FO

RM

F-3

CENTRAL BOARD OF SECONDARY EDUCATION MERIT SCHOLARSHIP SCHEME FOR

UNDERGRADUATE STUDIES[For single girl children who have passed Class XII from CBSE in May 2009

(Please see attached instructions)

Registration No.(To be filled by CBSE

1.Name of applicant (as per XII certificate) Date of Birth (DD/MM/YYYY)

…../…./…………XII Roll No.

2.

Mother’s name ……………………………. Address for correspondence Year of Passing class XII(First five subjects)

Marks obtained……. Out of 500 Name of the Board(CBSE/ICSCE/STATE BOARD) (Tick)

3.Father’s name ……………………………. % age

-----------------------

4.

No. of Brothers-----------(excluding you)

No. of Sisters ----------------(excluding you)

State Pin code Sex (Tick)

Male Femalecategory: GEN/OBC/SC/ST/PH (Tick)

5. Email Address____________________________(STD code of city)……………. Phone Number (…………………… ) Mobile No. (……………………..)

6. Particulars of Savings Bank Account (Mandatory; Application will be rejected if all the columns are not filled)

a)Account Number (of applicant only)

b)Name of the Bank & Address (City and State)

c)Bank Code Number

d)MICR Code

e)RTGS:NEFT:IFSC Code (11 digit Code of the Bank)

7.

Name and Address of present College/Inst. Where admitted for Undergraduate Studies

…………………………………………………………………………………………District…………..State……………(Is the Institution affiliated with UGC/AICTE/Central/State Govt./private etc.) Yes/No (Tick)

8.Name of Course

---------------------------------Duration of Course ____________years

9.

Enclosure attached

1. Copy of mark sheet Yes/No 2. Affidavit duly sworn in before the First Class Judicial Magistrate/SDM/Executive Magistrate, as per prescribed format Yes/No(Send fresh original affidavit even if already sent for SGC(X) Scholarship)NOTE: NOTARY ATTESTED AFFIDAVIT WOULD NOT BE ACCEPTED.

10. Signature of Applicant*--------------------------------------------------- DATE --------------------------

11.

Recent Color Photograph of the Applicant attested and stamped by

Principal of School/Institution where student is

presently studying

The facts stated above including fee by the applicant are hereby certified to be true and correct. The character and good conduct of the applicant are also certified.

Signature of Principal ----------------------------- Name/Designation---------------------------------- Name of Inst. --------------------------------------- Tel & Mobile No.---------------------------------- Email ID-------------------------------------------- Affiliation No. Institution------------------------- Seal--------------------------------------------------

12 CBSE Ref. No. ---------------

Instructions for filling form F (3)

CBSE Single Girl Child Merit Scholarship Scheme for Under-graduate studies

Eligibility:

All conditions are required to be fulfilled by the applicant.(i)The applicant should be an Indian national.and(ii) The applicant should be a single Girl child and(iii) The applicant should be the only child of her parent.And(ii) Applicant should be a student of CBSE Board in class XIIand(iii) scored 60% or more marks in Class XII, 2009 examinations conducted by the CBSEand(iv) Currently Pursuing under graduate course (non-medical/non-engineering) in any Central/State Government University or those recognized by UGC/AICTE

No. of Scholarships : 550 only

Value per month:  Rs.500/-

Duration: Three years (to be renewed subject to eligibility)

Signature:

All the applications must be signed by the applicant. Unsigned applications will be rejected.

Attestation:

All the applications must be certified by the Principal of the present Institution where the admission has been obtained along with his/her signature and stamp.

Bank Account Details:Applicants should write their Bank Account number with detailed address of the Bank along with the Bank Code, MICR Code and RTGS/NEFT code of the Bank. Applicant should open Bank Account in their name only. Scholarships will be sent by ECS mode directly to Bank Account of the selected candidates. In case the Bank details as mentioned above are not complete and in prescribed format the application will be rejected.

Documents to be sent with the Application:

1. F-3 Form, and an attested copy of 12th class mark sheet.2. An affidavit from the parent that the candidate is the only child of her parents on a non-judicial stamp paper of Rs.10/- duly

sworn in before First class Judicial Magistrate/SDM/Executive Magistrate should be submitted along with the application. Applications with Affidavit attested by Notary will be rejected summarily and no correspondence will be entertained in this regard.

3. An additional photograph mentioning the name of student and name of father/mother on its back should be sent with Application form. It should be stapled on a Plain paper and pinned with the application form.

Where to send the Applications

The duly filled in proforma be sent in an envelope super scribing “Application for UG SCHOLARSHIP-F-3” to the “Dy. Secretary(A&V), CBSE, Shiksha Kendra, 2 Community Centre, Preet Vihar, Delhi-110092” by Regd Post.

Change in Address

Any change in address must be immediately reported to “Dy. Secretary(A&V), CBSE, Shiksha Kendra, 2 Community Centre, Preet Vihar, Delhi-110092”

Last Date of Receipt of Application: 30th September, 2009

FORMAT OF AFFIDAVIT

(ON NON-JUDICIAL STAMP PAPER OF RS.10/- SWORN BEFORE I CLASS JUDICIAL MAGISTRATE/SDM/EXECUTIVE MAGISTRATE)

I ___________________ s/o,d/o _____________ r/o __________________ do hereby solemnly affirm and declare as under:-

1) That _____________________ is my only one daughter and her date of birth is ______________________.

2) That I am the father/mother and Ms. ____________________ is my only daughter.

3) That I have no other child except my above named daughter.

DEPONENT

VERIFICATION

VERIFIED AT ON THIS ______________ DAY OF ____________ AND THE CONTENT OF THIS AFFIDAVIT ARE TRUE AND CORRECT AND NOTHING MATERIAL HAS BEEN CONCEALED.

DEPONENT

(Strike off whichever is not applicable)