govt of india ministry of defence kendriya … sainik board ... bonafide certificate to be issued by...
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GOVT OF INDIA MINISTRY OF DEFENCE
KENDRIYA SAINIK BOARD
PRIME MINISTER’S SCHOLARSHIP SCHEME 2013-14
1. Applications are invited from the dependent wards / widows of Ex-servicemen and Ex-Indian Coast Guard personnel pursuing Professional Degree Courses, duly recognized by the respective government regulatory bodies such as MCI, AICTE and UGC etc. The scheme will be applicable only to those candidates who have joined the Professional Courses in the academic year 2013-14.
2. AMOUNT OF SCHOLARSHIP
(a) ` 2000/- per month for boys. Paid Annually
(b) ` 2250/- per month for girls.
3. Application Form and Information Brochure can be downloaded from the website http//www.desw.gov.in. at PM’s Scholarship link. 4. Last date of receipt of application at respective RSB / Coast Guard Headquarter is 30th November 2013. 5. Applications received after 30th November 2013 will not be entertained by RSBs.
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CHECK LIST OF DOCUMENTS TO BE ATTACHED WITH
THE APPLICATION FORM
Application Form of PM Scholarship of 2013-14 from Page 01 to 10 only. No other
documents will be accepted other than mentioned in the check list.
(a) If student born after discharge then affidavit is to be submitted by ESM / Ex-Coast Guard.
(b) Additional Certificates – Additional certificate is to be attached in support of the cat 1-5, as mention in brochure.
(c) Attested photocopy of Matriculation or equivalent examination certificate for verification of date of birth.
(d) Attested photocopy of mark sheet of MEQ as applicable (e.g. 10 plus 2, Graduation / Diploma). In case the MEQ is Graduation / Diploma, then complete mark sheets are required to be submitted. In case of MBA / MCA / B Ed / LLB applicants attested copy of MEQ i.e Graduation.
(e) Bonafide Certificate to be issued by Registrar / Dean / Principal of College / Institution pertaining to course for which scholarship is claimed.
Date: _____________________ ____________________________ Full Name & Signature of Candidate
Place: ____________________ _______________________________
Name & Signature of ESM / Ex-coast Guard / Widow
…………………………………………………………………………………………………………….
CERTIFICATE FROM RSB / ZSB / DIRECTORATE GENERAL OF COAST GUARD
“It is certified that PM Scholarship application form for academic year 2013-14 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:
Secretary / Director
Place: ________________ RSB / ZSB / Coast Guard Headquarter
Date : ________________
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Recent Photograph Of Student
(Write your name & ESM/Ex-Coast Guard/widow particular on
reverse)
Selection Serial Number
(To be allotted by KSB) ......................
APPLICATION FOR PRIME MINISTER’S SCHOLARSHIP FOR THE YEAR 2013-14
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 with 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).
D D M M Y Y Y Y
4. Your Rajya Sainik Board or Zila Sainik Board (Where ESM is registered and obtained Ex-Servicemen Identity Card).
(Only for ESM) RSB
ZSB
5. Full Address.
(a) Present Correspondence Address: - (Where you want your letter to be sent in case of selection / rejection)
House No.
LEAVE BLANK SPACE BETWEEN WORDS
Male Female
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(b) Permanent Address.
6. Telephone Number.
STD Code
Land Line No.
Mobile No.
E-Mail (mandatory)
LEAVE BLANK SPACE BETWEEN WORDS
Street No. &
Name
Tehsil
District
State
Pin Code
House No.
Street No. &
Name
Tehsil
District
State
Pin Code
4 7. Ex-Servicemen / Ex-Coast Guard Category - (Mention category as per Para 7 of the Brochure and attach supporting document duly attested).
8. Ex-Serviceman’s / Ex-Coast Guard’s Particulars.
(a) Name of ex-serviceman /
Ex-Coast Guard
(b) Service No.
(c) Rank
(d) Type of Service (Tick one) Army Air Force Navy Coast Guard
9. Details of MEQ / Course for qualifying examination for scholarship (10+2/equivalent or Diploma / Graduation)
(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 any Govt. / Private source for the course to which the scholarship applied for. If yes, then state the amount and source (Except Prime Minister Scholarship).
Yes No Rs (per month / year)
Name of the Source
LEAVE BLANK SPACE BETWEEN WORDS
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11. Name of the Course
12. Duration of Course in in figure
Years and Months
in words
13. Date of Commencement and Approximate Date of Completion. D D M M Y Y Y Y
(a) 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 Address
of College
State
Pin Code
Tele No. (with STD Code)
E-Mail ID (if any)
College Website
LEAVE BLANK SPACE BETWEEN WORDS
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15. Regulatory Bodies/ Council. (For example all Engineering Degrees and Management Degree Courses are recognized by AICTE & UGC and all Medical Degree are recognized by Medical Council of India or Dental Council of India, specify as per case).
16. Details of Bank Account of SBI or PNB for Electronic Clearing Services ((PLEASE
ATTACH A PHOTOCOPY OF PASS BOOK, ONE CROSSED BLANK CHEQUE LEEF SHOWING YOUR ACCOUNT NUMBER). Name of account holder:
Name of Bank (Put a tick mark (√) Branch Name:
(PLEASE ATTACH A PHOTOCOPY OF CHEQUE & PASS BOOK)
Account No.
REPEAT
Account No.
17. Furnish particulars of all children in order of age, as reflected in the Discharge Book or attached an affidavit in case child born after discharge.
Sl. No. Name of Child Gender Date of Birth
18. Details of brother/sister availing / availed the PM’s Scholarship, if any. (Including yourself if granted earlier)
Sl. No.
Selection Serial No.
given by KSB
Name of the brother/sister
Course of Study
Academic year in which applied
Amount received so far
LEAVE BLANK SPACE BETWEEN WORDS
SBI PNB
7 19. 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 PM’s Scholarship Scheme, besides recovery of scholarship already paid. I also undertake to abide by the conditions 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) ___________________________
__________________________________________________________________________
FOR OFFICIAL (KSB) USE ONLY
Signature of Supervisor/ IC PMSS Remarks of Supervisor / IC PMSS ___________________________ _______________________________
_______________________________
_______________________________
RECOMMENDED / NOT RECOMMENDED
Signature of JD PMSS Remarks of JD PMSS ____________________ _______________________________
_______________________________
_______________________________
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SPECIMEN COPY OF EX-SERVICEMEN / EX-COAST GUARD CERTIFICATE
(This is important document, fill it carefully)
(In lieu of Discharge Book)
1. Type of : _______________________________________ Service (Army, Navy, Air Force or Coast Guard)
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 ID Card issued vide sl no RSB/ZSB/………………………………………dated……………... 12. ESM / Ex-coast Guard died on (if applicable) : _______________________________________ 13. Cause of death & : _______________________________________
Whether Attributable to military / coast guard service 14. 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-Servicemen / Ex-Coast Guard and found to be correct.
Office Seal:
Dir RSB/ZSB/OI/C Record Office / Coast Guard Headquarter
Date: _______________________ Place: ______________________
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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._____________ per
month / year (If not getting write N/A) scholarship / stipend from this
Institute / College or any other sources.
Office Seal: Signature of Principal / Dean / Registrar
Date:- ______________
Place:-_____________
Note: Failure to attach bonafide certificate as per this specimen will lead to rejection of application. Amendment / Blank / use of whitener will not be accepted.
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PRIME MINISTER’S 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 / Coast Guard Headquarter)
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.
Office Seal: (Signature of RSB / Coast Guard Headquarter)
Note: Student copy duly stamped and signed by RSB / Coast Guard Headquarter is to be
given to the student by hand or by post. (Envelope enclosed alongwith the application may be used.) Office copy duly filled by the RSB/Coast Guard Hqs to be attached with the application.
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MINISTRY OF DEFENCE Department of Ex-Servicemen Welfare
PM‟S SCHOLARSHIP SCHEME
FOR DEPENDENT WARDS / WIDOWS OF EX-SERVICEMEN AND
EX-INDIAN COAST GUARD
BROCHURE
FOR ACADEMIC YEAR 2013-14
KENDRIYA SAINIK BOARD West Block-IV, Wing-VII, 2nd Floor
R K Puram, New Delhi-110066 Website: www.desw.gov.in
E-Mail: [email protected] Note: Application form is to be deposited by individual to respective RSB / Directorate General of Coast
Guard. Applications duly recommended by RSB‟s / Directorate General of Coast Guard will be considered by KSB. Therefore, candidates are advised not to forward applications directly to KSB. Applications received directly at KSB will be returned unactioned to individual.
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PRIME MINISTER‟S SCHOLARSHIP SCHEME (PMSS)
1. Introduction. Prime Minister’s Scholarship Scheme was introduced from the Academic year 2006-07. To encourage higher technical and professional education for the dependent wards of Ex-Servicemen / Ex-Coast Guard and their widows (below officer rank only) and dependent wards / widows of Ex-Servicemen / Ex-Coast Guard who died in harness due to causes attributable to military service / Coast Guard Service, irrespective of the rank. 2. Scholarships Available.
A total number of 4000 students will be selected. 3. Students eligible for the scholarship.
(a) Students who have taken admission in 2013 are only eligible for PMSS 2013-14. Students should have scored 60% and above in Minimum Educational Qualification (MEQ) i.e 10+2 / Diploma / Graduation.
(b) Students who are Dependent Wards / Widows of Ex-Servicemen & Ex-Coast Guard personnel who died in harness / disabled due to causes attributable to military service / coast guard service, irrespective of the rank.
(c) Dependent wards of Ex-Servicemen / Ex-Coast Guard and their widows (below
officer rank only).
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 in harness
due to causes attributable as mentioned in para 3 (b) above, there will be no rank restriction.
4. How to Apply For Scholarship. One candidate to submit only one application form for one course, if any candidate submit two applications for more than one course, both the applications will be rejected. Forms are to be downloaded from the website www.desw.gov.in. Application forwarded in any other format will not be considered. Application to be forwarded on plain A4 size paper (typed or handwritten) in the prescribed format duly completed in all respects with superscription on the envelope “Prime Minister‟s Scholarship Scheme for the Academic Year 2013-14”. 5. Documents to be attached alongwith PMSS Application Form.
(a) Specimen Copy Of Ex-Servicemen / Ex-Coast Guard Certificate (Page 8 of
Application Form).
(b) Matriculation certificate duly attested.
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(c) Minimum Educational Qualification certificate duly attested, as applicable. (10+2
Mark sheet / Graduation (mark sheets of 3 years) / Diploma (mark sheets of all semesters).
(d) Bonafide Certificate from Collage in original as per specimen (page 9 of
Application Form).
(e) Photocopy of Bank Passbook showing A/c No and one cancelled cheque leaf. (f) Attested copy of following supporting documents in case of Cat 1 – 5:-
Copy of
(i) Category 1: Part II Order POR in case of Air Force (ii) Category 2: Part II Order and Gen Form in case of (iii) Category 3: Part II Order Navy (iv) Category 4: Part II Order (v) Category 5: Award Certificate
Alongwith Gazette Notification
Note: Failure to attach above mentioned documents / certificate will lead to rejection of application. All column are to be filled in each documents. Amendment / use of whitener will not be accepted.
6. Selection Procedure. Applications will be short listed based on Ex-Servicemen / Ex-Coast Guard category (as given below in Para 7) and percentage of marks obtained in MEQ. 7. Priority for Grant of Scholarship. Order of preference for selection of candidates will be as under:-
Category 1 Wards / Widows of ESM / Coast Guard personnel killed in action. Category 2 Wards / Widows of ESM / Ex-Coast Guard disabled in action and
boarded out of service with disability attributable to Military / Coast Guard service.
Category 3 Wards / Widows of ESM / Coast Guard personnel who died while
in service for causes attributable to Military / Coast Guard service.
Category 4 Wards / Widows of ESM / Ex-Coast Guard personnel disabled in
service with disability attributable to Military / Coast Guard service.
Category 5 Wards / Widows of ESM / Ex-Coast Guard in receipt of gallantry
awards, irrespective of the rank.
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Category 6 Wards / Widows of ESM / Ex-Coast Guard (PBOR Only).
8. Eligible Courses. Professional Degree Courses like BE, B Tech, BDS, MBBS, B Ed, BBA, BCA, B Pharma, etc. duly recognized by the respective Government Regulatory Bodies, such as All India Council for Technical Education, Medical Council of India, UGC. (Master Degree Courses are not eligible for PMSS except MBA, MCA). Students can see the list of eligible courses for details. Students studying abroad are not eligible for this scheme. Students getting stipend for the Professional Degree Courses are also not entitled. No distance learning course is permitted under PMSS. PMSS can be availed for one course only. 9. Scholarship for Integrated Courses. The facility under PMSS is restricted for Professional Degree Course only, such as B Ed but not for BA+B Ed, also for LLB not for BA+LLB. In case of integrated ME / M Tech / M Pharma initial four years scholarship will be given.
10. Minimum Marks in MEQ should be 60%.
MEQ for entry to various Professional Courses differs e.g. for MBBS it is 10+2 where as for BE / B Tech it is 10+2 / Diploma, It is graduation for B Ed and MBA. A candidate must have minimum 60% marks in MEQ to be considered for scholarship. 11. Duration of Scholarship. Two to five years as duration of the course approved by the concerned Regulatory Body (Except one year for B Ed). 12. Amount of Scholarship. The amount of scholarship would be as follows: (a) Rs. 2000/- per month for boys
Paid annually after selection
(b) Rs. 2250/- per month for girls
13. Payment of Scholarship. First payment will be paid automatically just after the selection in merit list of 4000 candidates. For subsequent payments the candidate should submit the Payment cum Renewal Form along with Bonafide Certificate (as per Specimen) duly signed by the Principal / Dean / Registrar of the institution / college directly to Kendriya Sainik Board (KSB), R K Puram, New Delhi on completion of their each academic year, till completion of the course. For subsequent payments 50% marks are mandatory in each academic year. 14. Account Details. All candidates to open bank account in State Bank of India or Punjab National Bank which has “electronic clearance system” / Core Banking, to facilitate transfer of the scholarship
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amount. The scholarship will NOT be transferred in any MINOR ACCOUNT. In case of minor account of any candidate, the same must be converted into major account. In case of minor account a joint account with parent will also fulfill the requirement. Candidate to attach an attested photocopy of passbook, showing name and account number. A cancelled leaflet of a blank crossed cheque showing the account number. 15. IMPORTANT INSTRUCTIONS FOR PM‟S SCHOLARSHIP SCHEME.
Incomplete / amended form / documents will lead to rejection or returned to RSB / Coast Guard Headquarter unactioned.
(a) Check List duly signed by student & parent is to be attached with the Application Form.
(b) Application alongwith relevant documents & certificates are to be deposited to respective Rajya Sainik Board / Coast Guard Headquarter “latest by 30th Nov 2013. Late submitted or incomplete Application Form and non submission of required document will lead to rejection and returned unactioned. The application will be received by the RSBs / Coast Guard Headquarter and will be acknowledged with a seal and date of receipt. (c) The concerned RSBs / Coast Guard Headquarter to scrutinize / check the Application Forms with regard to their eligibility criteria prior to forwarding the same to KSB. No application will be accepted by KSB which is not scrutinized by RSB / Coast Guard Headquarter. (d) Candidates and RSB‟s / Coast Guard Headquarter to note that all applications received after the due date will not be considered and returned unactioned. (e) List of selected candidates will be forwarded to RSBs / Coast Guard Headquarter after the merit list is finalized by the BOO at KSB. Students will be informed by RSBs about their selection. The list of selected candidates will also be uploaded on the website www.desw.gov.in. (f) Two stamped (Rs. 5 each) blank window envelopes of 27x12 cms are to be attached with each application so as to facilitate correspondence with the candidate by KSB / RSB / Coast Guard Headquarter. (g) The scholarship is admissible for only two children of ESM / Ex-Coast Guard. Particulars of all children should be indicated in Para 17 of Application Form. This should be according to the Discharge Book / Certificate of the Ex-servicemen / Ex-Coast Guard. (h) The amount of scholarship, including any other scholarship or financial assistance from any other source will not exceed the total grant of assistance available under this scheme. (j) The first payment of scholarship will be paid automatically after the selection of the candidate. The subsequent payments will be made on successful completion of the each academic year with minimum 50% marks till completion of the course. The
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candidate should submit Payment cum Renewal Form along with Bonafide Certificate directly to KSB, In case, KSB ask a student to submit the mark sheet for the full year, a student is liable to produce the same, failing which the scholarship will be held up. It is the responsibility of the candidate to submit his / her document for claiming his / her subsequent payments, till completion of course. (k) Candidature of a student shall stand automatically rejected if, at any stage, it is discovered that he / she has secured scholarship fraudulently by making false statement or misrepresentation of facts. Candidate shall have to refund the amount already given. (l) The attached photocopies of the supporting documents should be duly attested by gazetted officer (unattested documents will not be considered).
(m) In case of change of any address, course, college, it is to be intimated immediately to Kendriya Sainik Board in writing. Always mention selection serial number, name of applicant and ESM / Ex-Coast Guard particular for any correspondence with KSB & RSB / Coast Guard Headquarter after getting selected for the scholarship.
(n) The Ministry of Defence, Government of India can suitably modify these instructions to remove anomalies, if any, for successful implementation of the scheme, as may be necessary from time to time and will be applicable to all students under the scheme.
(o) Ex-Servicemen entitlement will be governed as per the existing definition of Ex-Servicemen, as amended from time to time. The definition is available in the guide book available with the RSB / ZSB, also applicable to Ex-Indian Coast Guard personnel as per the rules of DGCG.
(p) For any query or help, candidate should contact 011-26715250 or email to [email protected].
……………………………………………………………………………………………………………….
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LIST OF AUTHORIZED PROFESSIONAL DEGREE COURSES FOR PMSS
S NO
MEDICAL DURATION TECHNICAL DURATION MANAGEMENT DURATION OTHERS DURATIO
N
1 M B B S (Bachelor of Medicine & Bachelor of Surgery)
4 Year and 6 months
B Tech (Bachelor of Technology)
4 Years
M B A (Master of Business Administration)
2 Years
B Sc Bio Tech (Bachelor of Science in Bio Technology)
3 Years
2 B D S (Bachelor of Dental Surgery)
5 Years
B E (Bachelor of Engineering)
4 Years
B B A (Bachelor of Business Administration)
3 Years
B Ed (Bachelor of Education)
1 Year
3 B A M S (Bachelor of Ayurvedic Medicine Surgery)
4 Year and 6 months
B Arch Degree in Architecture
5 Years
B B M (Bachelor of Business Management)
3 Years
L L B (Bachelor of Law)
3 Years
4 B H M S (Bachelor of Homeopathic Medicine Surgery)
4 Year and 6 months
B C A (Bachelor of Computer Application)
3 Years
B M C (Bachelor of Mass Communication)
3 Years
5 B S M S (Bechalor of Sidha Medicine Surgery)
4 Year and 6 months
M C A (Master of Computer Application)
3 Years
H M Degree in Hotel Management
4 Years
6 B U M S (Bechalor of Unani Medicine Surgery)
5 Years
B Plan (Bachelor of Planning)
4 Years
B P Ed (Bachelor of Physical Education)
1 Year
7 B Sc B P T (Bachelor of Physiotherapy)
4 Years
B F Sc (Bachelor of Fishery Science)
4 Years
8 B Sc M L T (Medical Lab Technician)
4 Years
B F A (Bachelor of Fine Art)
4 Years
9 B V Sc & AH (Bachelor of Veterinary Science & Animal Hospitality)
5 Years
B Sc Agriculture (Bachelor of Science in Agriculture)
4 Years
10 B Pharma (Bachelor of Pharmacy)
4 Years
B A S L P (Bachelor of Audiology & Speech Language Pathology)
4 Years
11 B Sc Nursing (Bachelor of Science in Nursing)
4 Years
B F T (Bachelor of Fashion Technology)
3 Years
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12 G N M
Genral Nursing
3 Year and 6 Month
B F D (Bachelor of Fashion Designing)
3 Years
13 B N Y S (Bachelor of Naturopathy & Yogic Science)
5 Years
B Sc Microbiology (Bachelor of Science in Microbiology)
14 Pharm „D‟ (Doctor of Pharmacy)
5 Years
B Sc HHA (Bachelor of Science Hospitality & Hotel Administration)
3 Years
15 B Sc Optometry (Bachelor of Science in Optometry)
3 Years
Note: Any other course covered under guidelines of PMSS will be considered.
PARA WISE GUIDE LINES FOR FILLING UP OF APPLICATION FORM
Para 1. Fill your name as in matriculation certificate only:-
(Not to be filled in any other format)
1st Name A J A Y Middle Name S I N G H Surname R A N A
Para 2. Put a tick (√) mark as shown.
Male √ Female
Para 3. Date of Birth as shown in matriculation certificate only. For Example:- (10 June 1982)
D D M M Y Y Y Y
1 0 0 6 1 9 8 2
Para 4. Mention your Rajya Sainik Board (See details at LIST OF RSBs) and Zila Sainik Board name, from where your father / mother have registered and have obtained ex-servicemen / widow identity card (Not for Ex-Coast Guard). Para 5. Write your permanent address and correspondence address in block letters.
Para 6. Write phone number along with STD code and email ID for any query (email ID is must).
Para 7. Category as per Para 7 of brochure to be written (attach the required document, for cat 1-5). Category 1 (One).
Category - 1 O N E
Para 8. Full Particulars of Father / Ex-Serviceman / Ex-Coast Guard 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
Para 9. Details of 10+2 or Diploma / Graduation. Marks to be shown in words and figures.
(a) Name of Course/MEQ 1 0 + 2
(b) Year in which exam passed 2 0 1 3
(c) 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
(d) 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
(e) % 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
Para 10. Whether the applicant is in receipt of any other financial assistance/scholarship/ fellowship from any Govt. / Private source for the course to which
the scholarship applied for. If yes, then state the amount and source. Tick as applicable.
Yes √ No Rs (per month / year) 45000/-
Source S T A T E G O V T
Para 11. The student is to specify the course which he / she is presently studying. (Example:- MBBS) M B B S
Para 12. Duration of the course both in numbers and figures to be mentioned (without Internship). For example 4 years 6 months. (In figure) Y Y M M
0 4 0 6
(In word) F O U R Y E A R S A N D S I X
M O N T H S
Para 13. Write date of commencement & completion of course as shown below: (Course Commencement / Date of Admission)
D D M M Y Y Y Y
0 1 0 7 2 0 1 3
(Course completion)
D D M M Y Y Y Y
3 1 1 2 2 0 1 7
Para 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 E
O F T E C H N O L O G Y
Full Address of P U S H K A R B Y P A S S A
College J M E R
State R A J A S T H A N
Pin Code 3 0 5 0 0 4
Tele No. (with STD Code) 0 1 4 5 - 2 3 0 0 6 2 8
E-Mail ID a i t _ a j m e r @ r e d i f f m a i
l . c o M
College Website w w w . a i t a j m e r . c o m
Para 15. Write the Regulatory Body of your course.
A I C T E
Para 16. Details of Bank Account of SBI or PNB for Electronic Clearing Services (PLEASE ATTACH A PHOTOCOPY OF PASS BOOK, ONE CROSSED BLANK CHEQUE
LEEF SHOWING YOUR ACCOUNT NUMBER AND NAME).
Name of Account Holder:
A J A Y S I N G H R A N A
Name of Bank (Put a tick mark (√)
Branch Name:
R A M A K R I S H N A P U R A M
(PLEASE ATTACH A PHOTOCOPY OF CHEQUE & PASS BOOK)
Account No. 3 0 8 3 0 0 0 6 0 8 0 6 5 8 8 5
SBI PNB √
REPEAT
Account No. 3 0 8 3 0 0 0 6 0 8 0 6 5 8 8 5
Para 17. Furnish the particulars of your all children as per specimen given:-
Sl. No. Name of Child Gender Date of Birth Age
1 Prakash Singh Rana M 10/10/1982 28 Years
2. Satish Singh Rana M 12/05/1984 26 Years
3. Ajay Singh Rana M 03/07/1987 23 Years
4. Komal Rana F 14/02/1989 21 Years
Para 18. Give details of the scholarship availed by your brother / sister in the past, if not availed write Not Applicable.
Sl. No.
Selection Serial No.
given by KSB
Name of the brother/sister
Course of Study
Academic year in which applied
Amount received so
far
1. 6359 Satish Singh Rana B Tech 2007-08 45000
……………………………………………………………………………………………………......................................