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

FRESH
APPLICATION FOR WB POST MATRIC SCHOLARSHIP 2021-22
Application ID: SSP2021020101096483 Application Date: 23-09-2021
BASIC INFORMATION
Student's Name: AJMUL ISLAM GAZI Father's Name: JIYARUL ISLAM GAZI
Date of Birth: 17-08-2003 Mother's Name: AJMIRA BIBI GAZI
Gender: Male Annual Family Income: 36000
Marital Status: Unmarried Guardian's / Husband's Name: JIYARUL ISLAM GAZI
E-mail Id: ajmulislam@gmail.com Religion: Muslim
Mobile No: 8695388567
ADDRESS INFORMATION
Permanent Address Present Address
Domicile State: WEST BENGAL State: WEST BENGAL
Domicile District: NORTH 24 PARGANAS District:NORTH 24 PARGANAS
Block/Municipality:Minakhan(BLOCK) Block/ Municipality:Minakhan(BLOCK)
Permanent Address: DHUTURDAHA Present Address: DHUTURDAHA
Post Office: DHUTURDAHA Post Office: DHUTURDAHA
Police Station: MINAKHAN Police Station: MINAKHAN
Pin: 743425 Pin: 743425

ACADEMIC INFORMATION
Previous Academic Information Present Academic Information
Previous Institute Name: DHUTURDAHA K.P HIGH Institution District :NORTH 24 PARGANAS
SCHOOL Institution Name: BAMANPUKUR HUMAYAN KABIR
Previous Class / Course Name: XII MAHAVIDYALAYA
Previous Year of Study: XII Current Class / Course Name : BACHELOR OF ARTS (B.A)
Name of the Board of Current year of Study :1st Year
last Exam Passed: West Bengal council of Higher Are you a Hosteller: No
Secondary Education Name of the Board / Council / University : West Bengal State
Year of Passing Last Exam: 2021 University
% of Marks Obtained Course Duration : 1 Year
in Last Examination: 57.20
BANK ACCOUNT DETAILS
Name as per Bank Passbook:MD AJMUL ISLAM GAZI
IFSC: BKID0004334
Savings bank account no.: 433410510007863
Declaration:I hereby declare that the details furnished above are true and correct to the best of my knowledge and belief and I
have not applied for any other scholarship/stipend, etc. from any other government sources.

___________________
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.36000 . 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 AJMUL ISLAM GAZI 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.

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