Directorate of Students Welfare

Guru Gobind singh Indraprastha University

Sector-16 C,Dwarka, Delhi-110078 Website : http://ipu.ac.in

APPLICATION FORM FOR FINANCIAL ASSISTANCE UNDER EWS SCHEME - 2023-2024

(to be filled in block letters)

PART- I
(Personal Information)
Personal Information
Application ID : 2024001801

CET Roll No./Year : IPU225656/2020

Enrollment Number : 08614802820

University Registration ID. : 08614802820

Name of Student : MD SAADAN ANJUM

Gender : Male

Father's Name : MD MUZAFFAR ALAM

Mother's Name : KAHKASHAN ANJUM

Address : Zeenat Tower,Samanpura,Raza Bazar, Bailey Road,Patna-14

Contact No. : 9304292828 (M)

Name of Programme : B. Tech Curent Semester : VIIIth

Name and Address of Institute : Maharaja Agrasen Institute of Technology, Sector - 22, Rohini, Delhi - 110085

Whether Back Paper in any Semester as on date : No

Whether Admission taken under Management Quota : No

Whether ever Penalized for adopting Unfair means in the Examination of University : No

Admission Category: GNGN (Outside Delhi)

Have you Received Financial Assistance under EWS Scheme from this University in the last Year : No

Proof of Income : Income Certificate issued by SDM Serial No. : BICCO20239774698 Date of Issue : 19/12/2023

Enclosed Copy of Income Certificate

Family Annual Income : Rs. 95000

Bank Account Details (The Bank Account must be in the name of Applicant) :
Bank Account No. *******3758
Name of the Bank STATE BANK OF INDIA
Bank Address SHEIKHPURA,RAZA BAZAR(PATNA)
IFSC Code SBIN0003563
Enclosed Copy of
Cheque or Passbook

Educational Qualifications (including marks of semester examination last appeared)

Sl Qualification Board/University Name & Address of Year of Division %age / Govt. / If admitted through EWS Quota
No: School/College Passing CPI Pvt. (prrof should be attached)
1 10th CBSE GYAN Niketan 2017 1st 10 Private No
Danapur Patna Bihar
2 12th CBSE Holy Mission Senior 2019 2nd 72 Private No
Secondary School
 Danapur Patna Bihar
3 Graduate GGSIPU Maharaja Agrasen institute 2024 1st 84 Private No
of Technology
Rohini Sector-22

PART- II
(Information for assessment of Financial Assisstance)
Remarks of the
committee member
Particulars For Assessment of Economic Condition of Family
at the time of
interview

Details of Father/Guardian/Mother
Father
Name : Md Muzaffar Alam Age : 54
Qualification : Graduate Occupation : Farmer
Name and Address of Employer :NA
Monthly Income : 7917 or If Retired, Monthly Pension (Rs.): NA
Mother
Name : KAHKASHAN ANJUM Age : 40
Qualification : NA Occupation : Housewife
Name and Address of Employer :NA
Monthly Income : NA or If Retired, Monthly Pension (Rs.): NA

Other Details
Details of Health of Family Members : NA
(If any member is patient of critical diseases, mention details and attach medical
report)
Status of family background, income sources and pattern of livelihood : NA

Details of Locality & Accomodation

Name of locality of Accommodation : Samanpura
Nature of accommodation rented or Owned
owned :
Total Plot Area of house (sq. mtr.) : NA
Total Carpet Area of flat/floor (sq. mtr.) : NA
If any floor given on rent? No
Is there any shop in house? No

Details of Property
Agricultural Land NA
(Mention area size and city) :
Any other immovable property of family : NA

Any other relevant information for NA

requirement of financial assistance:

Details of any other ScholarShip/Financial Assistance

NOTE - Applicant may enclose document proof, if any, for justifying their economic condition and financial
requirement of family.
UNDERTAKING

"I hereby declare that the above mentioned information furnished by me is true and correct to the best of my knowledge and
belief. If any information provided in the application form is found incorrect at any stage or if it is found that I had failed in
any one or more of the subject of the University examinations on the last date of submission of application or otherwise was
ineligible to be considered for financial assistance under this scheme, my application may be rejected and amount, if any,
received by me from the University shall be refunded along with penalty, as decided by the University. This is without
prejudice to other disciplinary and other legal measures with the University may take besides the refund of the financial
assistance received.”

________________________________ ________________________________
(Signature of Student) (Signature of Parents/Guardian)
Date : ______________ Date : ______________

CHECK - LIST
Name of Student : MD SAADAN ANJUM University Enrollment No. : 08614802820
Name of Programme : B. Tech Current Semester : VIIIth
Name of Institute : Maharaja Agrasen Institute of Technology, Sector - 22, Rohini, Delhi - 110085

Following documents should be self-attested and attached Along with the application form

1. Income Certificate issued by the Area SDM or other officer authorized in this behalf by the Revenue Department of
the Government. The date mentioned on the Income Certificate should be valid as per the Govt. norms on the
date of issue of the notice of EWS Scheme.

2. Provisional Seat Allotment/ Admission Slip issued by the University at the time of online/ offline admission.

3. Copy of all previous semester’s Mark sheets for which results have been declared
4. Attested copy of 10th & 12th Mark sheet
5. Fee Receipts issued by the institute/University for the current academic year

6. Copy of (CTS 2010 compliant) cancelled cheque and Pass Book of the Saving Bank Account. (Name of student,
Bank account number and IFSC code should be mentioned on the cheque /Pass Book)

7. Affidavit attested by notary as per prescribed format Download Affidavit format

8. Other relevant document for requirement of financial assistance.

(i) Aadhaar Card of Student issued by the UIDAI.
(ii)