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: SSP2021021800295634 Application Date: 19-09-2021
BASIC INFORMATION
Student's Name: MD AKIL ANSARI Father's Name: MD JAMIL
Date of Birth: 16-04-2006 Mother's Name: ZARINA KHATOON
Gender: Male Annual Family Income: 48000
Marital Status: Unmarried Guardian's / Husband's Name: Md Jamil
E-mail Id: sameer.ansari78945@gmail.com Religion: Muslim
Mobile No: 8777641940
ADDRESS INFORMATION
Permanent Address Present Address
Domicile State: WEST BENGAL State: WEST BENGAL
Domicile District: KOLKATA District:KOLKATA
Block/Municipality:Kolkata MC(MUNICIPALITY) Block/ Municipality:Kolkata MC(MUNICIPALITY)
Permanent Address: Z-3/157 Present Address: Z-3/157
Post Office: Badartala Post Office: Badartala
Police Station: Nadial Police Station: Nadial
Pin: 700044 Pin: 700044

ACADEMIC INFORMATION
Previous Academic Information Present Academic Information
Previous Institute Name: GARDENREACH K.C. Institution District :KOLKATA
MILLS HIGH (H.S) SCHOOL Institution Name: GARDENREACH K.C. MILLS HIGH (H.S)
Previous Class / Course Name: X SCHOOL
Previous Year of Study: X Current Class / Course Name : XI
Name of the Board of Current year of Study :XI
last Exam Passed: West Bengal Board of Are you a Hosteller: No
Secondary Education Name of the Board / Council / University : West Bengal council of
Year of Passing Last Exam: 2021 Higher Secondary Education
% of Marks Obtained Course Duration : 2 Year
in Last Examination: 60.00
BANK ACCOUNT DETAILS
Name as per Bank Passbook:MD AKIL ANSARI
IFSC: BARB0KIDDER
Savings bank account no.: 06838100021592
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.48000 . 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 MD AKIL ANSARI 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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