ZULFI EDUCATIONAL & WELFARE TRUST (Regd.

)
Reg No 219/2016-17 Dated 06.09.2016
No, 14, First Floor,4th A cross Anepalaya Bangalore – 560030,
E-Mail: zulfieducationalwelfaretrust@gmail.com

Scholarship Application form

New Applicant Tick anyone.
Renewal (old) Applicant: Application No.......................

1. Name of the Student (CAPITAL Letters) ...................................................................................................................

2. Date of Birth .......................................................... 3.Present Class/ Course of Study............................................................

4. Annual Fees.......................................................... 5.Duration of Course........................................................................

6. Name of the Institution & Address .................................................................................................................................

7. Father's Name......................................................Occupations: ........................Income: .................................

8. Mother's Name............................................... Occupations: ........................Income: ................................

9. Guardian’s Name……………………………………...........Relationship..............................................

10.Permanent address (As per Aadhaar Card) .............................................................................

……………………………………………………………………………………………………………….….............................

……………………………………………………………………………………………………Pin Code....................................

11. Present Address (CAPITAL Letters) ..........................................................................................................................

…………………………………………………………………………………………………………………………………...........

…………………………………………………………………………………………………………………PinCode......................

12. (A) Contact No………………………………...(B) E-mail…………………………………………………...........................

13. Account Details of institutions: (A) Bank A/c Number………………………………………………

. (B) IFSC …………………………
(C) Bank Name ………………… ….
(D) Branch………………………….
(E) City……………………………………………………………

1 of 1
 14. Details of Examination Passed: (Enclose copy of last year mark-sheet/certificate)

Examination
Board/University Year Division Percentage
Passed

15 Details of Brothers and Sisters of the applicant who are studying

S.No. Name Class Name of the Institution

16. Whether ZULFI EDUCATIONAL & WELFARE TRUST® or any other organization granted scholarship If Yes,
give organization name, amount & year: …………………………………………………………………………………….
----------------------------------------------------------------------------------------------------------------------------- -------------------------
17. Tell us about your financial conduction:

18. Recommendation by “Aalim e Deen” ……………………………………………………………………………………...

…………………………………………………………………………………………………………………………………....
(A) Name of Aalim e Deen ...................................................... Signature ……………………….............................
(B) Address.………….…………………………………………………………………………………………................
……………………………..……………………………………………..…………………………………....................
(C) Mobile No. ……………………………………...............................................................Pin Code....................

19. Recommendation by the Member of ZEWT® ……………………………………………………….

:…..……………………………………………………………………………………………………………………………..
……………………………………………………………………………………………………………………………………
(A) Name & Signature of Member of ZULFI EDUCATIONAL & WELFARE TRUST®
………………………………………………………………………………….
(B) Address …………………………………………………………………………………………………………………
…………………….……………………………………………………….……………………Pin Code..............
(C) Mobile No. ………………….…………… (D) Email: ………………….……………...........................
 DECLARATION BY APPLICANT AND HER/HIS PARENT (GUARDIAN)

• I hereby declare under Allah Subhanahu Tala & chaharda masoomeen (A.S) that all the information given
above are true and correct. If any information is found to be false or incorrect at any stage,
ZULFI EDUCATIONAL & WELFARE TRUST® is authorized to cancel or discontinue the scholarship and
candidate must refund the entire amount received.

• I have read all the instructions carefully and ascertain that I would abide by all the instructions and the Rules of
the ZULFI EDUCATIONAL & WELFARE TRUST®.

Signature of Parent/Guardian Signature of Applicant (Student)

Full Name ……………………………………… Full Name ………………………………………………

Place …………………… Date ………….…… Place …………………………… Date ………….…….
Mobile No. ……………………………………. Mobile No. ……………………………………………...

INSTRUCTIONS

1. Student should achieve minimum 86% in his/her last examination.

2. Use capital letters while filling the Application.
3. Photocopy of last examination passed (Marks card).
4. Photocopies of Aadhaar card should also be enclosed with the application.
5. Photocopies of Parents identity proof also be enclosed with the application.
 OFFICE USE ONLY
*Please fill in Capital Letter *All information are necessary

Date …. ......... Application No......................

(i) Name: ...............................................................................................

(ii) D.O.B..... /...../..........

(iii) Father's Name..........................................................................................

(iv) Class/Course................................................................................

(v) Year/Sem....................

(vi) Address: ............................................................................................................................

................................................................................................................Pin Code..............

(vii) Name of the Institution/College ......................................................................................................

Phone(s): Applicant +91-.............................................. Parent/Guardian +91-......................................

(viii) Sanction Amount in Rupees…………………………………………………

(ix) Category - Poor………... Orphans……………. Others…………………...

(x) Paid through: Cheque …………. Cash ……………. DD……………... Others………….

Signature of the Parent/Applicant

Signature of the ZULFI EDUCATIONAL & WELFARE TRUST®