9726721, 205 AM Print Application APPLICATION FOR FINANCIAL ASSISTAN' Application No : 21WP038771 1. Name: KAILASH PRASAD SHARMA Service No: 13962681M Aadhar No: 777572528865 2, Rank: Havaldar/Dafadar 3. Present Address: 0 0 GODDA DHODHRI RAMLA Godda Jharkhand 814133 4, Dates (dd/mmlyy) : Enrolment: 02/05/1985 Discharge: 01/01/2007 Birth: 25/01/1963 Death: 5. Reasons for discharge: (As in Discharge Certificate) 6. Character at the time of discharge : Exemplary 7. Name of Dependents Children : fa) (b) (e) 8. Children for whom the Grant is applied (* One year grant to be claimed for every successful academic year) SR| Child Name School/Gollage Name | Class Marks No.| Passed obtained/CGPA/Grade 1 Lokesh kumar Saint thomas school 9th 73.73% godda 9. Mobile No: 9162450560 Residence Landline No : 10. (a) Pension (Basic pm for pensioners) Rs: 0.00 (b) If re-employed, income there from employment : (c) Monthly income for non-pensioners (from other sources) : 11, Details of Financial Assistance received in past from KSB/RSB/ZSB(mention each type of grant): SR’ Received From Name of grant ‘Amount Year No.| 1 2 12, Name and address of Bank: SBI godda hatia chowk hitps164,100.188.7IKSBAdminvModules'SchomehWELFAREIEDUCATIONIPrint_ Application aspx?Data=GOISIZEBJDxpkG%2eS07ORCZBBAWNTS... 1/29726721, 205 AM Print Application 13. IFSC/NEFT Code of Bank: SBIN0001434 14. AccountNo: SBI: 11093564660 15. Additional Information if any : DECLARATION 16. | understand that this is only an assistance meant for education assistance @ Rs 1,000/- pm per child. (Max two children) and not a tuition fee reimbursement scheme. | have no legal right on the amount requested for. 17.1 solemnly deciare that | am not drwing children’s education allowance from Govt, current employer or any other agency. 18. | hereby declare that the information furnished in personal application cum financial condition report is correct to the best of my knowledge Name & Relationship (Signature/Thumb impression of the applicant) RECOMMENDATIONS BY ZSW OFFICER 19. Following original documents of ESM/Widow./Orphan have been personally checked by ZSW Officer (Photocopies attested by ZSWO are attached): - (a) Complete Discharge Certificate/book showing details of ESM, widow and children. (b) Certificate from school/college giving date of birth and marksheet of successful candidates. (c) ESM or widow or dependent (in case of orphan) Identity Card 20. Its certified that the applicant has not been provided any financial assistance for children's education from the State Govt or any other source. 21. | hereby confirm that the information furnished above is correct as per the original documents of the applicant. Hence, case is recommended, Date 26/09/2024 Signature Office Seal : Rank & Name : Designation : Dy Dir/Asst DirZSWO hitps164,100.188.73IKSBAdminvModules'SchomenWELFAREIEDUCATIONIPrint_ Application aspxData=GISIZEBJDxpkG%2eS07ORCZBBAWNTS.... 2/2