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 Annexure A
Application Form for Internet Allowance
1. Name of Student:

2. Father's Name:

3. Mother's Name:

4. Class:

5. Course:

6. Date of Birth of
student
7. Mobile Number of
Student
8. Email Address of student:

9. Mobile Number of Parent:

10. Address of the student:

Gali/street No.. Village/town.. Tehsil.
District. .state..
11. (A) Is student resident of Punjab (YES/NO)
(B) If yes proof of residence (attach copy of Proof

(C) Adhaar Card No.:

11. Name of college:

12. Tehsil in which college is situated:

13. District in which college is situated

14. Bank Details of Student:

a. Name of Bank:

b. Account Number:

c. IFS Code:

Declaration by Student:

Studying in.. .Colege, District...hereby do

, S/D/0.
above is true and correct and that I am eligible for
undertake that the information as provided
for all legal and financial consequences, in
case

theInternet allowance. shall be responsible

I
to be incorrect.
information given above is found
Signatures of Student
Date:

Certificate by Principal"
the student are correct 1s
that all the tacts a> given above by
I have verified and satisfied nyself
student of iny institutio
also certify that the student is regular
per the record. I
 Date:

Signatures of Principal
Name of Principal

Mobile No:

Email:
Note:

#In case the student is studying in University Campus then the

mentioned. name of University to be

## In case of students of University Campus, the certificate

is to be
signed by Dean (Academic)

N
 ANNEXURE
S.No Name Name Father'sClass Roll MobileBank IFSCBank/ Aadhar
of the of the
name No No A/c Code Branch No
institute student No Name