Dr. A.Q.

Khan Institute of Computer Science

&
Information Technology KRL, Kahuta

Application Form for Need Base Scholarship

Fall / Spring
Instructions :
Please follow these instructions carefully
1. Fill the form in BLOCK LETTERS
2. Fill the form completely; Incomplete Application will not be processed
3. Attach all the required documents. Application without the required documents, will be considered Incomplete
4. Applicant should fill the application form in his/her own handwriting
5. An income certificate is the document that shows monthly/annual income. If your parents/guardian are salaried,
an attested copy of pay slip can be attached, otherwise if your parents/guardian own a business they can submit
bank statement for the last six months. If parents/guardian do not fall in either of the above two cases ( i.e. is
salaried employee or business man ) they can submit an undertaking on a stamp paper/affidavit (of Rs 20/-)
stating their income and income source.
6. Any student having 3.0 SGPS or above is eligible to apply for NBS.

CHECKLIST OF THE REQUIRED DOCUMENTS:

Please attach the following with this form.
 Attested copy of NIC of your Parent/Guardian, Form B from NADRA
 Income certificate of your Parent/Guardian
 Latest original bills of Electricity, Gas and Telephone
 Copies of Medical bills if required
 Attested salary slip/ Pension documents
PERSONAL DETAILS: (Please use BLOCK LETTERS to fill the form)

Name:
Father’s/Guardian’s name:
Father’s/Guardian’s NIC # Date of Birth
(of student): _____/_____/_____
dd mm yyyy
Address:

CITY: DISTRICT: PROVINCE:

Phone No.:
(City Code) Mobile No.
Email:
Current Semester Section: Registration No.
Semester I II III IV V VI VII VIII
SGPA: SGPA
Current CGPA
Father’s/Guardian’s occupation:____________________________________________________________

Father’s Mobile No._________________________ Father’s/Guardian’s E-Mail_______________________

EDUCATION:

Obtained Marks/ School/College

Total Marks/ Grade
Matric/O-level
Intermediate/A-level 1st Year
Intermediate/A-level 2st Year
 Stream Pre-Engineering ICS DAE(Electronic) DAE(Electrical) DAE(Comp.IT)
Is any member of your family currently studying at KICSIT? YES NO If yes, state name and number:
Name: Registration No.

Give details about yourself and your siblings*: Mention clearly whether applicant is receiving merit scholarship or
candidate for merit scholarship.
*Siblings are brothers and sisters
If Obtaining Parent
School/College/University Annual Fee Scholarship Contribution
Name Age (If still studying) (in Rs) (in Rs) (in Rs)

FINANCIAL DETAILS:

a. ASSETS: House, Plots and other Property owned by the family

Current Value Area
S.# Assets Title Assets (in Pakistan (in Kanals/Marlas Location
Ownership* Rupees) Or Sq. Feet)
(I). House
(II). Land/Plot
(III). Agriculture Land
(IV). Commercial Land
*In this column provide information about who owns the specific asset. It can be your father, mother,
brother, or grandparents.

b. INCOME
(Give annual figures for items i, ii, iii, iv, v)

S.# Income/Profession Father’s Mother’s Guardian’s/ Brother’s & Sister’s

(I) Agricultural income
(Annual)
(II) Salary / Pension
(Annual)
(III) Return on Saving
& Investment (Annual)
(IV Rental
) Income(Annual)
(V) Business Income
(Annual)
Total (i, ii, iii, iv, v)
A: B: C:
Total Income: (A+B+C)

How many air-conditioners do you have in your house? __________________________________________

Details of Vehicles owned by Family

S.# Type of Vehicle Make and Model

1.
2.
 c. EXPENSES (of whole family):
Amount Amount
Annual Educational Expenses Annual Medical Expenses
Annual Rent (if living in Rented House) Transportation/Food/Travelling
Expenses/other Expenses(per Annum)
Annual Taxes Annual Electricity Bills
Annual Telephone Bills Annual Water/ Gas Bills

LABILITIES:

Is there any outstanding loan? Yes No If YES, then:

i. Please indicate the amount of loan in Rs _________________________________________________
ii. And also please specify the purpose for taking the loan______________________________________
iii. The source from where the loan was taken
Bank Relative Employer Other (Please Specify)

TUTION EXPENSES

 Please indicate the total amount of contribution you can make towards your tuition fee annually at
KICSIT Rs. ______________________________

OTHER SCHOLARSHIPS

Are you getting any other Scholarship? If yes then please provide following information:

1- Name of Institution and scholarship from which you are getting :____________________________
2- Amount:________________________
3- Time period for which scholarship is given:_______________________________

Please explain why do you require financial aid (Attach separate sheet if required)?
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In case of providing false information, candidate will be disqualified and his /her Scholarship will
have to refunded
___________________ _____________________
Applicant’s Signature Father’s/Guardian’s Signature

Date: _____/_____/_____ Date: _____/_____/_____

dd mm yyyy dd mm yyyy

CNIC# _______________________ CNIC#_______________________

For enquiry contact us at:

 Phone No. (051)-9285059, (051)-9285127
 Fax No. (051)-9285245
 E-mail Address: admin@kicsit.edu.pk
 Website: www.kicsit.edu.pk

-----------------------------------------------------For Office Use Only---------------------------------------------

Recommendations of Committee Members

_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________

Name and Signatures of Committee Members:

i. Name__________________________ Signature______________________

ii. Name__________________________ Signature______________________

iii. Name__________________________ Signature______________________

iv. Name__________________________ Signature______________________

Approved by
(Director I/C KICSIT)