NATIONAL INSTITUTE OF TECHNOLOGY KARNATAKA, SURATHKAL

MANGALORE 575025, INDIA

SC-ST CELL

Application for Academic Year 2022-23

SC ST
Financial Assistance for UG /PG / Ph. D SC/ST students

1. Name of the Candidate : ____________________________________________________________________________________________________

(Block letters as entered in Institutional Records)

2. Name of the Parent/Guardian : _____________________________________________________________________________________________________

3. Sex : M / F

4. Details : Year of Admission_____________________Roll No.__________________________________________________

Course____________________________ Branch _______________________________________________________

Mess Roll No._______________________________Hostel Block________________________________________

5.Family Income : Rs._________________________________________________________________________________________________

6. Bank Account Details : Name of the Bank__________________________ Branch Name _____________________________________

Account No. ______________________________________________________________________________________

IFSC Code: ________________________________________________________________________________________

7. Mobile No.:_________________________________Email ID:______________________________________________________________________________________

8.

Hostel Fees Book Allowances Laptop CGPA (for API)

(Rs.) (Rs.) (Rs.)

Total:

The details furnished above are true and correct to the best of my knowledge.

Date: Signature of the Candidate

_________________________
Dealing Clerk
Enclosure Xerox copies of
Caste Certificate and Income Certificate (Valid)
Bank Pass Book Copy (SBI or Canara Bank Only)
Grade Card of previous year (for 1st yr. Students no need)
Original Hostel fee receipt, Book bills & Laptop bill
Aadhaar Card (copy compulsory)
 NATIONAL INSTITUTE OF TECHNOLOGY KARNATAKA, SURATHKAL
MANGALORE 575025, INDIA
SC-ST CELL

UNDERTAKING

Mr./Mrs………………………………………Roll No…………………….……programme…………………………

Department…………………………….…….……student of National Institute of Technology Karnataka,

Surathkal do hereby undertake on this day…………month……….…year……..……, that I shall abide

by the admissible rules and regulations of NITK, Surathkal and will not claim reimbursement of

Financial Assistance/Scholarship in any form from any other sources. I acknowledge that the

institute has the authority of taking disciplinary action on me for non-compliance of the same.

………………………………………………………………

Signature of the candidate with date