S.

No

List of Male recommended students

Matric ,NAME OF
SCHOOL (Public/Private)
(SSC)

Intermediate, COLLEGE
NAME (Public/Private)
(HSSC)

Name of Last Institution

Per Month Fee of Last

Institution\college

Marital Status

Urban/Rural

3
DOB
Domicile

2
Contact No
National ID No

Father Name
Gender

Name of the
candidate
Program

Personnel Information

PART-A

5
6
7
8
9
9a
10
11
12
13
14

Father Status

Score

Parents/Guardian
relation and Profession

Total No of Dependent
Family Members

Score

Family member studying

Score

Earning Hands

Father / Guardian
Income

Mother Income

Income from Land

Misc Income

Total Monthly Income

Per Capita Income

PART-B
PART-C

Family Status
Total Income Monthly

15
16
17
18
19
20
21
22
23
24
25
26
27
28

Family Exp on Edu.

Avg. Family Exp on Edu.

Score

Candidate Edu Exp per

month

Food Exp

Medical

Medical Expenditure Vs
Income Ratio

Score

31
Sub Total

30
Water

29
Telephone/Mobile

Total Annual Income

Gas
Electricity

Score

Monthly Expenditure (Avg of Last Six Months)

PART-D

32
33
34
35
36
36a
37
38
39
40
41
42

Accomodation
Expenditure

Misc

Total Monthly
Expenditure

Disposable Monthly
Income

Annual Exp

43
44
45
46
47
48
49
50
51
52
53

Value of Land
Accommodation &
Location

Vehicle
Engine
Capacity / CC
Score

Model of the
Vehicle
Size of Land ( No of Acre)

No of Vehicles Vehicle Type

Score

Fixed Asset
PART-E

54
55
56

59

60

61

Misc

Total Score/ 100

Score

58

Stocks/Prize
bond

Interview Score/ 50

Structure

57

Bank Balance

Total Score
(Data)/50

Score

Value of
Home

Total Assets

Type of Accommodation
and Size

Current Assets

62

63

64

65

66

67

68

Remarks

Recommende
d/
Waiting/Not
Recommende
d

69

70