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

AIKYASHREE (FRESH)
APPLICATION FOR WB TSP SCHOLARSHIP 2022-23
Application ID: SSP2022040101515844 Application Date:14-09-2022
BASIC INFORMATION
Student's Name: JESMIN KHATUN Father's Name: KHOKAN ALI
Date of Birth: 19-05-2005 Mother's Name: AJEMA BIBI
Gender: Female Annual Family Income: 60000
Marital Status: Unmarried Guardian's / Husband's Name: KHOKAN ALI
E-mail Id: karanswarnakar955@gmail.com Religion: Muslim
Mobile No: 9836212139 Aadhar No : XXXXXXXX3987
Bangla shiksha ID: 09946419001198

ADDRESS INFORMATION
Permanent Address Present Address
Domicile State: WEST BENGAL State: WEST BENGAL
Domicile District: NORTH 24 PARGANAS District:NORTH 24 PARGANAS
Block/Municipality:Madhyamgram(MUNICIPALITY) Block/ Municipality:Madhyamgram(MUNICIPALITY)
Permanent Address: GANGANAGAR, SCOUT PARA
Present Address: GANGANAGAR, SCOUT PARA
Post Office: GANGANAGAR
Post Office: GANGANAGAR
Police Station: AIRPORT
Pin: 700132 Police Station: AIRPORT
Pin: 700132

ACADEMIC INFORMATION
Previous Academic Information Present Academic Information
Previous Institute Name: GANGANAGAR BEHARILAL Institution District :NORTH 24 PARGANAS
GHOSH VIDYPITH Institution Name: GANGANAGAR BEHARILAL GHOSH VIDYPITH
Previous Class / Course Name: X Current Class / Course Name : XI
Previous Year of Study: X
Current year of Study :XI
Name of the Board of
Are you a Hosteller: No
last Exam Passed: West Bengal Board of Secondary
Education Name of the Board / Council / University : West Bengal council of
Year of Passing Last Exam: 2022 Higher Secondary Education
% of Marks Obtained Course Duration : 1 Year
in Last Examination: 36.28
BANK ACCOUNT DETAILS
IFSC: IDIB000G525
Savings bank account no.: XXXXXXX4529
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.60000 . 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 JESMIN KHATUN 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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