West Bengal Minorities' Development and Finance Corporation

A statutory Corporation under Minority Affairs & Madrasha Education Department,

Government of West Bengal
"Amber", DD/27E,Salt Lake City Sector-I, Kolkata-700064, Toll free No:-18001202130

APPLICATION FOR WB MERIT CUM-MEANS SCHOLARSHIP 2019-20

Application ID: SSP2019031800056902 Application Date: 09-08-2019
BASIC INFORMATION
Student's Name: MD SAQLAIN MUSHTAQUE Father's Name: FAIZUL HAQUE
MUNSHI Mother's Name: AYESHA PARVEEN
Date of Birth: 13-12-1999 Annual Family Income: 72000
Gender: Male Guardian's / Husband's Name: FAIZUL HAQUE
Marital Status: Unmarried Religion: Muslim
E-mail Id: mdsaqlain21538@gmail.com
Mobile No: 8777583754

ADDRESS INFORMATION
Permanent Address Present Address
Domicile State: WEST BENGAL State: WEST BENGAL
Domicile District: KOLKATA District:KOLKATA
Block/Municipality:Kolkata MC Block/ Municipality:Kolkata MC
Permanent Address: 1/6R J.K GHOSH ROAD Present Address: 1/6R J.K GHOSH ROAD
Post Office: BELGACHIA Post Office: BELGACHIA
Police Station: ULTADANGA Police Station: ULTADANGA
Pin: 700037 Pin: 700037

ACADEMIC INFORMATION
Previous Academic Information Present Academic Information
Previous Institute Name: CHAK PANCHGHORA Institution Name: Jadavpur University
SITANATH HIGH SCHOOL Current Class / Course Name : BACHELOR OF ENGINEERING
Previous Class / Course Name: XII Current year of Study :2nd Year
Previous Year of Study: XII Are you a Hosteller: Yes
Name of the Board of Name of the Board / Council / University : Jadavpur University
last Exam Passed: West Bengal council of Higher Course Duration : 4 Year
Secondary Education
Year of Passing Last Exam: 2017
% of Marks Obtained
in Last Examination: 79.40
BANK ACCOUNT DETAILS
Bank:UNITED BANK OF INDIA
Branch:PAIKPARA
IFSC: UTBI0PKP130
Savings bank account no.: 0010360012

Declaration:I hereby declare that the details furnished above are true and correct to the best of my knowledge and belief.

___________________
Signature of Student
DECLARATION OF INCOME
(To be given by the parents/ guardians)

Certified that the gross annual income from all sources in respect of my family is Rs.72000 . I further undertake that in the
event of the particulars given in the declaration being found false, I shall refund the whole amount of the Scholarship paid to
the said Scholarship holder MD SAQLAIN MUSHTAQUE MUNSHI and the Government's decision in this regard shall be final
and binding on me.

__________________________
Signature of the parents/ guardian

Instruction
Student is to submit this ***computer-generated filled-in application form (duly signed) to the educational institution along with
following supporting document:
1. Photocopy of the bank-passbook where the details of bank a/c number,IFSC are mentioned clearly.
1/1

Powered by TCPDF (www.tcpdf.org)