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    Amin Ezatullah: Main Bawana Road, Rohini Sector 17, PIN-110042

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    Amin Ezatullah
    Ezatullah Amin, an Afghan national studying at Delhi Technological University, has applied for an ICCR summer camp. He provides his personal details such as name, file number, address, nationality, passport information, and university. He selects Chandigarh as his first choice and Mumbai as his second choice for the summer camp locations. As an ICCR scholar, he will pay the camp fees of Rs. 3,000 by bank draft and is responsible for any medical expenses incurred during the camp. He confirms the accuracy of the information and agrees to maintain discipline and follow instructions during the camp.

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    Amin Ezatullah: Main Bawana Road, Rohini Sector 17, PIN-110042

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    Amin Ezatullah
    21 views2 pages
    Ezatullah Amin, an Afghan national studying at Delhi Technological University, has applied for an ICCR summer camp. He provides his personal details such as name, file number, address, nationality, passport information, and university. He selects Chandigarh as his first choice and Mumbai as his second choice for the summer camp locations. As an ICCR scholar, he will pay the camp fees of Rs. 3,000 by bank draft and is responsible for any medical expenses incurred during the camp. He confirms the accuracy of the information and agrees to maintain discipline and follow instructions during the camp.

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    camp 2022

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    Ezatullah Amin, an Afghan national studying at Delhi Technological University, has applied for an ICCR summer camp. He provides his personal details such as name, file number, address, nationality, passport information, and university. He selects Chandigarh as his first choice and Mumbai as his second choice for the summer camp locations. As an ICCR scholar, he will pay the camp fees of Rs. 3,000 by bank draft and is responsible for any medical expenses incurred during the camp. He confirms the accuracy of the information and agrees to maintain discipline and follow instructions during the camp.

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    21 views2 pages

    Amin Ezatullah: Main Bawana Road, Rohini Sector 17, PIN-110042

    Uploaded by

    Amin Ezatullah
    Ezatullah Amin, an Afghan national studying at Delhi Technological University, has applied for an ICCR summer camp. He provides his personal details such as name, file number, address, nationality, passport information, and university. He selects Chandigarh as his first choice and Mumbai as his second choice for the summer camp locations. As an ICCR scholar, he will pay the camp fees of Rs. 3,000 by bank draft and is responsible for any medical expenses incurred during the camp. He confirms the accuracy of the information and agrees to maintain discipline and follow instructions during the camp.

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    of 2

    INDIAN COUNCIL FOR CULTURAL RELATIONS

    AZAD BHAVAN, I.P. ESTATE, NEW DELHI – 110002.

    APPLICATION FORM
    (To be submitted by 5th May 2022)

    Note: It is compulsory to fill up all columns neatly in Capital Letters with Postal address as
    well as Tele./Mob. and E-Mail address.

    1. Amin Ezatullah
    Name in Full ______________________________________________________________
    (Surname) (Other name in full)

    2. F.NO SSSAN-36/2019-20
    File No. with Scholarship Scheme _____________________________________________

    3. Sex _______
    MALE (Male/Female)

    4. North Delhi PG, DTU Boy Hostel,


    Postal Address (with pin no.) _________________________________________________

    Main Bawana Road, Rohini Sector 17, PIN-110042


    ________________________________________________________________________

    5. ezatullahamin@gmail.com Tel./Mob. __________________


    E-Mail ____________________________ 9289090379
    6. Nationality ______________
    Afghan Date of Birth ____________
    04/04/1997 P02311270
    Passport No. _____________
    Date & Place of issue _____________________
    20,Jul 2019 Afghanistan Date of first arrival in India to take up
    present course of study _________________________________________
    07 Aug, 2019 Year of
    Study _________________
    2019-2023(4years)

    7. Name of the University/Institute ____________________________________________


    Delhi Technological University
    8. Scholarship Holder/Self-financing, if scholarship holder please state the scheme of
    Indian Council for Culture and Relation (ICCR)
    scholarship. ___________________________________________________________

    9. I wish to join :
    3
    a. First Choice (Sl. No._____) 14 mention serial number of
    b. Second Choice (Sl. No.____)
    the camp in the bracket

    List of Sectors with dates for Summer Camps June 2022


    S.No. SECTORS Dates
    1 Siliguri /Gangtok/ Darjeeling/Kallimpong 2nd - 9th June 2022

    2 Siliguri /Gangtok/ Darjeeling/Kallimpong 4th - 11th June 2022

    3 Chandigarh/Shimla/Chail/Tirthan/Manali 2nd - 9th June 2022

    4 Chandigarh/Shimla/Chail/Tirthan/Manali 4th - 11th June 2022

    5 Chandigarh/Shimla/Chail/Tirthan/Manali 6th - 13th June 2022

    6 Chandigarh/Shimla/Chail/Tirthan/Manali 8th - 15th June 2022

    7 Chandigarh/Shimla/Chail/Tirthan/Manali 10th - 17th June 2022

    8 Corbett/Ranikhet/Kosani/Bhimtal/Mukhteshwar 2nd - 9th June 2022

    9 Corbett/Ranikhet/Kosani/Bhimtal/Mukhteshwar 4th - 11th June 2022

    10 Corbett/Ranikhet/Kosani/Bhimtal/Mukhteshwar 6th - 13th June 2022

    11 Corbett/Ranikhet/Kosani/Bhimtal/Mukhteshwar 8th - 15th June 2022

    12 Corbett/Ranikhet/Kosani/Bhimtal/Mukhteshwar 10th - 17th June 2022

    13 Corbett/Ranikhet/Kosani/Bhimtal/Mukhteshwar 12th - 19th June 2022


    14 Mumbai/Khandala/Pune/Panchghani/Mahabale 2nd - 9th June 2022
    Shwaram

    15 Mumbai/Khandala/Pune/Panchghani/Mahabaleshwar 4th - 11th June 2022


    am

    16 Mumbai/Khandala/Pune/Panchghani/Mahabaleshwar 6th - 13th June 2022


    am

    17 Chandigarh/Amritsar/Dharamshala/Dalhouise/Cham 2nd - 9th June 2022


    ba

    18 Chandigarh/Amritsar/Dharamshala/Dalhouise/Cham 4th - 11th June 2022


    ba

    19 Bangalore/Mysore/Ooty 2nd - 9th June 2022

    20 Bangalore/Mysore/Ooty 4th - 11th June 2022

    10. Have you ever attended any Camp organized by ICCR earlier (Yes/No).

    11. If yes, place visited ________________________________________ year and duration


    from ________________________ to ___________________

    12. (a) I am sending herewith the Summer Camp fee of Rs.3,000/- by Bank Draft, Bank
    Name, _____
    SBI No. _______________
    38755110366 Dated _________________
    04/21/2022 for
    Rs. 3,000/- payable in favour of Director General, ICCR, New Delhi. (for ICCR
    scholars).

    (b) I am sending herewith the Summer Camp fee of Rs.10,000/- by Bank Draft, Bank
    Name, _____ No.
    _______________ Dated _________________ for Rs.10,000/- payable in favour of
    Director General, ICCR, New Delhi. (for self financing scholars).

    13. In case of any expenses during the camp on medical/hospitalization, the same will be
    borne by me (ICCR scholars as well as self financing students).

    14. I hereby confirm that all the information provided by me in this form is correct.

    15. I undertake to maintain discipline, follow all instructions given by the Camp Officer and not
    take any action which will violate the discipline or order of the camp.

    16. No Applications/request for Change of Camp will be entertained after 5th May 2022.

    17. If I fail to abide by the undertaking given by me in para 12, 13, above, I understand that the
    Camp Officer can ask me to leave the Camp immediately, and that in such circumstances I
    will have to make my own arrangements for the return journey.

    (Signature of the student)


    Name of the student ____________________
    Ezatullah Amin

    This is to certify that Mr./Miss/Mrs. _________________________________is a bonafide student


    of ____________________________. (Name of the Institute)

    Signature with seal


    Head of the Institution/ISA

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