APPLICATION FOR AWARD OF AMMAIYAR EDUCATIONAL SPONSORSHIP

FOR SCHOLARS IN TAMILNADU AND PONDICHERRY

For Office Use Only

Received : _ _/_ _/_ _

Intake No :
GS

1)

AS

VT

PS

AT

ST

Name of the student (in BLOCK LETTERS)

2) Name of Father / Guardian :

3) DOB

4) Gender
Male

Female

5) Nationality
Other

7) Physically Handicap
Yes / No

8) First Graduate

*If Yes then attach the medical

Yes / No

_________________
* Copy of community
Certificate to be
enclosed in the case of
SC/ST/MBC/OBC

certificate

9) Name of the Examination

Passed / Date (DD/MM/YYYY)

Affix the current

Photograph
(Passport size)

6) Community

10) Admitted through

11) Year of
Admission

12) Current Course / Institution

Single Window system

Management

13) The date on which the student joined the Institution for academic year 20_ _- 20_ _

14) Whether the applicant is already accessing any scholarships / Sponsorship : Yes / No
If Yes mention the names of the schemes those on receipt :
________________________________________________________________________________
15) Family Details:
Name

Relationship

Age

Qualification

Occupation

Income / Annum

16) Academic Details:

Examination

Board / College Name

Secured
Marks

Total
Marks

Percentage /
Class

Year of
Passing

SSLC
HSC
DIPLOMA
UG
PG
PRE RESEARCH
17) DD Particulars
DD Number

Bank Name / Branch

DD Date

Amount

18) Applicant had awarded Junior Scientist / any other awards : Yes / No
* If Yes attach the copy of the Attested certificate

19) Annual Family Income(INR)

19) Contact
Address for Communication

Permanent Address

Phone
Mobile
Father /
Guardian Ph
No.
e-Mail ID

20) Bank Account Details

Account Holder Name

Account Number

Bank and Branch

Each item should be read carefully before the form is filled

Aadhar Card / Voter ID Number

CHECK LIST( To be attached with this Application)

Particulars

Fill the following with Black Pen

Yes

Self Declaration Form

No change will be permitted after submission of this

application. If any entry is found to be incorrect, the

sponsorship, if awarded then it will be liable to be

Bonafide
Copy of SSLC mark sheet

cancel forthwith
Incomplete statement or statements received after the

Copy of HSC / equivalent

prescribed date will not be considered

Necessary certificates should be attached for the
required criteria where the applicant is eligible for. In
absents of any, applicant will not be consider for that
particular beneficiary criteria

DD of Application Fee
Copy of semester mark list
(Up to last semester- If Eligible)
Copy of Community Certificate

For all copies that has to be attached should have

Copy of Income Certificate

attested by gazette officer

Application Fee of Rupees 125/- ( For UG), 275/-(For
PG), 550/- (For Research scholars) have to be taken as
a DD in any centralized bank in the favor of Lineesha
Science and Technology Pvt Ltd, payable at Karaikal.
Application should be send to Lineesha Science &

Medical Certificate (If Eligible)

Proof of Single Window system
(If Eligible)
Copy of Aadhar Card

Technology Pvt Ltd, 38 Ganaprakasam Street,

Karaikal-609602 for further details contact +91-

Copy of Family Card

7200065165, 7200065965
Copy of BankPass Book

Declaration
All information that I have mentioned above is true and best of my knowledge.

Place : ______________
Signature of the Applicant

Date : ______________

No