ANNEXURE I - NISF SELF-DECLARATION

(To be filled and signed by the applicant)

I am not a recipient of any other scholarship/loan scholarship/educational aid from Central Govt./State
Govt./University or from any other Institution/Agency/Person. If yes, full particulars should be given including
the monthly rate and the date of the award, etc.

List of documents to be attached in:

(1) Nomination by the HoD/Dean/Principal/Director of present College (as per Annexure-II)
(2) Income Certificate/Affidavit (as per Central Govt./State/Govt. issuing Authority)
(3) Mark sheet attested by the HoD/DeanPrincipal/Director of present College
(4) Bonafide certificate issued by the present College
(5) Proof of Address & Nationality (Aadhar) self-attested

I hereby declare that the statements made by me and documents attached in this application form are
true and correct to the best of my knowledge & belief. I am aware that if there are false statements in the
foregoing application, I am liable to be prosecuted under the Indian Penal Code of Forgery as well as any
other panel consequences.

I further agree to abide by the terms and conditions of the NASA India Scholarship Funds. The entire amount
of the Scholarship can be recovered in a lump sum from me in case the above information is found fully or
partially incorrect.

Signature of the Student Date & Place