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 SVMCM SCHOLARSHIP 2023-24
Application ID: SSP2023050801448397 Application Date: 26-09-2023
BASIC INFORMATION
Student's Name: BASIR MOLLA Father's Name: AJMAT MOLLA
Date of Birth: 17-01-2006 Mother's Name: SARIFA BIBI
Gender: Male Annual Family Income: 48000
Marital Status: Unmarried Guardian's / Husband's Name: AJMAT MOLLA
E-mail Id: basirmolla336@gmail.com Religion: Muslim
Mobile No: 8509465880 Aadhar No XXXXXXXX1563
Class X Registration No: 3201-066519 Name as per Aadhaar: BASIR MOLLA
ADDRESS INFORMATION
Permanent Address Present Address
Domicile State: WEST BENGAL State: WEST BENGAL
Domicile District: BIRBHUM District:BIRBHUM
Block/Municipality:Dubrajpur(BLOCK) Block/ Municipality:Dubrajpur(BLOCK)
Permanent Address: PACHHIARA Present Address: PACHHIARA
Post Office: PACHHIARA Post Office: PACHHIARA
Police Station: DUBRAJPUR Police Station: DUBRAJPUR
Pin: 731124 Pin: 731124
ACADEMIC INFORMATION
Previous Academic Information Present Academic Information
Previous Institute Name: HETAMPUR RAJ HIGH SCHOOL Institution District :BIRBHUM
Previous Class / Course Name: XII Institution Name: KRISHNA CHANDRA COLLEGE HETAMPUR
Previous Year of Study: XII Institution UDISE/AISHE/NCVT Code : C-44739
Name of the Board of Current Class / Course Name : BACHELOR OF ARTS (B.A)
last Exam Passed: West Bengal council of Higher Secondary Current year of Study :1st Year
Education Are you a Hosteller: No
Year of Passing Last Exam: 2023 Name of the Board / Council / University : BURDWAN UNIVERISITY
% of Marks Obtained Course Duration : 4 Year
in Last Examination: 88.60
BANK ACCOUNT DETAILS
IFSC: CNRB0001713
Savings bank account no.: XXXXXXX1400
Name as per bank Account: BASIR MOLLA (Self)
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(one-student-one-
scholarship).NB:The application of student applying for more than one scholarship application/scheme is liable to be rejected.

___________________
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 BASIR MOLLA 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 within 7 days:

1. Photocopy of the bank-passbook where the details of bank a/c number,IFSC are mentioned clearly.

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