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 (RENEW)
APPLICATION FOR WB SVMCM SCHOLARSHIP 2023-24
Application ID: SSP2022051000505696 Application Date: 18-10-2023
BASIC INFORMATION
Student's Name: SAIFULLA MONDAL Father's Name: HABIBULLA MONDAL
Date of Birth: 28-06-2006 Mother's Name: SNEHAR MONDAL
Gender: Male Annual Family Income: 60000
Marital Status: Unmarried Guardian's / Husband's Name: HABIBULLA MONDAL
E-mail Id: saifullam591@gmail.com Religion: Muslim
Mobile No: 9339681570 Aadhar No: XXXXXXXX9744
Class X Registration No: F1331-00307Bangla Name as per Aadhaar: Saifulla Mondal
shiksha ID: 05794921000983
ADDRESS INFORMATION
Permanent Address Present Address
Domicile State: WEST BENGAL State: WEST BENGAL
Domicile District: NADIA District:NADIA
Block/Municipality:Hanskhali(BLOCK) Block/ Municipality:Hanskhali(BLOCK)
Permanent Address: VILL - MURAGACHHA
Present Address: VILL - BARAMURAGACHA
Post Office: BAGULA
Post Office: BAGULA
Police Station: HANSKHALI
Pin: 741502 Police Station: HANSKHALI
Pin: 741502
ACADEMIC INFORMATION
Previous Academic Information Present Academic Information
Previous Institute Name: Furfura Fatehia Senior Institution District :HOOGHLY
Madrasah Institution Name: Furfura Fatehia Senior Madrasah
Previous Class / Course Name: XI Current Class / Course Name : XII
Previous Year of Study: XI
Current year of Study :XII
Name of the Board of
Are you a Hosteller: Yes
last Exam Passed: West Bengal Board of Madarsa
Education Hostel Name:FURFURA FATEHIA SENIOR MADRASAH SOCIETY
Year of Passing Last Exam: 2023 HOSTEL
% of Marks Obtained Name of the Board / Council / University : West Bengal Board of
in Last Examination: 60.00 Madarsa Education
Course Duration : 1 Year
BANK ACCOUNT DETAILS
IFSC: BKID0004294
Savings bank account no.: XXXXXXXX1823
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.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 SAIFULLA MONDAL 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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