ekSykuk vkt+kn f'k{kk izfr"BkuMAULANA AZAD EDUCATION FOUNDATION

¼vYila[;d dk;Z ea=ky;] Hkkjr ljdkj½(MINISTRY OF MINORITY AFFAIRS, GOVT. OF INDIA)

lkekftd U;k; lsok dsUnz] psElQksMZ jksM] ubZ fnYyh - 110055Social Justice Service Centre, Chelmsford Road, New Delhi - 110055

Qksu/Phone : 23583788, 23583789 QSDl@Fax : 011-23561945

osclkbV/Website : www.maef.nic.in

ekSykuk vkt+kn f'k{kk izfr"BkuMAULANA AZAD EDUCATION FOUNDATION

ekSykuk vktkn jk"Vªh; Nk=o`fr ;kstuk

vYial[;dksa ls lacaf/kr es/kkoh Nk=kvksa ds fy,MAULANA AZAD NATIONAL SCHOLARSHIP

FOR MERITORIOUS GIRL STUDENTS SCHEMEBELONGING TO MINORITIES

ekSykuk vkt+kn jk"Vªh; Nk=o`fr ;kstukvYila[;dksa ls lacaf/kr es/kkoh Nk=kvksa ds fy,

MAULANA AZAD NATIONAL SCHOLARSHIP SCHEMEFOR MERITORIOUS GIRL STUDENTS BELONGING TO MINORITIES

ekSykuk vktkn f'k{kk izfr"Bku dh LFkkiuk ekSykuk vcqy dyke vktkn ds tUe 'krkCnh lekjksg ds volj ij dh xbZFkhA bldk iathdj.k lkslk;Vh iathdj.k vf/kfu;e 1860 ds rgr 06 tqykbZ 1989 dks fd;k x;k FkkA ;g izfr"Bku] ,dLoSfPNd] vjktuSfrd] ykHk u dekus okyk lkekftd lsok laxBu gS ftldh LFkkiuk lkekt ds 'kSf{kd :i ls fiNM+s oxksZa esaf'k{kk dks c<+kok nsus ds fy, dh xbZ FkhA ;s vYila[;d dk;Z ea=kky;] Hkkjr ljdkj }kjk foÙkiksf"kr gSA ekuuh; vYila[;ddk;Z ea=h bl izfr"Bku ds insu v/;{k gSaA izfr"Bku dk m)s';] 'kSf{kd :i ls fiNM+s oxksZ] fo'ks"kr% vYila[;dks esa vkSjlkekU;r%a detksj oxksZa ds ykHk ds fy, 'kSf{kd ;kstukvksa dks rS;kj o dk;kZfUor djuk gSAMaulana Azad Education Foundation was established on the occasion of Maulana Abul KalamAzad’s birth centenary. The Foundation was registered under the Societies Registration Act1860, on 6th July, 1989. The Foundation is a voluntary non-political, non-profit marking socialservice organization established to promote education amongst the educationally backwardsections of the society. It is funded by the Ministry of Minority Affairs, Government of India.The Hon’ble Minister of Minority Affairs is its Ex-officio President. The aim of the Foundation isto formulate and implement educational schemes and plans for the benefit of the educationallybackward minorities in particular and weaker sections in general.

;kstuk dk 'kh"kZd %TITLE OF SCHEME

^^vYila[;d es/kkoh Nk=kvksa ds fy, ekSykuk vktkn jk"Vªh; Nk=o`fr ;kstuk**“Maulana Azad National Scholarship Scheme for Girls beloging to Minorities”

;kstuk dk m)s'; %OBJECTIVE OF THE SCHEME

jk"Vªh; vYila[;dksa ls lacfU/kr mu es/kkoh Nk=kvksas dh igpku djuk] c<+kok rFkk lgk;rk nsuk tks foÙkh; lgk;rk ds fcukviuh f'k{kk tkjh ugha j[k ldrh gSATo recognize, promote and assist meritorious Girl students belonging to National Minoritieswho can not continue their education without financial support.

Nk=o`fÙk dk iz;kstu%PURPOSE OF SCHOLARSHIP

;g Nk=o`fr] Ldwy@dkWyst Qhl] ikB;Øe dh iqLrdksa] ikB;Øe ds fy, visf{kr ys[ku lkexzh@midj.kksa dh [kjhn rFkk vkokl,oa Hkkstu izHkkjksa ds Hkqxrku ij gksus okys [kpsZa ds fy, ns; gksxhAScholarship will be admissible for expenditure on payment of School/College Fee, purchaseof syllabus books, purchase of stationery/equipments required for the course & payment ofBoarding/Lodging charges.

(1)

egÙoiw.kZ %IMPORTANT

1. vkosnu i=@QkZe osclkbV : www.maef.nic.in ls MkmuyksM fd;k tk ldrk gSA vkosnu i= dh QksVksdkWihHkh mi;ksx dh tk ldrh gSA vkosnu ds fy, Qhl@fdlh vU; jkf'k dk Hkqxrku ugh fd;k tkuk gSaAApplication can be downloaded from the web site www.maef.nic.in Photocopy of theapplication form can be used freely. No fee/any other amount is to be paid for application.

2. vkosnu i= izfr"Bku dks lh/ks Mkd }kjk Hkstk tk ldrk gS ;k izfr"Bku dk;kZy; esa 10.00 cts ls lk;a 5.00 ctsrd lHkh dk;Z fnol esa nLrh tek fd;k tk ldrk gSAApplication form can be sent by the student directly to the Foundation by post or can besubmitted by hand from 10.00 a.m. to 5.00 p.m.on all working days in the office of theFoundation.

3. fdlh lsok ds fy, fdlh dks Hkh dksbZ izHkkj@Qhl vkfn dk Hkqxrku ugha djuk gksrk gSANo charges/fee is to be paid to any one for any services.

4. fu/kkZfjr dkx+t i=ksa@vkSipkfjdrkvksa ds iwjk gksus ij Nk=o`fr eatwjh i=@pSd] lQy mEehnokj ds irs ij jftLVMZMkd }kjk lh/ks gh Hkstk tk,xkASanction letter/cheque for scholarship will sent by Regd. Post directly to the address ofsuccessful candidate on completion of prescribed papers/formalities.

5. fdlh iz'u@lwpuk ds fy, lfpo] ekSykuk vktkn f'k{kk izfr"Bku dks lh/ks gh laidZ fd;k tkuk pkfg,AFor any query/information, only Secretary, MAEF should be contacted directly.

ik=rk ekunaM@dkSu vkosnu dj ldrk gSAELIGIBILITY CRITERION / WHO CAN APPLY

1. jk"Vªh; vYila[;dksa ¼vFkkZr eqfLye] bZlkbZ] ckS)] fl[k] ikjlh½ ls lacfU/kr dsoy yM+fd;ka gh vkosnu dj ldrh gSAOnly Girl Students belonging to National Minorities, (i.e. Muslims, Christians, Buddhists,

Sikhs, Parsis) can apply :

2. fdlh ekU;rk izkIr dsUnzh;@jkT; ek/;fed f'k{kk cksMZ }kjk vk;ksftr ek/;fed Ldwy ¼nloha d{kk½ ijh{kk esa de lsde 55% vad ¼,xzhxsV esa½ izkIr fd, gq, gksus pkfg,A ekU;rk izkIr 33 cksMksZ@ifj"knksa dh lwph layXud&AAA esa nhxbZ gSA ;g vkosnu djus ds fy, dsoy ;ksX;rk fu/kkZj.k gsrq gS vkSj Nk=o`fr iznku djus dh dksbZ xkjaVh ugh nsrk gS;s jkT; ls izkIr ik= vkosnuksa esa ls lacf/kr jkT; ds fy, fu;r dksVs ds vk/kkj ij mPp Js.kh ds vkosndksa dks ;sNk=o`fr iznku dh tkrh gSA

Should have secured not less than 55% marks (in aggregate) in the secondary schoolcertificate examination (Class xth) conducted by any recognized Centre/State Board ofSecondary Education. The List of 33 recognized Boards/Councils is given inAnnexure-III. This is only qualifying percentage for applying and does not guaranteegrant of scholarship which is given to the top eligible applicant based on the quota fixedfor the concerned state from amongst the eligible application received from the state.

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3. fiNys foÙk o"kZ esa Nk= ds ifjokj dh lHkh Lkzksrksa lfgr dqy vk; 1,00,000/- :i, ¼dsoy ,d yk[k :i,½ ls degksuh pkfg,A

Family income of the student from all sources should be less than Rs. 1,00,000/- (Rupees

one lakh only) in the preceding financial year:

� osru Hkksxh oxZ ds ekeys esa Nk=k dks vius ekrk&firk@vfHkHkkod dk inuke] osrueku] ewyosru rFkk dqy ,oa?kj ij yk, tkus okys osru lfgr iwjk fooj.k nsuk pkfg,A dsoy ̂ ^lfoZl^^ fy[k nsuk Lohdk;Z ugha gksxkA Nk=kdks vkosnu ds lkFk vius ekrk&firk@vfHkHkkod ds fu;a=d izkf/kdkjh }kjk lka{;fdr osru izek.ki= vFkokisa'ku izek.ki= ¼lsokfuo`Ùk O;fDÙk;ksa ds ekeys esa½ layXu djuk gksxkA

In case of salaried class, the student must indicate the designation, pay-scale,basic pay and other allowances alongwith total gross & take home emoluments ofthe parent/guardian. A mere statement saying “Service” will not be acceptable.The student must attach a Salary Certificate or Pension Certificate (in case ofretired persons), duly authenticated by controlling authority, of her parent/guardianalongwith the application.

� d`f"k@ckxokuh ds ekeys esa Nk=k dks flafpr vkSj vflafpr rFkk mlds ifjokj }kjk vU; Hkwfe laink ds C;kSjs,oa ifjokj dh dqy vk; lfgr dqy Hkwfe gksfYMax dk mYys[k djuk gksxkA ekrk&firk@vfHkHkkod }kjk fn, tkusokys 'kiFk i=k ¼layXud&II½ ds lkFk&lkFk jkTkLo izkf/kdkjh ls izek.k i= esa bu C;kSjksa dk mYys[k Hkh fd;ktk,xkA

In case of agriculture/horticulture etc., the students has to mention total land holdingwith details of irrigated and non-irrigated and other landed property owned by herfamily alongwith total income of the family. These details will also be mentioned inthe affidavit of the parent/guardian (Annexure-II) as well as in the certificate fromRevenue authority.

� O;kikjh oxZ ds ekeys esa Nk=k dks ifjokj ds dqy djksckj vkSj dqy vk; lfgr Li"V :i ls fctusl dk ukevkSj fdLe crkuk gksxkA bu C;kSjksa dk muds ekrk&firk@vfHkHkkod }kjk fn, tkus okys 'kiFk i=k ¼layXud&II½esa Hkh mYys[k djuk gksxkA

In case of business class, the student must categorically state the name & type ofthe business alongwith the total turn over and the total income of family. Thesame details will also be stated in the Affidavit (Annexure-II) from her parent/guardian.

� vU; lHkh lzksrksa ls gqbZ vk; dk Hkh mYys[k fd;k tkuk pkfg,] fo'ks"kdj ;fn Nk=k dh ekrk Hkh jkstxkj esa gSaA

Income form all other sources must also be mentioned, specially if mother is alsoemployed.

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� ;g uksV fd;k tk, fd Nk=k }kjk vkosnu esa fn, x, lHkh vk; izek.ki= ,oa fooj.kksa dh ekSykuk vktkn f'k{kkizfr"Bku }kjk vkxs tkap dh tk ldrh gSA rF;ksa esa tkucw> dj dh xbZ xyrh@rF;ksa dks Nqik, tkus ds ekeysesa ;g izfr"Bku] Nk=o`fr dks jn~n@igys ls iznku@tkjh dh xbZ Nk=o`fr dh olwyh djus ds lkFk&lkFk dkuwuds vuqlkj vko';d dkjokbZ 'kq: dj ldrk gSAIt must be noted that all income certificate and statements made by the studentsin the application is subject to further verification of Maulana Azad EducationFoundation. In case of any deliberate discrepancy/concealment of facts, the MAEFmay cancel/recover the scholarship granted/released as well as initiate necessaryaction as per law.

� vk; izek.ki=@'kiFk i= ¼layXud&II vo'; gh ekrk&firk@vfHkHkkod dh rjQ ls gksus pkfg, rFkk ;slaEcf/kr gkse LVs'ku ls tkjh gq, gkus pkfg,A gkse LVs'ku ds vykok tgka Nk=k i<+ jgh gS ml LFkku ls tkjhfd;k x;k vk; izek.ki= vFkok 'kiFk i=] Lohdk;Z ugha gksxk ¼QksVkdkWih ds ekeys esa] ;g jktif=r vf/kdkjh;k laLFkku izeq[k }kjk izekf.kr fd;k tkuk pkfg,½AThe income certificate/affidavit (Annexure-II) must be from the parents/guardian’sside and should have been issued from the respective home station. The incomecertificate issued or affidavit made from the place where the student is studying,as against the home station, will NOT be acceptable (in case of photocopy, itshould be attested by Gazetted Officer or Head of Institution).

4. Nk=k dk d{kk & XI esa nkf[kyk iDdk ¼dUQeZ½ gksuk pkfg,A dkWyst@Ldwy }kjk tkjh dh xbZ nkf[kyk fLyi tgka blle; i<+ jgh gS] vkSj fu/kkZfjr izi= ¼layXud&I½ esa iz/kkukpk;Z }kjk dh xbZ tkap Hkh vkosnu i= ds lkFk vo';Hksth tkuh pkfg,AShould have Confirmed admission in class-XI. Admission Slip issued by the college/school where the student is presently studying and verification of the principal(Annexure-I), in the prescribed proforma must be sent with the application.

5. nkf[kyk nsus okyk fo'ofo|ky;@dkWyst@laLFkku] ljdkj }kjk dsUnzh; ;k jkT; Lrj vFkok fdlh vU; l{ke inkf/kdkjh}kjk ekU;rk izkIr gksuk pkfg,AThe University/College/Institute offering admission should be recognized by the

Government at the Central or State level or any other competent authority.

6. ;g dsoy ,d ckj ¼ouVkbe½ feyus okyh Nk=o`fr gS vkSj LFkk;h ykHkxzkgh ds :i esa dksbZZ nkok Lohdkj ugha fd;ktk,xkA Nk=o`fr ds fy, ,d ckj p;u dh xbZ Nk=k] dks nqckjk ;g Nk=o`fr iznku ugha fd;k tk;sxkAIt is one time scholarship, and no claim as permanent beneficiary will be entertained.

Student once selected for scholarship can not avail the same again.

7. tks Nk=k fdlh vU; lzksr ls Nk=o`fr izkIr dj jgh gSa og bl Nk=o`fr ds fy, ik= ugha gksxhAA student getting a scholarship from any other source would not be eligible for this

Scholarship.

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8. ekSykuk vktkn f'k{kk izfr"Bku ds dk;kZy; esa vkosnu i= tek djus dh vafre frfFk 31 vxLr vxLr vxLr vxLr vxLr gS] ftldk vo';gh ikyu fd;k tkuk pkfg,A 31 vxLr vxLr vxLr vxLr vxLr ds ckn izkIr gq, Nk=o`fr ds vkosnu dks fdlh Hkh gkyr esa Lohdkj ugh fd;ktk,xkA ;s izfr"Bku bl ekeys esa Mkd esa gqbZ nsjh ds fy, ftEesnkj ugha gksXkkAThe last date for receipt of application in the office of the Maulana Azad EducationFoundation is August 31st which must be adhered to. The application of the scholarshipreceived after 31st August, will not be entertained under any circumstances. MAEF willnot be responsible for postal delay in the matter.

9. Nk=o`fr dh dqy jkf'k : 12,000/- :i, ¼ckjg gtkj :i, ek=½ gksxh ftls : 6,000/- ¼:i;s Ng gt+kj dsoy½dh nks fdLrksa esa tkjh fd;k tk;sxkA igyh fdLr dk psd Nk=o`fr ds Lohd`fr ds ckn fn;k tk;sxk rFkk nwljh fdLrd{kk XI esa ikl dj d{kk XII esa izos'k ikus ds izek.k dks izfr"Bku ds dk;kZy; esa tek djkus ds ckn fn;k tk;sxkAThe amount of Scholarship will be Rs. 12,000/- (Rupees twelve thousand only) whichwill be released in two installments of Rs. 6,000/- each. The first installment will bereleased after sanction of scholarship and the second installment will be released whenthe student will submit proof of passing class XIth, and adminsson to Class XIIth in theoffice of the Foundation.

10. ;g Nk=o`fr] d{kk -X dh ijh{kk ikl djus ds ckn ml o"kZ XI oha d{kk esa nkf[kyk ysus] ij nh tkrh gSs ckn ds o"kksZaesa nkf[kyk ysus okyh Nk=kvksa ls izkIr vkosnu i= Lohdkj ugha fd, tk,xsaAThe scholarship is given to student passing Xth exam and taking admission in XIth in theyear when result of Xth exam is declared. Applications received in subsequent years willnot be entertained.

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vkosnu i= izkIr djus dh vfUre rkjh[k % 31 vxLrLast Date for Receipt of Application Form : 31st August

ekSykuk vkt+kn f'k{kk izfr"BkuMAULANA AZAD EDUCATION FOUNDATION

vYila[;dksa ls lacf/kr es/kkoh Nk=kvksa ds fy, ekSykuk vkt+kn jk"Vªh; Nk=o`fr gsrq vkosnu i=APPLICATION FORM FOR MAULANA AZAD NATIONAL SCHOLARSHIP FOR MERITORIOUS

GIRLS STUDENT BELONGING TO MINORITIES

iathdj.k la- /Reg. No.a----------------------------------

uksV % lHkh dkWye vo'; gh Hkjs tk,aA tgka vko';d gks ^^ykxw ugha** fy[ksaA v/kwjs ;k lefFkZr nLrkostksa ds fcuk izkIr vkosnuksa dks Lohdkjugha fd;k tk,xkA lHkh nLrkost fgUnh@vaxzsth esa nsus gksaxsA Nk=k dk laidZ VsyhQksu la- nsuk vR;ar vko';d gS% orZeku Ldwy@dkWyst dk Qksula- Hkh nsuk vko';d gSANOTE: All colums must be filled. Write NOT APPLICABLE where necessary. Application received in an incomplete form orwithout supporting document will not be entertained. All documents will be required in Hindi/English version. It is absolutelynecessary to give contact telephone number of the student; present School/College Telephone no. must also be given.

1) ukeName

2) tUe LFkku ,oa tUe frfFkPlace & date of birth

3) jk"Vªh;rk vkSj jkT; ftllsvkosnd lacf/kr gSNationality &the State to which the applicant belongs

4) /keZ ¼nLrkosth lcwrvfuok;Z gS½Religion (compulsory with documentary evidence)

5) iwjk irk % ¼d½ orZekuFull Address: (a) Present

ftyk / District

jkT; / State

VsyhQksu ua0 / Telephone No.

¼;fn vko';d gks rks] ih- ih- uEcj nsa½ (If necessary, give PP no.)

¼[k ½ LFkkbZ (b) Permanent

ftyk / District

jkT; / State

VsyhQksu ua0 / Telephone No.

¼;fn vko';d gks rks] ih- ih- uEcj nsa½ (If necessary, give PP no.)

Ldwy ds iz/kkukpk;Z ls izekf.krgky dh ikliksVZ vkdkj

dh QksVks fpidk,a

fiudksM/Pin Code

fiudksM/Pin Code

Affix Recent PassportSize Photographattested by the

Principal of the School

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(7)

6) ¼d½ firk dk iwjk uke(a) Father’s Full Name

¼[k½ vfHkHkkod dk uke(b) Guardian’s Name

¼x½ firk@ifr ds laj{kdu gksus dk dkj.k

(c) Reasons for father/husband Not being the guardian

7) firk@laj{kd dk O;olk;Occupation of father/Guardian

¼d½ lfoZl ds ekeys esa i) in(a) In case of Service: i) Designation

ii) dk;kZy; dk irkii) Office Address

iii) osrueku ¼xzsM½iii) Pay-Scale (grade)

iv) ewy osruiv) Basic Pay

v) HkÙksv) Allowancesvi) dqy ekfld vk;vi) Total emoluments (monthly)

vii) vU; lzksrks ls vk;vii) Income from other sources

v) ekrk dh vk;] ;fn dksbZ gSv) Mother’s income, if any

vi) iSu la- ¼;fn vk; dj nsrs gSa½vi) PAN No. (if income-tax payee*)

firk / Father

ekrk / Mother

vfHkHkkod / Guardian

¼[k½ d`f"k ds ekeys esa(b) In case of Agriculture:

i) dqy Hkwfei) Total land holding

ii) flafprii) Irrigated

iii) vflafpriii) Non-irrigated

iv) LFkku ¼irk½iv) Located at (address)

v) vU; Hkwfe laifÙkv) Other landed property

vi) dqy vk; ¼okf"kZd½vi) Total income (Annual)

vii) iSu la- ¼;fn vk; dj nsrs gSa½vii) PAN No. (If Income-tax payee*)

viii) dqy ifjokfjd vk; ¼okf"kZd½viii) Total family income (annual)

¼x½ fctusl ds ekeys i) fdLe(c) In case of Business:i) Type:

ii) LokfeRo@Hkkxhnkjhii) Ownership/Partnership

iii) nwdku@dk;Z'kkyk dk LokfeRoiii) Ownership of shop/workshop

iv) irkiv) Address

v) Hkwfe okyh lEifÙkv) Landed Property

vi) dqy vk; ¼okf"kZd½vi) Total income (Annual)

vii) iSu la- ¼;fn vk; dj nsrs gSa½vii) PAN No. (If Income-tax payee*)

viii) dqy ifjokfjd vk; ¼okf"kZd½viii) Total family income (annual)

¼?k½ fdlh vU; O;olk; vkfn ds ekeys esa %(d) In case of any other profession etc.

8½ eSfVªd ;k lerqY; ds vkjaHk ls ikl dh xbZ lHkh ijh{kkvksa dk fooj.k %Particulars of all examination passed commencing with the Matriculation or equivalent Examination :

ijh{kk dk ukeName of Examination

(1) (2) (3) (4) (5)

fo'ofo|ky;@cksMZUniversity / Board

o"kZYear

jksy ua-Roll No.

izkIr vadks dkizfr'kr

% Age ofMarks obtained

9) ¼d½ Ldwy@dkWyst dk uke o iwjkirk tgka Nk=k vHkh i<+ jgh gS(a) Name & full address of the

School/College where thestudent is Presently enrolled

ftyk / District

jkT; / State

VsyhQksu ua- ¼vfuok;Z gS½Telephone No. (Compulsory)

fiudksM/Pin Code

(8)

[k½ fo'ofo|ky;@cksMZ dk ukeftlds lkFk ;s laLFkku lac) gS

(b) Name of the University/Board withWhich the institution is affiliated to

¼x½ nkf[kys dh rkjh[k(c) Date of Admission¼?k½ d{kk@o"kZ ftlesa vkosnd vHkh

i<+ jgh gSa(d) Class/Year in which the applicant is presently studying¼M½ ikB;Øe bldh vof/k vkSj

fy, x, fo"k;(e) Course its duration & and Subjects taken¼p½ nku ds Hkqxrku ;k [kqyh

izfr;ksfxrk@eSfjV ds ek/;e lsnkf[kyk gqvkA

(f) Admitted through payment of Donation orthrough open Competition/merit

10) ;fn vkosnd fdlh dsUnz@jkT; ljdkj ds fo'ofo|ky; ;k fdlh vU; laLFkku@,stsalh O;fDr ls dksbZ vU; Nk=o`fr@_.k@'kSf{kd lgk;rkizkIr dj jgh gS rks mldh ekfld nj rFkk nsus dh rkjh[k lfgr iwjk fooj.k nsaIf the applicant is in receipt of any other scholarship/loan scholarship / educational aid from Central / State Govt.University or from any other Institution/Agency/Person, then full particulars should be given including the monthlyrate and the date of award etc.

11) fgUnh@vaxzsth esa vfuok;Z :i ls layXu fd, tkus okys nLrkostksa dh lwph %List of documents to be attached compulsorily in Hindi/English version:¼d½ vk; izek.ki=@'kiFki= ¼layXud&II ds vuqlkj½ ( )(a) Income Certificate/Affidavit (as per Annexure-II)¼[k½ orZeku Ldwy@dkWyst ds iz/kkukpk;Z }kjk izekf.kr Xth d{kk dh vad lwph ( )(b) Mark sheet of class Xth attested by the Principal of present School/College¼x½ orZeku Ldwy@dkWyst ds iz/kkukpk;Z }kjk tkap ¼layXud&I ds vuqlkj½ ( )(c) Verification by the Principal of present School/College (as per Annexure-I)¼?k½ orZeku Ldwy@dkWyst ds iz/kkukpk;Z }kjk izekf.kr QksVks ( )(d) Photo attested by the Principal of present School/College¼M+½ orZeku Ldwy@dkWyst ds iz/kkukpk;Z }kjk izekf.kr /keZ@tkfr ds izek.k dk izek.ki= ( )(e) Proof of Religion certificate attested by the Principal of present School/College

12) eSa ,rn}kjk ;g ?kks"k.kk djrh gw¡ fd esjs }kjk bl vkosnu i= esa fn;k x;k fooj.k esjh tkudkjh vkSj fo'okl ds vuqlkj lR; ,oa lghgSA eSa ;g tkurh gw¡ fd ;fn mDr vkosnu esa fn;k x;k fooj.k xyr gS rks eq>s tkylkth gsrq Hkkjrh; naM lafgrk ds rgr ltk ds lkFk&lkFknaMkRed dkjZokbZ dk lkeuk djuk gksxkA ;fn eSa ekSykuk vktkn jk"Vªh; Nk=o`fr ds fy, p;fur gksrh gw¡ rks eSa bl Nk=o`fr dh fuca/ku,oa 'krksZa dk ikyu d:axhA ;fn mDr lwpuk iw.kZr;k ;k vkaf'kd :i ls xyr ikbZ tkrh gS rks Nk=o`fr dh iwjh jkf'k esjs ls ,deq'r olwyhdh tk ldrh gSAI hereby declare that the statements made by me in this application form are true and correct to the best of myknowledge & belief. I am aware that if there are false statements in the foregoing application, I am liable to beprosecuted under the Indian Panel Code for forgery as well as any other panel consequences. I further agree toabide by the terms and conditions of the scholarship if selected for the Maulana Azad National Scholarship. Theentire amount of Scholarship can be recovered in lump sum from me in case the above information is found fullyor partially incorrect.

fnukad / Place--------------------------------------- ¼vkosnd ds grk{kj½(Signature of applicant)

LFkku/Date:---------------------------------------------

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layXud &AAnnexure – I

Ldwy@dkWyst ds iz/kkukpk;Z }kjk tkap fd;k tkus okyk QkeZ*VERIFICATION FORM BY PRINCIPAL OF SCHOOL/COLLEGE*

¼;s QkeZ Ldwy@dkWyst ds iz/kkukpk;Z }kjk Hkjk ,oa gLrk{kj fd;k tk,xk tgka bl le; Nk=k@vkosnd i<+ jgh gS½(To be filled and signed by the Principal of the school/college where the student/applicant is presently studying).

(i) izekf.kr fd;k tkrk gS fd dqekjh ------------------------------------------------------------------------------------------------------lqiq=h Jh------------------------------------------------------------------------------------------------------------------------------dks bl Ldwy@dkWyst esa fu;fer ,oa iw.kZdkfyd Nk=k ds :i esa **--------------------------------------------------------------------oxZ esa d{kk@ikB;Øe --------------------------------- esa rkjh[k ----------------------------- dks nkf[kyk fn;k x;k gS vkSj bl le;og 'kS{kf.kd l= ----------------------------------------- esa d{kk@o"kZ ---------------------------------------esa i<+ jgh gSACertified that Miss……………….......................……………..daughter/ward of …..…………………………………..

has been admitted in the School/College against**……………….………......…………………as a regular and full

time student in Class/course…………………………...…….……….on………..……………………and is at present

studying in class/ Year………………….........….in the academic session…………..…………………

(ii) og dsUnz@jkT; ljdkj@fo'ofo|ky; ;k fdlh vU; laLFkku@,stsalh@O;fDr ls ---------------------------------------- :i;s dh nj ls¼-------------------------------------------------- :i;s½ Nk=o`fr@'kSf{kd _.k lgk;rk izkIr dj jgh@ugha dj jgh gSAShe is/is not in receipt of Scholarship/educational Loan aid from………………………………. @ Rs……………..

(Rupees……………………………………………….only) per month/per annum from Central/State Govt. University

or from any other Institution/Agency/Person.

(iii) ;g vkSj izekf.kr fd;k tkrk gS fd bl laLFkku esa Nk= ds nkf[kyk fjdkMZ esa fyf[kr buds firk@vfHkHkkod dk uke irk rFkk O;olk;---------------------------------------------------------------------------------------------- gSaAIt is further certified that the name, address & occupation of the Father/Guardian mentioned in the admission

record of the student in this Institution is……………………………

(iv) og ---------------------------------------------------------------------------------------- leqnk; ¼vFkkZr eqfLye@bZlkbZ@fl[k@ckS)@ikjlh½ls lacaf/kr gSAShe belongs to………………………………..community (i.e. Muslim/Christian/Sikh/Buddhist/Parsi)

¼Ldwy@dkWyst ds iz/kkukpk;Z dh eksgj lfgr gLrk{kj ,oa iwjk uke½ (Signature and Full Name with Seal of Principal of the School/College)++

uke / Name:...............................................................................Ldwy@dkWyst / School/College............................................................iwjk irk / Full Address....................................................................ftyk /Distt............................................ jkT; /State.......................Qksu@eksckbZy la- Ph./Mobile No.***(Compulsory)......................................

* bl tkap QkeZ dks gLrk{kj djus ls igys Nk=k ds nkf[kyk fjdkMZ ds vuqlkj vkosnu i= dh tkap dj ysaA ;g vo'; gh tkap dh tk, fdfirk@vfHkHkkod ds vk; okys dkWye esa fn, x, fooj.k] O;olk;@/keZ ml laLFkku tgka Nk=k i<+ jgh gS] esa miyC/k fjdkMZ ls feyrk gSAThe application must be scrutinized as per the admission record of the student before signing the verification form.It must be verified that the statements made in the income column of the father/guardian, the occupation/religiontallies with the records available if any, in the institution where the student is studying.

** d`i;k ;gka nkf[kys dk oxZ] fo'ks"k :i ls mYys[k djsa tSls fd isesaV lhV] fu'kqYd lhV] vkjf{kr lhV] lkekU; eSfjV vkfnAPlease specifically mention here the category of admission like against payment seats, free seats, reserved seats,general merit etc.

*** laidZ VsyhQksu la- ¼ySaMykbu vkSj eksckby nksuksa½ Hkh vo'; fy[ks tkus pkfg,AContact Telephone no. (both landline and Mobile) must be mentioned.

LFkku /Place :....................

rkjh[k / Date:....................

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layXud &AAAnnexure – II

vk; ds 'kiFki= ds fy, uewukSPECIMEN FOR INCOME AFFIDAVIT

(20 #i;s ds xSj&U;kf;d LVki isij ij Vkbi fd, tkus okyk uewuk½(Specimen to be typed on Rs. 20/- Non-judicial Stamp paper)

eS Jh@Jherh ----------------------------------------------------------------------------- tks---------------------- dk firk@laj{kd

gw¡ rFkk ------------------------------/keZ ls laEcf/kr gwa vkSj iwjk irk ------------------------------------------------------------

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

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

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

-------------------------------------------------------------------- ftyk --------------------------------------------------- fiu

dksM -------------------------------------------------- jkT; ----------------------------------------- ¼tks ekSykuk vktkn f'k{kk

izfr"Bku] ubZ fnYyh }kjk izLrkfor ekSykuk vktkn jk"Vªh; Nk=o`fr ;kstuk ds rgr Nk=o`fr ds fy, ,d mEehnokj gS½ ,rn }kjk ;g

?kks"k.kk djrk gw¡ fd fiNys o"kZ 31 ekpZ] 20...................... dks lekIr gq, o"kZ esa esjh /keZiRuh dh vk; lfgr esjh dqy vk;

-------------------------------------- #i;s ¼--------------------------------------------- #i;s½ FkhA vk; dk C;kSjk bl izdkj gSA

I, Shri/Smt…………………………………………………..Father/Guardian of…………………………………………

belonging to…………………......…….. religion, full Address………..............……………………………......…….

……………………………………………………...…………..Distt…………….......……….………………..

Pin Code………………….…… State…………………………............………… (a candidate for scholarship under

Maulana Azad National Scholarship Scheme offered by Maulana Azad Education Foundation, New Delhi)

hereby declare that my total income including income of my spouse in the preceding year ended on

March, 31st, 20…….., was Rs………............. (Rupees…………………………………………...................only).

The break-up of the income is as follow:

(1) d`f"k :Agriculture

(2) vU; Hkwfe laifÙk :Other Landed Property

(3) fctusl :Business

(4) dksbZ vU; O;olk; ¼Li"V djsa½ :

Any other profession (Specify)

eS vk;dj dk Hkqxrku ugaha djrk gw¡ ;k eSa vk;dj nsrk gw¡ vkSj esjk iSu la- ------------------------------------------------------------ gSAI am not an Income Tax payee or I am an Income Tax payee and my PAN No. is.....…………………...........…………

¼ekrk firk@vfHkHkkod dk uke vkSj gLrk{kj/Name & Signature of the Parent/Guardian)

¼eftLVsªV @ uksVªh ifCyd dk uke vkSj gLrk{kj/Signature with seal of Magistrate / Notary Public)

uksV % (1) ;fn ekrk vkSj firk nksuksa dk;Zjr gSa rks nksuksa dk osru izek.ki= vko';d gksxkA

(2) vk; vkSj vk; dk lzksr ds C;ksjs dk mYys[k djuk vko';d gS ftlds fcuk vkosnu i= ij fopkj ugh fd;k tk,xkANote: (1) In case both the parents are working, salary certificate of both would be required.

(2) The break-up of Income & Source of Income is necessary to be mentioned, without which application will notbe considered.

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layXud &AAAAnnexure – III

cksMksZa @ ifj"knksa dh lwphLIST OF BOARDS/COUNCILS

(1) vka/kz izns'k ek/;fed f'k{kk cksMZ] vka/kz izns'kAAndhra Pradesh Board of Secondary Education, Andhra Pradesh.

(2) v:.kkpy izns'k ek/;fed f'k{kk cksMZ] v:.kkpy izns'kAArunachal Pradesh Board of Secondary Education, Arunachal Pradesh.

(3) ek/;fed f'k{kk cksMZ] vleABoard of Secondary Education, Assam.

(4) fcgkj Ldwy ijh{kk cksMZ] fcgkjABihar School Examination Board, Bihar.

(5) NÙkhlx<+ ek/;fed f'k{kk cksMZ] NÙkhlx<+AChattisgarh Board of Secondary Education, Chattisgarh.

(6) xksok ek/;fed ,oa mPprj ek/;fed f'k{kk cksMZ] xksokAGoa Board of Secondary & Higher Secondary Education, Goa.

(7) xqtjkr ek/;fed ,oa mPprj ek/;fed f'k{kk cksMZ] xqtjkrAGujarat Secondary & Higher Secondary Education, Gujarat.

(8) gfj;k.kk f'k{kk cksMZ] gfj;k.kkAHaryana Board of Education, Haryana.

(9) fgekpy izns'k Ldwy f'k{kk cksMZ] fgekpy izns'kAHimachal Pradesh Board of School Education, Himachal Pradesh.

(10) tEew ,.M d'ehj jkT; Ldwy f'k{kk cksMZ] tEew ,.M d'ehjAJ. & K State Board of School Education, Jammu & Kashmir.

(11) >kj[kaM ek/;fed f'k{kk cksMZ] >kj[kaMAJharkhand Board of Secondary Education, Jharkhand.

(12) dukZVd ek/;fed f'k{kk cksMZ] dukZVdAKarnataka Secondary Education Examination Board, Karnataka.

(13) dsjy ifCyd ijh{kk cksMZ] dsjyAKerala Board of Public Examination, Kerala.

(14) e/; izns'k ek/;fed f'k{kk cksMZ] e/; izns'kAMadhya Pradesh Board of Secondary Education, Madhya Pradesh

(15) egkjk"Vª jkT; ek/;fed ,oa mPprj ek/;fed f'k{kk cksMZ] egkjk"VªAMaharashtra State Board of Secondary & Higher Secondary Education, Maharashtra.

(16) ef.kiqj Ldwy ijh{kk cksMZ] ef.kiqjAManipur Board of School Education, Manipur.

(17) es?kky; Ldwy f'k{kk cksMZ] es?kky;+AMeghalaya Board of School Education, Meghalaya.

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(18) fetksje Ldwy f'k{kk cksMZ] fetksjeAMizoram Board of School Education, Mizoram.

(19) ukxkySaM Ldwy f'k{kk cksMZ] ukxkySaMANagaland Board of School Education, Nagaland.

(20) mfM+lk ek/;fed Ldwy f'k{kk cksMZ] mfM+lkAOrissa Board of Secondary Education Orissa.

(21) iatkc Ldwy f'k{kk cksMZ] iatkcAPunjab School Education Board, Punjab.

(22) jktLFkku ek/;fed f'k{kk cksMZ] jktLFkkuARajasthan Board of Secondary Education, Rajasthan.

(23) flfDde ek/;fed f'k{kk cksMZ] flfDdeASikkim Board of Secondary Education, Sikkim.

(24) rfeyukMq ek/;fed f'k{kk cksMZ] rfeyukMATamil Nadu Board of Secondary Education, Tamil Nadu.

(25) f=iqjk ek/;fed f'k{kk cksMZ] f=iqjkATripura Board of Secondary Education, Tripura.

(26) ;w- ih- gkbZ Ldwy ,oa baVjehfM;sV f'k{kk cksMZ] mÙkj izns'kAU.P. Board of High School & Intermediate Education, Uttar Pradesh.

(27) mÙkjk[kaM ek/;fed f'k{kk cksMZ] mÙkjk[kaMAUttaranchal Board of Secondary Education, Uttranchal.

(28) if'pe caxky ek/;fed f'k{kk cksMZ] if'pe caxkyAWest Bengal Board of Secondary Education, West Bengal.

vf[ky Hkkjrh; cksMZ@ifj"knsaALL INDIA BOARDS / COUNCILS

(1) vyhx<+ eqfLye fo'ofo|ky;] vyhx<+A

Aligarh Muslim University, Aligarh.

(2) dsUnzh; ek/;fed f'k{kk cksMZ] fnYyhACentral Board of Secondary Education, Delhi.

(3) Hkkjrh; Ldwy izek.ki=k ijh{kk ifj"knACouncil for the Indian School Certificate Examinations.

(4) tkfe;k fefy;k bLykfe;k] ubZ fnYyhAJamia Millia Islamia, New Delhi.

(5) jk"Vªh; vksiu Ldwy] fnYyhANational Open School, Delhi.

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