Download - Department of Higher Education
Download - Department of Higher Education
Download - Department of Higher Education
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11. Aadhar Card / Aadhar Registration No. ..........................................................................<br />
12. Registration No. <strong>of</strong> the student ........................................………………………………<br />
13. Name <strong>of</strong> the Bank …Acc. No.(Latest Bank Statement attached ***)……………………IFSC Code<br />
**** …………………………………………………………………………..…………<br />
14. Whether student is admitted against regular seat /paid Seat ….........................…………….<br />
15. Income <strong>of</strong> the Parents/Guardian from all sources (Certificate be attached) PA…….……….<br />
16. Day Scholar/Hosteller*****………………………………………………………………<br />
( Sr. No. 17 to 19 to be filled by the Directorate <strong>of</strong> Hr. Edu.)<br />
17. Amount <strong>of</strong> Scholarship (Maintenance allowance for PMSS)……………………………….<br />
18. Amount <strong>of</strong> non-refundable Fees only (Recommended by the competent<br />
authority******)……………………………………………………………………………….<br />
19. Total Refundable amount (Sr. No. 17+18)…………………………………………………<br />
Declaration<br />
I hereby declare that all statements made in this application are true and correct to the best <strong>of</strong><br />
knowledge and belief. Neither I am in receipt <strong>of</strong> any scholarship from any other source nor I am<br />
working anywhere I understand that in the event <strong>of</strong> particulars /information given herein being found<br />
false or incorrect my claim for award <strong>of</strong> scholarship is liable to be rejected or cancelled and in the event<br />
<strong>of</strong> discrepancy being detected after the award <strong>of</strong> scholarship, I shall be liable to refund the entire<br />
amount <strong>of</strong> scholarship/fee with interest @ 18% and the department will be free to initiate legal action<br />
against me.<br />
.<br />
Signature <strong>of</strong> Parents/Guardian<br />
Signature <strong>of</strong> the student<br />
Signature <strong>of</strong> warden<br />
Signature <strong>of</strong> Principal/Head <strong>of</strong> Institution<br />
With seal<br />
with seal<br />
(In case <strong>of</strong> hostler for PMSS/IRDP)<br />
……………………………………………………………………………………………………………<br />
Mandatory list <strong>of</strong> enclosures:-<br />
* Caste certificate, attached in original duly signed by the competent authority for Post<br />
Matric Scholarship Scheme (SC/ST/OBC) / Attached Caste certificate & Bonafide<br />
Certificate for all Scholarship Schemes.<br />
** Attested copy <strong>of</strong> certificate, diploma, degree etc. in respect <strong>of</strong> all/previous examination<br />
passed.<br />
*** Bank Statement must be attached for verification <strong>of</strong> student A/C No & Branch Name.<br />
**** IFSC code is must for online payment <strong>of</strong> scholarship amount in the Student’s A/C.<br />
***** Hostel verification must be verified by the Hostel Warden in the prescribed forms.<br />
****** Copy <strong>of</strong> Fees Structure and affiliation <strong>of</strong> Institution in case <strong>of</strong> Post Matric SC/ST/OBC<br />
scholarship must be attached.<br />
.................................................................................<br />
Receipt<br />
Received a sum <strong>of</strong> Rs............ (Rupees.............................................................................) on<br />
account <strong>of</strong> Scholarship amount through Cheque / RTGS/NEFT. No. ....................... Dt.
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