

6. Annual amount that your family can pay towards your educational expenses per annum: 7. Please indicate the amount of assistance your require for your educational expenses per annum:

8. (Please add any additional details here) Supporting documents required: 1. 2. 3. 4. 5. 6. Fathers recent salary slip (if employed)/ Pension payment order (if retired) Domicile certificate. Bank statement (Last 6 months) Electricity Bill (Last Month) Telephone Bills (Past three months) Tax returns.

Declaration: 1. I hereby declare that the information provided in this form is correct to the best of my knowledge and belief. 2. I undertake to abide by the terms & conditions and other rules applicable to award of this scholarship. I understand that Bahria University shall have all the rights to withdraw this scholarship in case of my misconduct on my part or due to paucity of funds available to the University or violation of rules applicable to award of scholarship. Applicant Signature: Page 2 of 3

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