Only for XI, XII, Polytechnic, ITI & Vocational Courses (XI and XII Level) Students

APPLICATION FORM FOR POST-MATRIC SCHOLARSHIP

FOR STUDENT BELONGING TO THE MINORITY COMMUNITIES OF BIHAR

For the Year

UID No.
DISTRICT SL. NO. CLASS

FRESH / RENEWAL FOR OFFICE USE ONLY

PERCENTAGE YES (PLEASE FILL THE FORM IN BLOCK LETTERS) APPROVED NO

1. Students Name 2. Fathers Name 3. Mothers Name 5. Residential Address Block DISTRICT 6. Contact No. * 8. Male * 10. Present Course * 11. Registration No. (Matriculation or Equivalent) * 12. Annual Income of the parent * Enclose attested copy of income certificate issued by competent authority or affidavit of Parents / Guardian or Certificate of employer.
Name of the Board / Council / University Marks Obtained

4. Occupation Vill. / Mohalla Panchayat * PIN 7. Religion Female * Age 9. Date of Birth *
Note : Document not required for Muslim

Ward No.

---------/---------/------------Roll No.

13. Details of Last Passed Examination * (enclose attested copy of Mark Sheet)
Name of the Examination Year of Passing % of Marks

14. Hosteller / Day Scholar Name & Address of the Hostel / Rented Accommodation PIN 15. Name & Address of the Present Institution / College * Contact No.

DISTRICT * Contact No. 16. Institution / College Recognized by 17. Status of the Institution 18. Student Bank Name & A/c No. *

STATE * PIN

PRIVATE

GOVT.

IFS Code* I do hereby declare that the information given above is correct. Signature of the Parent / Guardian Signature of the Student TO BE FILLED-UP BY THE INSTITUTION 19. Actual Annual Course Fee Payable to Institution / College * (Attach fee receipt issued by the institution) Rs .. 20. College Bank Name & A/c No. * IFS Code* Certified that the information given above is correct. The applicant is a bonafide student of this School/Institution and is a Day Scholar / Hosteller as per above. Student is not availing any other scholarship for this purpose from any other source. The course fee given above in actually being charged from the students. I declare that is sanctioned the course fee will be reimbursed to the student it already paid by him.

Date :- ..

Signature of the Head of the School / Institution With Office Seal

Note : 1. All columns are to be filled. Incomplete application is liable to be rejected. 2. Asterisk (*) marked column is mandatory.

1. 2.

3.

4. Regular class XI

XII , Polytechnic, ITI

Vocational Courses (class XI and XII

5.

BDO/CO/SDO/DM)

Monasteries

6. 7. 8. 9. 10.

IFS Code

11. 12.

(Correspondence Course)

13. 14.

Contact No.

15. 16. Over writing 17. 18. 19. FRESH 20. 21. RENEWAL Column

POST MATRIC SCHOLARSHIP