to download ICT-Registration Form 2013 - COMSATS Institute of ...

SECTION 3: PERSONAL INFORMATION:a) Name in Full:b) CNIC #: ‐ ‐ (Write your own CNIC No. or B Form No.)c) Father’s Name:d) Father’s CNIC #: ‐ ‐ (Write your father’s or guardian’s CNIC Number)e) Father’s /Guardian’s Occupation:d d m m y y y yf) Date of Birth: ‐ ‐ g) Gender: Male Female(Area Code ‐ Tel. Number for example 0157‐2919456) (Keep this number active for correspondence)h) Telephone No.: Mobile: ‐i) Email:j) Postal Address:k) Union Council:l) City/Town/Village:m) Tehsil/Taluka:n) District/Agency:(Provide Agency Name in case of FATA)o) Province/Region: Punjab Balochistan Islamabad(Rural)Sindh FATA AJ&KKhyber PakhtunkhwaGilgit BaltistanSECTION 4: ACADEMIC INFORMATION:a) Provide six digit code of your school/college from where you attended F. Sc. classesas a regular student.Six digit code can be found in the list of registered schools/colleges available at www.ictrdf.org.pk/scholarship. Forfurther help, dial 0304‐899 1341, 0304‐899 1342, 0305‐588 4499, 0341‐517 8798b) School/College attended during F. Sc.: (Specify the name of school/college from where you attended F. Sc. classesas a regular student.)School/College Name:Page [3] of [5]

Please read instructions as given above and provide admission information below:a) University Name:b) Campus:c) City:d) Discipline / DegreeTitleEnrolment / Admission:Fall 2012 IntakeSpring 2013 Intakee) Date of Admission:e) University Registration No.:SECTION 6: ATTESTATION BY AUTHORIZED REPRESENTATIVE OF UNIVERSITY:It is certified that above information regarding admission of applicant as provided in “SECTION 5”; is correct and he/she is abonafide student of the university.Name:Signature & Stamp:Designation: Date:University:SECTION 7: UNDERTAKING:It is solemnly affirmed that all the information provided herein this Scholarship Application Form is correct. If any informationcontained herein is found to be untrue, I shall be liable to any disciplinary action including rejection of this Scholarship ApplicationForm or cancellation of Scholarship/Financial Assistance by National ICT R&D Fund for Prime Minister’s National ICT ScholarshipProgram 2012. If approved, I shall use this Scholarship up to the best of my knowledge and abilities and after completion of studies; Ishall serve my country for at least two years.I further affirm that I have read, understood and shall abide by all the instructions provided in this Scholarship Application Form.I also understand and agree that all decisions made by National ICT R&D Fund related to Prime Minister’s National ICT ScholarshipProgram 2012 would be final and binding upon me.Applicant’s SignatureName:Stamp & Signature:ATTESTATION BY GAZZETTED OFFICERCNIC Number:PLEASE NOTE:Any information by the Applicant provided in the course of obtaining Scholarship shall be accurate, without omission of any relevant facts and notmisleading. If any error or omission is found in the information supplied in acquiring this Scholarship, Applicant shall not be offered a Scholarship,or he/she may have Scholarship withdrawn or terminated. For verification and other purposes pertinent to the Prime Minister’s National ICTScholarship Program 2012, Applicant’s information will be shared with relevant authorities and related personnel.National ICT R&D Fund (“Company”) reserves the right to amend or alter any of the terms and conditions with respect to the Prime Minister’sNational ICT Scholarship Program 2012 (“Program”). Final decisions pertaining to the Program rest with the Company.Page [5] of [5]