Jamiat Ulama-i-Hind (Arshad Madani) Public Trust

TALEEMI IMDAADI FUND

1, Bahadur Shah Zafar Marg, New Delhi-110002

Application Form For Financial Assistance-2019-20

Section-A
Affix recent
1. Name of the course/training for which the candidate has been admitted self attested
photograph
...............................................................................................................................
2. %age of marks in the qualifying examination/result of 2018-19 ................................
3. Name & Address of institution / University............................................................................... ...............
....................................................................................................................................................................
....................................................................................................................................................................
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4. Tuition Fee amount for year 2019-20 Rs. .............................................

5. Name the Candidate. (BLOCK LETTERS):

6. Aadhar No.

7. Father's/Guardian's Name: .........................................................................................................................

Tel/mobile number:

8. Postal Address ............................................................................................................................................

....................................................................................................................................................................
....................................................................................................................................................................
9. Contact details of the applicant:
Mobile No.
Email ID

10. Bank details (1) Bank Name ........................... (2) A/c No. ........................ (3) IFSC Code.................

11. Why do you need financial help, give five reasons.

a) ............................................................................................................................................................
b) ......................................................................................................................................................

c) ......................................................................................................................................................

d) ......................................................................................................................................................

e) ......................................................................................................................................................
 Section-B

Attach photo state of the following documents:

(a) Receipt of the recent tuition fee paid.
(b) Mark sheet of qualifing exame-2018-19 Final Examintion.
(c) Latest and currently valid Identity Card issued by the university/institution.
(d) Copy of the bank pass book showing details about the bank and the account holder.
(e) BPL Ration Card photo state copy if you have it.
(f) Income certificate of father issued by competent authority.

I ............................................................................... S/o ...........................................................................

solemnly declared as all information given in application are true and correct to the best of my knowledge
and belief. I understand in case any information furnished by me, my application will be rejected.

Date ................................... Signature of applicant

Place .................................. Name of applicant

.....................................................

Verification by the competent authority of the institution

This is to certify that Mr./Ms………..........................….. S/D/o Mr./Ms……………..............……. is

persuing. Name of the course .................................................................................. semester/year.....................
as a full time regular student in the current academic session 2019/2020.
He/She has paid Rs………............. towards fees on dated…………....…….. vide receipt No………..
Date ..................................

________________________________
Name and signature of the candidate Signature:
Name & Stamp
_________________________________ Head of institution
Name and signature of father/guardian

Note : Last date of submission 15 October 2019.