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RecentPhotographOf Student
(Write your name &ESM/widow
particular onreverse)
Selection Serial Number (To be allotted by KSB) ......................
APPLICATION FOR PRIME MINISTERS SCHOLARSHIP FOR THE YEAR 200_ - ___.
Note: 1.) Please read column wise guide lines carefully before filing the application 2.) Application Form to be filled in Capital letters except email ID.3.) Checklist must be attached on the top of application duly tick marked.4.) One candidate to submit only one application form for one course.
1. NAME:- First Name
Middle Name
Surname
2. Put a tick mark ()
3. Date of Birth (please attach proof of age) (i.e : Matriculation certificate)DD MM Y Y Y Y
4. Your Rajya Sainik Board or Zila Sainik Board (Where ESM is registered and obtained Ex-servicemen Identity card)RSB
ZSB
5. Full Address: a) Present Correspondence Address: - (Where you want your letter to be sent in case of selection / rejection )
LEAVE BLANK SPACE BETWEEN WORDS
Male Female
House No.
Street No. & Name
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b) Permanent Address :-
6. Telephone Number.
STD Code
Land Line No.
Mobile No.
E-Mail (mandatory)
7. Ex-servicemen Category - (Mention category as per Para 6 of the brochure and attachsupporting documents duly attested).
LEAVE BLANK SPACE BETWEEN WORDS
Tehsil
District
State
Pin Code
House No.
Street No. & Name
Tehsil
District
State
Pin Code
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8. Ex-servicemans Particulars:-
a) Name of ex-serviceman
b) Service No.
c) Rank
d) Type of Service (Tick one) Army Air Force Navy
9. Details of MEQ / course for qualifying examination for scholarship (10+2/equivalent orminimum entry qualification)
a. Name of Course/MEQ
b. Year in which exam passed
c. Total Marks (in words)
(in figure)
d. Marks obtained (in words)
(in figure)
e. % of marks scored (in words)
(in figure)
10. Whether the applicant is in receipt of any other financial assistance/scholarship/ fellowship from anygovt. / Private source for the course to which the scholarship applied for. If yes, then state the amount andsource
Yes No
Amount
Source
11. Name of the Course(as per specimen)
LEAVE BLANK SPACE BETWEEN WORDS
12. Duration of Course in Years in figureand months
in words
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13. Date of Commencement and Approximate Date of Completion.
D D M M Y Y Y Ya) Course commenced on
D D M M Y Y Y Y b) Course completion date
approximately
14. Details of College / Institute .
Name of Student
Roll No.
Name of College
Full Addressof college
State
Pin Code
Tel No. (withSTD Code)
E-Mail ID (if any)
College Website
15. Regulatory bodies/ Council. (For example all engineering degrees and management degreecourses are recognized by AICTE & UGC and all medical degree are recognized by Medical Councilof India or Dental Council of India, specify as per case).
16. Furnish particulars of all children in order of age, as reflected in the discharge certificate orattached by the RSB/ZSB/Record Office.
LEAVE BLANK SPACE BETWEEN WORDS
Sl. No. Name of Child Gender Date of Birth
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17. Details of brother/sister availing the PMs Scholarship, if any. (Including yourself if grantedearlier)
Sl.No.
Selection SerialNo. given by
KSB
Name of thebrother/sister
Course ofStudy
Academic yearin which applied
Amoureceived s
18. Details of Students Bank account for payment of Scholarship through Electronic ClearingService.
Name of account holder
Bank Name
Branch Name
Branch Address
State
Bank Tel. No.
Branch Code
MICR (9 digit) No.
(PLEASE ATTACH A PHOTOCOPY OF CHEQUE & PASS BOOK)
Account No.
REPEAT
Account No.
LEAVE BLANK SPACE BETWEEN WORDS
19. Details of Demand Draft.Issue D D M M Y Y Y
YDemand Draft No. Date
Amount (Rs.) in figure
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Amount (Rs.) in word
Issuing Bank Name
Issuing Bank Branch
20. Declaration: Certified that the particulars given by me in the application are correct and
any false statement made by us will disqualify me / my ward for award of PMs ScholarshipScheme, besides recovery of scholarship already paid. I also undertake to abide by theconditions mentioned in the general instructions of the scheme.
Place: (Signature of ward) ________________________
Date: (Full Name of Ward) _______________________
Place: (Signature of Parent) _______________________
Date: (Full Name of Parent) ______________________
CERTIFICATE FROM RSB / ZSB
It is certified that PM Scholarship application form for academic year 20___ - ___
in respect of Mr./Ms. __________________________________________ _________
_______S/o / D/o Ex -____________________________________________________
has been checked, found correct as per check list provided by KSB and the applicant is
eligible to apply as per rules of the scheme.
Office seal: Director, RSB / ZSB
Place : ________________
Date : ________________
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SPECIMEN COPY OF BONAFIDE CERTIFICATE
CERTIFICATE FOR PM SCHOLARSHIP
1. It is certified that Ms. / Mr ._____________________ is Bonafide student of
__________________________________ college. His / Her roll number is __________
and he / she is studying in the I / II / III / IV / V year or ______ semester of the One / Two /
Three / Four / five years _______________ course in ____________________ branch (if
any). He / she has joined this college in the academic year 20___ - ___ and the course
will be completed in the month of ___________ 20___ -___.
2. This is also certified that _____________ course is a professional degree course
and this college is approved by _______________ ____ __________________ __ __ _ .
3. This is also certified that student is getting Rs.__________________ (If not getting
write N/A) stipend from this Institute / College or any other sources. l
Office Seal: Signature of Principal / Dean / Registrar
Date:- ______________
Place:-_____________
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SPECIMEN COPY OF EX-SERVICEMEN CERTIFICATEEX-SERVICEMEN CERTIFICATE
(In lieu of Discharge Book)
1. Type of Service (Army, Navy or Air Force) : _______________________________________
2. Service No. : _______________________________________
3. Rank : _______________________________________
4. Name & Initials : _______________________________________ 5. Trade : _______________________________________
6. Date of enrolment : _______________________________________
7. Date of Discharge : _______________________________________
8. Reason for Discharge : _______________________________________
9. Duration/Length of Service : _______________________________________
10. Regular : _______________________________________ Reserve
11. ESM died on (if applicable) : _______________________________________
12. Cause of death & : _______________________________________ Whether Attributable
13. Particulars of dependent children:- Sl. No. Name Gender Date of Birth
1.2.3.4.5.6.
It is certified that the above information is duly checked from the discharge book of Ex-servicemenand found to be correct.
Office Seal: Dir RSB/ZSB/OI/C Record Office
Date: ________________________
Place: ______________________
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PRIME MINISTERS SCHOLARSHIP SCHEME ACKNOWLEDGEMENT SLIP
OFFICE COPY
Your Renewal form dated_________ has been received on__________. The
application will be examined for eligibility. The dak receipt number ____________ is to
be mentioned for further correspondence with this office.
Office Seal: (Signature of RSB)
Tear off Tear off
ACKNOWLEDGEMENT SLIP
STUDENT COPY
Your Renewal form dated_________ has been received on__________. The
application will be examined for eligibility. The dak receipt number ____________ is to
be mentioned for further correspondence with this office.
Office Seal: (Signature of RSB)
Note: This copy duly stamped and signed by RSB given to the student by hand or bypost.
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Selection Serial Number......................
PROFORMA FOR RENEWAL OF SCHOLARSHI P UNDER PRI ME MI NI STERSSCHOLARSHI P SCHEME
(To be send only if selected for scholarship)1. Name of the applicant (Ward/widow):
2. Selection serial No. given by KSB:
3. Particular of ESM:
4. Present address (where you want your letter is to be sent)(To be filled up only in case of change from previous address or write N / A)
5. Details of Bank account of SBI or PNB for Electronic Clearing Services ((PLEASE ATTACH APHOTOCOPY OF PASS BOOK, CROSSED BLANK CHEQUE SHOWING YOUR ACCOUNT NUMBER TO BE FORWARDED, EVEN IT IS SUBMITTED EARLIER).
Place: ________________________________ Date: Full Name & Signature of the ward / widowIt is certify that the information submitted by my child / Self is correct.
Place : _____________________________
Date : Full Name & Signature of the ParentLEAVE BLANK SPACE BETWEEN WORDS
Name of ESM
Rank Service Number
House No.
Street No. & Name
Tehsil & Post
DisttRSB
Pin Code
Name of account holderand account number
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SPECIMEN COPY OF BONAFIDE CERTIFICATE FOR RENEWAL
CERTIFICATE FOR RENEWAL OF PM SCHOLARSHIP
1. It Is certified that Ms. / Mr ._____________________ is a Bonafide student of
__________________________________ college. His / Her roll number is __________
and he / she is studying in the I / II / III / IV / V year or ______ semester of the two / three
/ four / five years _______________ course in ____________________ branch (if any).
He / she had joined this college in the academic year 20___ - ___ and the course will be
completed in the month of ____________ 20___ - ___.
2. This is also certified that Ms. / Mr. ___________________________
__________ has successfully completed his / her 1 st / 2 nd / 3 rd / 4 th / 5 th year and scored
________ % / Grade__________ (Total marks obtained were _____________ out of
____________) and he / she is continuing the course in 2 nd / 3 rd / 4 th / 5 th year .
Office Seal:
Signature of Principal / Dean / Registrar
Date: ________________
Place: _______________
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CHECKLIST FOR RENEWAL OF SCHOLARSHIPDOCUMENTS TO BE ATTACHED:
(a) A Bonafide certificate from the College/Institute indicating that the candidatecontinues to study in the subject course and showing his / her percentage of marksfor which the Prime Ministers Scholarship has been sought (As per the specimenattach).
(b) Candidate to attach a self addressed envelope, duly stamped to receive theacknowledgement of renewal form by post.
________________________________
Full Name & Signature of the Candidate
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PRIME MINISTERS SCHOLARSHIP SCHEME
ACKNOWLEDGEMENT SLIP
OFFICE COPY
Your Application Form dated_________ has been received on__________. The
application will be examined for eligibility. The dak receipt number ____________ is to
be mentioned for further correspondence with this office.
Office Seal: (Signature of RSB)
Tear off Tear off
ACKNOWLEDGEMENT SLIP
STUDENT COPY
Your Application Form dated_________ has been received on__________. The
application will be examined for eligibility. The dak receipt number ____________ is to
be mentioned for further correspondence with this office.
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Office Seal: (Signature of RSB)
Note: This copy duly stamped and signed by RSB given to the student by hand or bypost. (Envelope enclosed along with the application may be used.)
MINISTRY OF DEFENCE Department of Ex-Servicemen Welfare
PMS SCHOLARSHIP SCHEME
FORDEPENDENT WARDS OF EX-SERVICEMEN /
WIDOWS
Brochure-Cum-Application Form For Academic Year 2009-10
Application Form consists of Col No 1 to 20, Renewal Form and list of RSB at stateand UT level. (Brochure-Cum-Application consists of 31 pages)
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KENDRIYA SAINIK BOARDWest Block-IV, Wing-VII, 2 nd Floor
R K Puram, New Delhi-110066Website: www.mod.nic.in
Tele : 011- 26715250E-Mail : [email protected]
Note: This application form (page number 13 to 22 alongwith required documentsonly) is to be deposited by individual to RSB. Applications dulyrecommended by RSBs shall only be considered by KSB. Therefore,candidates are advised not to forward applications direct to KSB as the sameshall not be considered.
PRIME MINISTERS SCHOLARSHIP SCHEME
1. Introduction.
To encourage higher technical and professional education for the dependent wardsof ESM and their widows (below officer rank only) and dependent wards / widowsof ex-servicemen who died in harness due to causes attributed to military service,irrespective of the rank, Prime Ministers Scholarship Scheme has been introducedfrom the Academic year 2006-07.
2. Scholarships Available.
A total number of 4000 scholarships will be allotted.
3. Students eligible for the scholarship.
(a) Dependent wards of ex-servicemen and their widows (below officer rankonly)
(b) Dependent Wards/widows of ex-servicemen who died in harness due tocauses attributed to military service, irrespective of the rank.
(c) The scheme is open only for widows and wards of ESM.
Note: (i) The candidate irrespective of his marital status is eligible for PMSS.However, an earning / serving candidate is not eligible.
(ii) For dependent wards of widows and widows of personnel died inharness due to causes attributable as at (b), there will be no rank restriction.
4. How to Apply For Scholarship.
One candidate to submit only one application form for one course, if anycandidate submit two application for more than one course, both the
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applications will be rejected. Forms are to be downloaded from the websitewww.mod.nic.in . Application forwarded on any other format will not be considered.
Application to be forwarded on plain A4 size paper (typed or handwritten) in theprescribed format duly completed in all respects with superscription on theenvelope Prime Ministers Scholarship Scheme.
Documents to be attached alongwith PMSS application form are as follows:-
(a) Photocopy of ESM valid I card duly certified by RSB / ZSB.
(b) Extract of ESM discharge book as per specimen. (Refer page number 22)
(c) Matriculation certificate duly attested.
(d) Minimum Entry Qualification certificate duly attested. (10+2 Marksheet or
full Graduation Marksheet which ever is applicable)
(e) Bonafide studentship certificate from Collage in original as per specimen.
(Refer page number 21)
(f) Demand Draft of Rs. 30/- not made before 20 th December 2009.
Note: Failure to attach any above mentioned documents / certificate will lead torejection.
5. Selection Procedure.
Applications will be short listed based on Ex-servicemen category (as given in para6) and percentage of marks obtained in minimum entry qualification (MEQ).
6. PRIORITY for Grant of Scholarship.
Order of preference for allotment of scholarships will be as under:-
Category 1 Wards/ widows of defence personnel killed in action.
Category 2 Wards of ex-servicemen disabled in action and boarded out ofservice with disability attributable to military service.
Category 3 Wards/widows of defence personnel who died while in servicefor causes attributable to military service.
Category 4 Wards/widows of Defence personnel disabled in service withdisability attributable to military service.
Category 5 Wards of ex-servicemen in receipt of gallantry awards.
Category 6 Wards of ex-servicemen (PBOR).
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7. Eligible Courses.
First year professional degree programme in BE, B Tech, BDS, MBBS, B Ed,BBA, BCA, B Pharma, etc. duly recognized by the respective governmentregulatory bodies, such as All India Council for Technical Education, MedicalCouncil of India, UGC etc. The scheme is open for courses mentioned above inrecognized institutions (in India only). Students studying abroad are not eligiblefor this scheme. Students getting stipend for the professional degree course arealso not entitled. The candidates may avail only one time facility for firstdegree course (Professional) i.e. graduate level only under PMSS.
8. Scholarship for Integrated Courses.
The facility under PMSS is restricted for professional courses only duly recognizedby the respective Government regulatory bodies such as All India Council forTechnical Education, Medical Council of India etc.
9. Minimum Eligible Marks in 10+2 or Graduation.
(Minimum Educational Qualification for Entry) should be 60%. Minimum educational qualification (MEQ) for entry to different professional courseis different e.g. for MBBS and B E it is 10+2 where as it is graduation for B Ed andMBA. A candidate must have minimum 60% marks in MEQ to be considered forscholarship.
10. Duration of Scholarship.
Two to five years as approved by the concerned regulatory body (Except one yearfor B Ed and five and half years for MBBS).
11. Amount of Scholarship.
a) The amount of scholarship would be as follows:
(i) Rs. 1250/- per month for boys Paid after successful completion ofeach
academic year. (ii) Rs. 1500/- per month for girls
12. Renewal of Scholarship.
Candidate shall submit new Renewal Form along with two acknowledgement slipand Bonafide Certificate duly signed by the Principal / Dean / Registrar of theinstitution / college to the respective RSBs either in person or by post for renewalof scholarship for the subsequent academic year. RSBs will scrutinize and checkthe application forms and forward the same complete in all aspects to KSBimmediately. RSBs will issue acknowledgement slip to the candidates at the timeof submission of the application in person otherwise dispatch by post to them.Candidate to attach a self addressed envelope, duly stamped to receive theacknowledgement of renewal form by post. For easy comprehension anillustration has been given below:-
Student admitted in B Tech. Se tember 2008
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Incomplete form / pages / column / documents will lead to rejection orreturned to RSB unactioned.
* Dates given above are to illustrate an example for easy comprehension and thesame may not be quoted as authority.
IMPORTANT INSTRUCTIONS FOR PMS SCHOLARSHIP SCHEME
(a) PM SCHOLARSHIP SCHEME is to be written in superscript on top
of the Envelope for any correspondence with KSB & RSB.(b) Checklist duly signed by student & parent is to be attached on the top ofthe application form.
(c) Applications alongwith relevant documents & certificates are to be depositedto respective Rajya Sainik Board, latest by 15 th Feb 2010 . Incompleteapplication form and non submission of required document is liable to berejected and will be returned unactioned . The application will be received by theRSBs and will be acknowledged with a seal and date of receipt.
(d) The concerned RSBs may scrutinise / check the application forms withregard to their eligibility criteria from all aspects prior to forward the same toKSB.
(e) Candidates and RSBs to note that all applications received after thedue date will not be considered and returned unactioned.
(f) List of selected candidates will be forwarded to RSBs after the meritlist is finalized by the BOO at KSB .
Marks in 10+2. 61%Applied for PMSS. Before 31 December 2009Finds his name in the list of 4000 successful candidatesselected for grant of PMSS.
June 2009
Applied for first renewal of Scholarship by submitting firstyear / first two semester result.
October 2009
Granted first installment. December 2009
Applied for second renewal of Scholarship by submittingsecond year / second two semester result.
October 2010
Granted second installment. December 2010Applied for third renewal of Scholarship by submittingthird year / third two semester result.
October 2011
Granted third installment. December 2011Applied for fourth renewal of Scholarship by submittingfourth year / fourth two semester result.
October 2012
Granted fourth installment. December 2012
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(g) Three stamped (Rs. 5 each) blank envelopes of 27x12 cms and onestamped (Rs. 35) blank envelope of 35x25 cms are to be attached with eachapplication so as to facilitate correspondence with the candidate by KSB/RSB.
(h) The scholarship is admissible for only two children of ESM . Particularsof all children should be indicated in column 17 of application form. This should bein uniformity with the discharge book / certificate of the ESM.
(i) The amount of scholarship, including any other scholarship or financialassistance from any other source will not exceed the total grant of assistanceavailable under this scheme.
(j) The payment of scholarship will be granted after the successful completionof each academic year and on the submission of the renewal form (in original), asper the percentages mentioned in Criteria for eligibility. In case, KSB ask astudent to submit the mark sheet for the full year, a student is liable to produce thesame, failing which the scholarship will be held up.
(k) Candidature of a student shall stand automatically rejected if, at any
stage, it is discovered that he / she has secured scholarship fraudulently bymaking false statement or misrepresentation of facts. Candidate shall haveto refund the amount already given, if any.
(l) The attached photocopies of the supporting documents should be dulyattested by gazetted officer (unattested documents will not be considered) . Incase of legally adopted son/daughter or child born after retirement, the certificatesare to be attached with the application form duly attested by Secretary, RSB / ZSB.
(m) If the marks in the qualifying examination are expressed in grades only, then
equivalent percentage (100 point scale) duly certified by the concerned college / Board must be furnished (RSB & KSB will not be calculating the percentage ofmarks).
(n) All candidates to open individual bank accounts in the nearest State Bankof India branch or Punjab National Bank which has electronic clearancesystem / Core Banking, to facilitate transfer of the scholarship amount . Accountnumber of the sister concern bank will not be accepted. i.e State Bank ofTravancore, State Bank of Bikaner & Jaipur, etc . Candidate to attach a attestedphotocopy of passbook, showing name and account number of the individual. Acancelled leaflet of a blank crossed cheque will duly authenticate the account
number. A joint account with parent will also fulfill the requirement .
(o) The candidates should have secured a minimum of 60% marks at 10+2 / MEQ level or equivalent and have to secure minimum of 50% marks,uninterrupted for continuation of scholarship in every year for the duration ofcourse up to a maximum period of 5 years as prescribed for that programme ofstudy. A person granted scholarship for one programme would not be entitled forscholarship for another programme.
(p) In case of change of any address, course, college, it is to be intimatedimmediately to Kendriya Sainik Board & Rajya Sainik Board in writing. Always
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mention selection serial number, name of applicant and ESM particular for anycorrespondence with KSB & RSB after getting selected for the scholarship.
(q) The Ministry of Defence, Government of India can suitably modifythese instructions to remove anomalies, if any, for successfulimplementation of the scheme, as may be necessary from time to time andwill be applicable to all students under the scheme.
(r) Ex-servicemen entitlement will be governed as per the existing definition ofex-servicemen, as amended from time to time. The definition is available in theguide book available with the RSB/ZSB.
(s) The application form should be downloaded from the official website ofMOD, i.e. www.mod.nic.in . The application form should be submitted to therespective Rajya Sainik Board, (List of RSBs is attached along with thebrochure) duly completed, along with a Demand Draft ( Repeat ) Demand Draftonly for Rs.30/- in favour of Secretary, Kendriya Sainik Board , payable at NewDelhi. In case of any difficulty in obtaining the form, the same can be obtained
from the Secretary / Director Rajya Sainik Board. The Demand Draft should notbe issued before 20 th December 2009 (the Demand Draft is not refundable inany case).
(t) While filling the application form, leave 1 (one) box blank between 2 (Two)words. Column wise guidelines are explained further for filling up the applicationform.
COLUMN WISE GUIDE LINES FOR FILLING UP OF APPLICATION FORM
(i) Column -1. Fill your name as in matriculation certificate only :-
(Not to be filled in any other format.)
1 st Name A J A YMiddle Name S I N G HSurname R A N A
(ii) Column -2. Put a tick ( ) mark as shown.
Male Female
(iii) Column 3. Date of Birth as shown in matriculation certificate only.
For Example:- (10 June 1982)
D D M M Y Y Y Y1 0 0 6 1 9 8 2
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(iv) Column 4. Mention your Rajya Sainik Board and Zila Sainik Board name,
from where your father / mother have registered and have obtained ex-servicemen
/ widow identity card.
(v) Column 5. Write your permanent address and correspondence address inblock letters.
(vi) Column 6. Write phone number along with STD code and email ID for any
query (email ID is must) .
(vii) Column 7. Category as per para 6 to be written (attach the required
document, if any). Category 1 (One).
Category - 1 O N E
(viii) Column 8. Full Particulars of Father/ Ex-Serviceman is to be
mentioned as per the discharge book. A blank space to be provided between
names. (Example: - KAMLESH CHANDRA CHOUDHURY)
K A M L E S H C H A N D R A C H O U D H U R Y
1 4 5 2 3 6 K
S E R G E A N T
A I R F O R C E
(ix) Column 9. Details of 10+2 or MEQ. Leave blank space between words.
Marks to be shown in words and figures.
a. Total Marks O N E T H O U S A N D(in words) T W O H U N D R E D(in figure) 1 2 0 0
b. Marks obtained N I N E H U N D R E D
(in words) F O R T Y
(in figure) 9 4 0
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c. % of marks scored S E V E N T Y E I G H T(in words) P O I N T T H I R T Y
T H R E E(in figure) 7 8 . 3 3
(x) Column 10. Tick as applicable.
Yes No
(xi) Column 11 . The student is to specify the course which he / she is
presently studying. (Example:- B TECH )
B T E C H
(xii) Column 12. Duration of the course both in numbers and figures to be
mentioned. For example 5 years 6 months.
(In figure)
Y Y M M
0 5 0 6
(In word)
F I V E Y E A R S A N D S I XM O N T H S
(xiii) Column 13. Write date of commencement & completion of course as
shown below:
(Course Commencement / Date of Admission)
D D M M Y Y Y Y0 1 0 7 2 0 0 7
(Course completion)
D D M M Y Y Y Y3 1 1 2 2 0 1 2
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(xiv) Column - 14 Write the full name and address of the college with email ID
and phone number of principal.
Name of Student A J A Y S I N G H R A N A
Roll No. 0 8 E A T I T 0 4 3
Name of College A J M E R I N S T I T U T EO F T E C H N O L O G Y
Full Address P U S H K A R B Y P A S S Aof college J M E R
State R A J A S T H A N
Pin Code 3 0 5 0 0 4
Tel No. (with STD Code) 0 1 4 5 - 2 3 0 0 6 2 8
E-Mail ID (if any) a i t _ a j m e r @ r e d i f f m a il . c o M
College Website w w w . a i t a j m e r . c o m
(xv) Column - 15 Write the regulatory body of your college.
A I C T E
(xvi) Column 16. Furnish the particulars of your all children as per specimen
given:-
Sl. No. Name of Child Gender Date of Birth Age1 Prakash Singh Rana M 10/10/1982 27 Years2. Satish Singh Rana M 12/05/1984 25 Years3. Ajay Singh Rana M 03/07/1987 22 Years4. Komal Rana F 14/02/1989 20 Years
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(xvii) Column 17. Given details of the scholarship availed by your brother /
sister in the past, if not availed write Not Applicable.
Sl.No.
SelectionSerial No.
given by KSB
Name of thebrother/sister
Course ofStudy
Academic yearin whichapplied
Amoreceived s
1. 6359 Satish Singh Rana B Tech 2007-09 15000
(xviii) Column - 18 Please write the full details of bank account of the student and
attach the photocopy of passbook and cancelled cheque as required to verify the
correctness of the account number (individual student account is preferred.
However, a joint account with the father / mother is also accepted).
Name of account holder A J A Y S I N G H R A N A
Bank Name S T A T E B A N K O F I N DI A
Branch Name A J M E R
Branch Address A J M E R I N S T I T U T E O F TE C H N O L O G Y
State R A J A S T H A N
Bank Tel. No. 0 1 4 5 - 2 3 0 0 6 2 2
Branch Code 0 5 1 4
MICR (9 digit) No. 5 1 8 0 0 2 0 0 7
(PLEASE ATTACH A PHOTOCOPY OF CHEQUE & PASS BOOK)
Account No. 3 0 2 0 0 1 5 2 4 6 8
REPEAT
Account No. 3 0 2 0 0 1 5 2 4 6 8
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(xix) Column 19. Fill up attached Demand Draft particulars.
Issue D D M M Y Y YY
Demand Draft No. 0 2 3 1 5 0 Date 1 4 1 2 2 0 0 9
Amount (Rs.) in figure 3 0
Amount (Rs.) in word T H I R T Y
Issuing Bank Name S T A T E B A N K O F I N D I A
Issuing Bank Branch A J M E R
Note: Application form from page number 13 to 22 along with required documents only to be forwarded.
CHECK LI ST OF DOCUMENTS TO BE ATTACHED W I TH
THE APPLI CATI ON FORM
1. Candidates / ESM are to ensure that the following documents areattached (as applicable) along with the Application Form (non submission ofthese certificate will lead to rejection and application will be returnedunactioned) .
(a) Attested copy of Ex-Serviceman/Widow I-card issued byRSB/ZSB. This is an important document to be attached.
(b) Extract of ESM discharge book as per specimen.
(c) If child born after discharge then affidavit is to be submitted by ESM,that child is dependent on him and he / she is a ward of ESM.
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(d) Additional Certificates Attested copy of following documents.
(i) Category 1: Part II Order Equivalent of other
(ii) Category 2: Part II Order services i.e. Army /
(iii) Category 3: Part II Order Navy / Air Force
(iv) Category 4: Part II Order(v) Category 5: Award Certificate
(e) Attested photocopy of matriculation or equivalent examinationcertificate for verification of date of birth.
(f) Attested photocopy of mark sheet of MEQ as applicable (e.g. 10plus 2, graduation / diploma etc). In case the MEQ is graduation / diploma,then complete mark sheet is required to be submitted.
(g) In case of MBA/MCA applicants, attested copy of minimum entryqualification certificate. i.e Graduation
(h) Bonafide studentship certificate to be issued byRegistrar/Dean/Principal of College/Institution pertaining to course for whichscholarship is claimed (As per specimen attach).
(i) Demand Draft of Rs. 30/- (Rupees Thirty only) attached.(Application form without Demand Draft will not be processed and
Demand Draft should not be made before 20th
December 2009.)
(j) Photocopy of passbook showing name, account number withphotograph of individual and cancelled leaflet cheque. ( Scholarship willnot be sent in absence of photocopy of passbook)
Date: _____________________
_______________________________Place: ____________________ Full Name & Signature ofCandidate
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_______________________________________
Checked / counter singed by ESM / Widow
DEPTT OF SAINIK WALFARE/RAJYA SAINIK BOARDS
Sl No Address of RSB For Detail, Pl contact RSB
1ANDAMAN &NICOBARISLANDS (UT)
Col KV Cherian (Retd)SecretaryRajya Sainik BoardA & N Administration, SecretariatPort Blair - 744 101
Port Blair-
03192-235621 (O)03192-235621(F)03192-320360 (R)
09434281518 (M)
2 ANDHRAPRADESH
Brig CS Vidyasagar (Retd)DirectorDeptt of Sainik WelfareBlock IV, II Floor, GruhakalpaComplex, MJ Road, Nampally,Hyderabad - 500 001
Hyderabad
040-24736890 (O)040-27990144 (R)040-24747991 (F)09440401470 (M)
3 ARUNACHALPRADESH
Shri K KholieDirectorDte of Relief, Rehabilitation &Settlement, Govt of ArunachalPradesh, New Itanagar-791110
Itanagar-
0360-2212282 (O)0360-2290778 (R)0360-2212282 (F)0360-2213615 (F)09436041927 (M)
mailto:[email protected]:[email protected]:[email protected]:[email protected] -
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4 ASSAM
Cmde K C Choudhury (Retd)DirectorDte of Sainik Welfare, SainikBhavan, Lachit NagarGuwahati - 781 007
Guwahati-
0361-2522229 (O)0361-2412196 (R)0361-2522229 (F)
5 BIHAR
Shri Md. Saood, BASDirectorSainik Kalyan NideshalayaHome Deptt, Old SecretariatBarrack No.10, Patna 800015
Patna
0612-2217301 (O)0612-2217301 (F)0612-2280333 (R)
6 CHANDIGARH(UT)
Lt Col Raj Kumar Singh (Retd)
Zila Sainik Welfare OfficerZila Sainik Welfare Office (UT)Opposite Aroma Hotel, Sector-21-D, Chandigarh - 160 022
Chandigarh
0172-2701947 (O)0172-2700317 (O)0172-2726325 (F)0172-2721064 (R)09888880566 (M)
7CHHATTISGARH
Col K L Yadav (Offg) (Retd)DirectorDeptt of Sainik Welfare, CGNear Collectorate Parisar, BehindHome Guard OfficeRaipur - 492 001
Raipur
0771-2445165 (O)0771-2427449 (O)0771-2352529 (R)0771-2420084 (F)09893164219 (M)
8 DELHI
Gp Capt RK Sharma (Retd)SecretaryRajya Sainik BoardOpp Tis Hazari CourtNo.1, Rajpur Road, Delhi-110 054
Delhi-
011-23991876 (F)011-23969260 (O)09818953191 (M)
9 GOA
Maj Venugopal Nair (Retd)SecretaryDeptt of Sainik WelfareCollectorate BuildingPanaji - 403 001
Panaji
0832-2227138 (O)0832-2443236 (R)0832-2227138 (F)09420686834 (M)
mailto:[email protected]:[email protected]:[email protected]:[email protected]:[email protected]:[email protected]:[email protected]:[email protected]:[email protected]:[email protected] -
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10 GUJARAT
Lt Col Kishor Sinh Gohil (Retd)DirectorDistt Sainik Welfare office &Resettlement, Bachat Bhawan,Ground Floor, Opp - Jyoti Sangh,Relief Road, Ahmedabad-380001
Gandhinagar
079-23251295 (O)079-23251296 (O)079-23251298 (O)079-23251294 (F)079-23245346 (R)079-25508539 (O)
11 HARYANA
Brig KS Budhwar (Retd)SecretaryRajya Sainik BoardSainik Bhawan, Sector 12,Shaheed Capt Rohit KaushalMarg, Panchkula - 134 109
Panchkula
0172-2560462 (O)0172-2562102 (R)0172-2560462 (F)0172-2560321 (O)09888527189 (M)
12 HIMACHALPRADESH
Maj Jogi Dass Mankotia (Retd)DirectorDeptt of Sainik WelfareGovt of Himachal PradeshHamirpur - 177 001
Hamirpur-
01972-221854 (O)01972-224659 (O)01972-225961 (R)01972-225643 (F)09418090708 (M)
13 JAMMU ANDKASHMIR
Brig RS Langeh, VSM (Retd)DirectorDeptt of Sainik WelfareAmbphalla, Jammu - 180005
Jammu
0191-2561547 (O)0191-2465141 (R)0191-2575362 (F)09419180672 (M)
14 JHARKHAND
Col AP Singh (Offg) (Retd)DirectorSainik Kalyan NideshalayaRanchi (Jharkhand)
Ranchi-
0651-2330178 (O)0651-2330469 (R)0651-2331434 (F)09431105964 (M)
15 KARNATAKA
Col CM Uthaiah (Retd)DirectorDeptt of Sainik Welfare &Resettlement,Fd Mshl KM Cariappa, Bhavan,No 58, Fd Mshl KM CariappaRoad, Bangalore - 560 025
Bangalore-
080-25589459 (O)080-28445706 (R)080-25589459 (F)09886205130 (M)
mailto:[email protected]:[email protected]:[email protected]:[email protected]:[email protected]:[email protected]:[email protected]:[email protected] -
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16 KERALA
Shri KK Govindan NairDirectorDeptt of Sainik WelfareVikas Bhavan,Thiruvananthapuram - 695 033
Thiruvananthapuram
0471-2304980 (O)0471-2472401 (R)0471-2304980 (F)0471-2329279 (R)
17 MADHYAPRADESH
Brig Pramod Kumar (Retd)DirectorDeptt of Sainik WelfareSouthern Shopping CentreGuru Teg Bahadur Complex, TTNagar, New Market,P.B.NO 364, Bhopal - 462 003
Bhopal-
0755-2553992 (O)0755-2666081 (R)0755-2577209 (F)09993030601 (M)
18 MAHARASHTRA
Col Suhas S Jatkar (Retd)DirectorDeptt of Sainik WelfareMaharashtra State Raigad, OppNational War Memorial, SolapurRoad, Ghorpadi, Pune-411 001
Pune-
020-26332763 (O)020-26332764 (O)020-26850613 (F)09422314276 (M)
19 MANIPUR
Lt Col H Sharat Singh (Retd)SecretaryRajya Sainik BoardSainik Rest HouseOpp. Lamphel Police Station,Imphal-795004
Imphal-
09862672547 (M)
20 MEGHALAYA
Brig WJB Sturgeon, YSM, SM(Retd)DirectorDte of Sainik WelfarePublic Service CommissionBuilding Beyond DC BuildingShillong - 793 001
Shillong-
0364-2225613 (O)0364-2536574 (R)0364-2225613 (F)09436101551 (M)
21 MIZORAM
Col John Zama, SM (Retd)DirectorDeptt of Sainik Welfare & Res,Tuikual A, PB No. 119Aizawl - 796 001
Aizawl-
0389-2322732 (O)0389-2322732 (F)0389-2325811 (R)09436142593 (M)
mailto:[email protected]:[email protected]:[email protected]:[email protected]:[email protected]:[email protected]:[email protected]:[email protected]:[email protected]:[email protected] -
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22 NAGALAND
Brig Brij Pal Singh (Retd)SecretaryRajya Sainik Board, Home Deptt,Home Br, Nagaland Civil Sectt.,Kohima - 797 001
Kohima-
0370-2270029 (O)0370-2270029 (F)0370-2221991 (R)09436830124 (M)
23 ORISSA
Col (Dr) DK Das (Retd)SecretaryRajya Sainik Board, NageswarTangi, Lewis Road,Bhubaneshwar-751002
Bhubaneshwar
0674-2432268 (O)0674-2435998 (F)0674-2721156 (R)09937940807 (M)
24 PUDUCHERRY(UT)
Col Jacob Mathen Anand (Retd)DirectorDeptt of Sainik WelfareJawan Bhavan Complex, LawspetMain Road, Pakkamudayanpet,Puducherry - 605 008
Puducherry
0413-2253107 (O)0413-2250575 (F)09443228260 (M)
25 PUNJAB
Brig IS Gakhal (Retd)DirectorDte of Sainik Welfare, PunjabPunjab Sainik Bhawan, Sector21-D, Chandigarh - 160 022
Chandigarh
0172-2701845 (O)0172-2740991 (R)0172-2707345 (F)09814297113 (M)
26 RAJASTHAN
Col Phool Singh Mehla (Retd)(Offg) NideshakSainik Kalyan VibhagSecretariat Building, North Block,Jaipur - 302 005
Jaipur-
0141-2227897 (O)0141-2227650 (F)0141-2356464 (R)09314933120 (M)
27 SIKKIM
Lt Col PB Gurung (Retd)SecretaryRajya Sainik Board, PaljorStadium Road, Gangtok-737 101
Gangtok-
03592-202534 (O)03592-221456 (O)03592-202156 (R)03592-221456 (F)09434448861 (M)
mailto:[email protected]:[email protected]:[email protected]:[email protected]:[email protected]:[email protected]:[email protected]:[email protected]:[email protected]:[email protected] -
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28 TAMIL NADU
Capt S M Aslam, (Retd)Joint DirectorDte of Ex-Servicemens Welfare22, Raja Muthiah Salai, ChoolaiChennai - 600 003
Chennai-
044-26691747 (O)044-26691342 (O)044-22331052 (R)044-26691886 (F)09444823182 (M)
29 TRIPURA
Lt Col Mohit Ghosh (Retd)SecretaryRajya Sainik Board, Nehru OfficeComplex, Gorkhabasti, P.O.Kunjaban, Agartala - 799 006West Tripura
Agartala
0381-2326507 (O)0381-2323795 (F)0381-2319005 (R)09436510584 (M)
30 UTTARPRADESH
Shri AK Chaturvedi, PCS
(Additional Charge)DirectorDte of Sainik Kalyan EvamPunarvas, Kariappa Bhawan,Kaiserbagh, Lucknow - 226 001
Lucknow-
0522-2625354 (O)0522-2625354 (F)0522-2305107 (F)0522-2391701 (R)09415404142 (M)
31 UTTARAKHAND
Brig AN Bahuguna, KC, YSM,VSM (Retd)DirectorNideshalaya Sainik KalyanUttarakhan, Kalidas margP O- Haathi BadkalaDehradun - 248121
Dehradun-
0135-2744208 (O)0135-2743773 (F)0135-2741481 (O)0135-2670813 (R)09358254621 (M)
32 WEST BENGAL
Col PR Pal (Retd)SecretaryRajya Sainik Board, Block 'F'(First Floor), Writers BuildingKolkata - 700 001
Kolkata-
033-22141347 (O)033-22144643 (F)033-22143220 (O)09874535628 (M)
rajyasainikboardwestbengal@gmom
Note:
Dadar Nagar Haveli: ESM of these states can submit their Prime Minister application formto
Gujrat RSB.Daman & Div
mailto:[email protected]:[email protected]:[email protected]:[email protected]:[email protected]:[email protected] -
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Lakshadweep: ESM of this state can submit their Prime Minister application form toKerala RSB.