prime minister's scholarship scheme acknowledgement slip ...

2MINISTRY OF DEFENCEDepartment of Ex-Servicemen WelfarePM’S SCHOLARSHIP SCHEMEFORDEPENDENT WARDS / WIDOWS OF EX-SERVICEMENAND EX-INDIAN COAST GUARDBrochure-Cum-Application FormFor Academic Year 2010-11Application Form consists of Col No 1 to 19, Renewal Form and list of RSB / CoastGuard Headquarter at state and UT level. (Brochure-Cum-Application form consists of32 pages)KENDRIYA SAINIK BOARDWest Block-IV, Wing-VII, 2 nd FloorR K Puram, New Delhi-110066Website: www.mod.nic.inE-Mail: jdpmscholarshipksb@gmail.comNote: This application form (page number 13 to 19 alongwith required documents only) is to bedeposited by individual to respective RSB / Directorate General of Coast Guard. Applicationsduly recommended by RSB’s / Directorate General of Coast Guard shall only be considered byKSB. Therefore, candidates are advised not to forward applications directly to KSB as the sameshall not be considered and will be returned unactioned to individual.

31. Introduction.PRIME MINISTER’S SCHOLARSHIP SCHEMEPrime Minister’s Scholarship Scheme has been introduced from the Academic year2006-07. To encourage higher technical and professional education for the dependentwards 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 inharness due to causes attributable to military service / Coast Guard Service,irrespective of the rank.2. Scholarships Available.A total number of 4000 scholarships will be allotted.3. Students eligible for the scholarship.(a)Dependent wards of ex-servicemen / Ex-Coast Guard and their widows (belowofficer rank only)(b) Dependent Wards / widows of Ex-servicemen & Ex-Coast Guard who died inharness due to causes attributable to military service / coast guard service,irrespective of the rank.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 theapplications 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 the envelope“Prime Minister’s Scholarship Scheme for the Academic Year 2010-11.”Documents to be attached alongwith PMSS application form are as follows:-(a)(b)(c)Photocopy of Ex-servicemen / Ex-Coast Guard valid I card duly certified byRSB / ZSB / Coast Guard Headquarter as applicable.Extract of Ex-servicemen / Ex-Coast Guard discharge book as per specimen.(Refer page number 22)Matriculation certificate duly attested.

4(d)(e)Minimum Entry Qualification certificate duly attested. (10+2 Marksheet or fullGraduation Marksheet which ever is applicable)Bonafide studentship certificate from Collage in original as per specimen. (Referpage number 21)(f) Postal Order of Rs. 30/- not issued before 01 st January 2011.Note: Failure to attach above mentioned documents / certificate will lead to rejection.5. Selection Procedure.Applications will be short listed based on Ex-servicemen / Ex-Coast Guard category(as given in para 6) 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 1Category 2Category 3Category 4Category 5Category 6Wards/ widows of defence / Coast Guard personnel killed inaction.Wards of Ex-servicemen / Ex-Coast Guard disabled in action andboarded out of service with disability attributable to Military / CoastGuard service.Wards / widows of defence / Coast Guard personnel who diedwhile in service for causes attributable to Military / Coast Guardservice.Wards / widows of ESM / Ex-Coast Guard personnel disabled inservice with disability attributable to Military / Coast Guard service.Wards of ex-servicemen / Ex-Coast Guard in receipt of gallantryawards.Wards of ex-servicemen / Ex-Coast Guard (PBOR).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 government regulatory bodies,such as All India Council for Technical Education, Medical Council of India, UGC etc(master degree course are not eligible to apply for Prime Minister’s Scholarshipexcept MBA, MCA). The scheme is open for courses mentioned above in recognizedinstitutions (in India only). Students studying abroad are not eligible for thisscheme. Students getting stipend for the professional degree course are also notentitled. The candidates may avail only scholarship for first degree course(Professional) i.e. graduate level only under PMSS.

58. Scholarship for Integrated Courses.The facility under PMSS is restricted for professional courses only, such as B Ed butnot for BA+B Ed, also for LLB not for BA+LLB duly recognized by the respectiveGovernment regulatory bodies such as All India Council for Technical 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 course isdifferent e.g. for MBBS and B E it is 10+2 where as it is graduation for B Ed and MBA.A candidate must have minimum 60% marks in MEQ to be considered for scholarship.10. Duration of Scholarship.Two to five years as approved by the concerned regulatory body (Except one year forB Ed).11. Amount of Scholarship.a) The amount of scholarship would be as follows:(i) Rs. 1250/- per month for boys Paid after successful completion of eachacademic year.(ii) Rs. 1500/- per month for girls12. Renewal of Scholarship.Candidate shall submit new Renewal Form alongwith two acknowledgement slip, BonafideCertificate (as per Specimen) duly signed by the Principal / Dean / Registrar of the institution/ college and Photocopy of Passbook to the respective RSBs / Coast Guard Headquartereither in person or by post for renewal of scholarship for the subsequent academic year.RSBs / Coast Guard Headquarter will scrutinize and check the application forms andforward the same complete in all aspects to KSB immediately. RSBs / Coast GuardHeadquarter will issue acknowledgement slip to the candidates at the time of submission ofthe application in person or by post. Candidate to attach a self addressed envelope, dulystamped to receive the acknowledgement of renewal form by post. For easycomprehension an illustration has been given below:-Student admitted in B Tech. September 2010Marks in 10+2. 61%Applied for PMSS. Before 31 December 2010Finds his name in the list of 4000 successful candidates June 2011selected for grant of PMSS.Applied for first renewal of Scholarship by submitting first October 2011year / first two semester result.Granted first installment. December 2011

7IMPORTANT INSTRUCTIONS FOR PM’S SCHOLARSHIP SCHEMEIncomplete form / pages / column / documents will lead to rejection orreturned to RSB / Coast Guard Headquarter unactioned.(a) Checklist duly signed by student & parent is to be attached on the top of theapplication form.(b) Applications alongwith relevant documents & certificates are to be deposited torespective Rajya Sainik Board / Coast Guard Headquarter “latest by 28 th February2011. Incomplete application form and non submission of required document isliable to be rejected and will be returned unactioned. The application will bereceived by the RSBs / Coast Guard Headquarter and will be acknowledged with aseal and date of receipt.(c) The concerned RSBs / Coast Guard Headquarter to scrutinise / check theapplication forms with regard to their eligibility criteria prior to forwarding thesame to KSB.(d) Candidates and RSB’s / Coast Guard Headquarter to note that allapplications received after the due date will not be considered and returnedunactioned.(e) List of selected candidates will be forwarded to RSBs / Coast GuardHeadquarter after the merit list is finalized by the BOO at KSB.(f) Two stamped (Rs. 5 each) blank window envelopes of 27x12 cms are to beattached with each application so as to facilitate correspondence with the candidate byKSB / RSB / Coast Guard Headquater.(g) The scholarship is admissible for only two children of ESM / Ex-CoastGuard. Particulars of all children should be indicated in column 16 of application form.This should be in uniformity with the Discharge Book / Certificate of the Ex-servicemen/ Ex-Coast Guard.(h) The amount of scholarship, including any other scholarship or financialassistance from any other source will not exceed the total grant of assistance availableunder this scheme.(i) The payment of scholarship will be granted after the successful completion ofeach academic year and on the submission of the renewal form (in original), as per thepercentages mentioned in ‘Criteria for eligibility’. In case, KSB ask a student to submitthe mark sheet for the full year, a student is liable to produce the same, failing whichthe scholarship will be held up. On receipt of renewal for at KSB it may takeapproximately two months for processing the form and completing the paymentprocedure.(j) Candidature of a student shall stand automatically rejected if, at anystage, it is discovered that he / she has secured scholarship fraudulently by

8making false statement or misrepresentation of facts. Candidate shall have torefund the amount already given, if any.(k) The attached photocopies of the supporting documents should be duly attestedby gazetted officer (unattested documents will not be considered). In case oflegally adopted son / daughter or child born after retirement, the certificates are to beattached with the application form duly attested by Secretary, RSB / ZSB / CoastGuard Headquarter.(l) In case of change of any address, course, college, it is to be intimatedimmediately to Kendriya Sainik Board & Rajya Sainik Board / Coast GuardHeadquarter in writing. Always mention selection serial number, name of applicantand ESM / Ex-Coast Guard particular for any correspondence with KSB & RSB /Coast Guard Headquarter after getting selected for the scholarship.(m) The Ministry of Defence, Government of India can suitably modify theseinstructions to remove anomalies, if any, for successful implementation of thescheme, as may be necessary from time to time and will be applicable to allstudents under the scheme.(n) Ex-servicemen entitlement will be governed as per the existing definition ofex-servicemen, as amended from time to time. The definition is available in the guidebook available with the RSB / ZSB, also applicable to Ex-Indian Coast Guardpersonnel as per the rules of DGCG.(o) The application form should be downloaded from the official website of MOD,i.e. www.mod.nic.in. The application form should be submitted to the respectiveRajya Sainik Board / Coast Guard Headquarter, (List of RSBs / COAST GUARDHEADQUARTER is attached along with the brochure) duly completed, along witha Postal Order (Repeat) Postal Order only for Rs.30/- in favour of Secretary,Kendriya Sainik Board, payable at New Delhi. In case of any difficulty in obtainingthe form, the same can be obtained from the Secretary / Director Rajya Sainik Board /Coast Guard Headquarter.*Note: - The Postal Order should not be issued before 01 st January 2011 (thePostal Order is not refundable in any case).(p) While filling the application form, leave 1 (one) box blank between 2 (Two)words. Column wise guidelines are explained further for filling up the application form.

9IMPORTANT INSTRUCTIONS FOR RENEWAL FORM(a) A Bonafide certificate from the College/Institute indicating that the candidatecontinues to study in the subject course and showing his / her percentage of marks forwhich the Prime Minister’s Scholarship has been sought (As per the specimen attach).(b) Photocopy of passbook showing name, account number with photograph ofindividual and cancelled leaflet cheque. (Scholarship will not be sent in absence ofphotocopy of passbook)(c) Candidate to attach a self addressed envelope, duly stamped to receive theacknowledgement of renewal form by post.

10(i)COLUMN WISE GUIDE LINES FOR FILLING UP OF APPLICATION FORMColumn -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(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 (Not for Ex-Coast Guard).(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 anyquery (email ID is must).(vii) Column – 7. Category as per para 6 to be written (attach the requireddocument, if any). Category 1 (One).Category - 1 O N E(viii) Column – 8. Full Particulars of Father/ Ex-Serviceman / Ex-Coast Guard isto be mentioned as per the discharge book. A blank space to be providedbetween 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 Y1 4 5 2 3 6 KS E R G E A N TA IR 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

11(in figure) 1 2 0 0b. Marks obtained N I N E H U N D R E D(in words) F O R T Y(in figure) 9 4 0c. % 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 YT H R E E(in figure) 7 8 . 3 3(x)Column – 10. Tick as applicale.Yes √ No(xi) Column – 11. The student is to specify the course which he / she is presentlystudying. (Example:- B TECH)B T E C H(xii) Column – 12. Duration of the course both in numbers and figures to bementioned (without Internship). For example 4 years 6 months.(In figure)Y Y M M0 4 0 6(In word)F O U R 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 shownbelow:(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(xiv) Column - 14 Write the full name and address of the college with email ID andphone number of principal.Name of Student A J A Y S I N G H R A N ARoll No. 0 8 E A T I T 0 4 3Name 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

12Full Address P U S H K A R B Y P A S S Aof college J M E RState R A J A S T H A NPin Code 3 0 5 0 0 4Tel No. (with STD Code) 0 1 4 5 - 2 3 0 0 6 2 8E-Mail ID (if any) a i t _ a j m e r @ r e d i f f m a il . c o MCollege 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 specimengiven:-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(xvii) Column – 17. Given details of the scholarship availed by your brother /sister in the past, if not availed write Not Applicable.Sl.No.Name of thebrother/sisterCourse ofStudySelectionSerial No.given by KSBAcademic yearin whichappliedAmountreceived so far1. 6359 Satish Singh Rana B Tech 2007-09 15000(xviii) Column – 18. Fill up attached Postal Order particulars.Postal Order No. 0 2 3 1 5 0Issue D D M M Y Y Y YAmount (Rs.) in figure 3 0 Date 1 4 1 2 2 0 1 0Amount (Rs.) in word T H I R T YNote: Application form from page number 13 to 19 alongwith required documents onlyto be forwarded.

13CHECK LIST OF DOCUMENTS TO BE ATTACHED WITHTHE APPLICATION FORM1. Candidates / ESM / Ex-Coast Guard are to ensure that the following documentsare attached (as applicable) along with the Application Form (non submission of thesecertificate will lead to rejection and application will be returned unactioned).(a) Attested copy of Ex-Serviceman / Ex-Coast Guard & Widow I-card issued by RSB/ ZSB / Coast Guard Headquarter.This is an important document to be attached.(b)Extract of ESM / Ex-Coast Guard discharge book as per specimen.(c) If child born after discharge then affidavit is to be submitted by ESM / Ex-CoastGuard, that child is dependent on him and he / she is a ward of ESM / Ex-Coast Guard.(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 / Coast(iv) Category 4: Part II Order Guard(v) Category 5: Award Certificatealongwith gazettenotification(e) Attested photocopy of matriculation or equivalent examination certificate forverification of date of birth.(f) Attested photocopy of mark sheet of MEQ as applicable (e.g. 10 plus 2, graduation/ diploma etc). In case the MEQ is graduation / diploma, then complete mark sheet is requiredto be submitted.(g) In case of MBA / MCA applicants, attested copy of minimum entry qualificationcertificate. i.e Graduation(h) Bonafide studentship certificate to be issued by Registrar / Dean / Principal ofCollege / Institution pertaining to course for which scholarship is claimed (As per specimenattach).(i) Postal Order of Rs. 30/- (Rupees Thirty only) attached. (Application form withoutPostal Order will not be processed and Postal Order should not be made before 01 stJanuary 2011.)Date: _____________________Place: ___________________________________________________Full Name & Signature of Candidate_______________________________________Checked / counter singed by ESM / Ex-Coast Guard / Widow

14FOR OFFICIAL (KSB) USE ONLYSignature of Supervisor/ IC PMSSRemarks of Supervisor________________________________________________________________________________________________________________________RECOMMENDED / NOT RECOMMENDEDRemarks of JD PMSS_______________________________Signature of JD PMSS___________________________________________________________________________________________________________________________________________________________Note:Selection Serial Number(To be allotted by KSB) ......................APPLICATION FOR PRIME MINISTER’S SCHOLARSHIP FOR THE YEAR 2010 - 11 ___.1.) Please read column wise guide lines carefully before filing the application2.) 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.RecentPhotographOf Student(Write your name &ESM/Ex-CoastGuard/widowparticular onreverse)1. NAME:-First NameMiddle NameSurname2. Put a tick mark (√)MaleLEAVE BLANK SPACE BETWEEN WORDSFemale

3. Date of Birth (please attach proof of age) (i.e : Matriculation certificate)DD MM Y Y Y Y154. Your Rajya Sainik Board or Zila Sainik Board (Where ESM is registered and obtained ExservicemenIdentity card)(Only for ESM)RSBZSB5. Full Address:a) Present Correspondence Address: - (Where you want your letter to be sent in case ofselection / rejection)House No.Street No. & NameTehsilDistrictStatePin Codeb) Permanent Address :-House No.Street No. & NameLEAVE BLANK SPACE BETWEEN WORDS

Tehsil16DistrictStatePin Code6. Telephone Number.STD CodeLand Line No.Mobile No.E-Mail (mandatory)7. Ex-servicemen / Ex-Coast Guard Category - (Mention category as per Para 6 of the brochureand attach supporting documents duly attested).8. Ex-serviceman’s / Ex-Coast Guard’s Particulars:-a) Name of ex-serviceman /Ex-Coast Guardb) Service No.c) Rankd) Type of Service (Tick one) Army Air Force Navy Coast Guard9. Details of MEQ / course for qualifying examination for scholarship (10+2/equivalentor minimum entry qualification)a. Name of Course/MEQb. Year in which exam passedc. Total Marks (in words)(in figure)LEAVE BLANK SPACE BETWEEN WORDS

d. Marks obtained (in words)17(in figure)e. % of marks scored (in words)(in figure)10. Whether the applicant is in receipt of any other financial assistance/scholarship/ fellowshipfrom any govt. / Private source for the course to which the scholarship applied for. If yes, thenstate the amount and source11. Name of the Course(as per specimen)Yes No Rs (per month / year)12. Duration of Course in Years in figureand monthsin words13. Date of Commencement and Approximate Date of Completion.a) Course commenced onD D M M Y Y Y Yb) Course completion dateapproximatelyD D M M Y Y Y Y14. Details of College / Institute.Name of StudentRoll No.Name of CollegeFull Addressof collegeLEAVE BLANK SPACE BETWEEN WORDS

State18Pin CodeTel No. (withSTD Code)E-Mail ID (if any)College Website15. Regulatory bodies/ Council. (For example all engineering degrees and managementdegree courses are recognized by AICTE & UGC and all medical degree are recognizedby Medical Council of India or Dental Council of India, specify as per case).16. Furnish particulars of all children in order of age, as reflected in the dischargebook or attached a certificate in case child born after discharge, by the RSB / ZSB /Record Office / Coast Guard Headquarter, as applicable.Sl. No. Name of Child Gender Date of Birth17. Details of brother/sister availing the PM’s Scholarship, if any. (Including yourself ifgranted earlier)Sl.No.SelectionSerial No.given by KSBName of thebrother/sisterCourse ofStudyAcademic yearin whichappliedAmountreceived so far18. Details of Postal Order.Postal Order No.Amount (Rs.) in figureIssue D D M M Y Y Y YDateAmount (Rs.) in wordLEAVE BLANK SPACE BETWEEN WORDS

1919. Declaration: “Certified that the particulars given by me in the application are correctand any false statement made by us will disqualify me / my ward for award of PM’sScholarship Scheme, besides recovery of scholarship already paid. I also undertake toabide 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) ___________________________

20CERTIFICATE FROM RSB / ZSB /DIRECTORATE GENERAL OF COAST GUARD“It is certified that PM Scholarship application form for academic year 2010 - 11 inrespect of Mr. / Ms. __________________________________________________________S/o / D/o Ex -____________________________________________________ has beenchecked, found correct as per check list provided by KSB and the applicant is eligible to applyas per rules of the scheme”.Office seal:Secretary / DirectorRSB / ZSB / Coast Guard HeadquarterPlace: ________________Date : ________________

21CERTIFICATE FOR PM SCHOLARSHIP1. It is certified that Ms. / Mr._____________________ is Bonafidestudent of __________________________________ college. His / Her rollnumber is __________ and he / she is studying in the I / II / III / IV / V yearor ______ 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 thecourse will be completed in the month of ____________ 20___ -___.2. This is also certified that _____________ course is a professionaldegree course and this college is approved by________________________________________________.3. This is also certified that student is getting Rs._____________ permonth / year (If not getting write N/A) scholarship / stipend from thisInstitute / College or any other sources.Office Seal:Signature of Principal / Dean / RegistrarDate:- ______________Place:-_____________

22SPECIMEN COPY OF EX-SERVICEMEN / EX-COAST GUARD CERTIFICATEEX-SERVICEMEN / EX-COAST GUARD CERTIFICATE(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 : _______________________________________Reserve11. ESM / Ex-coast Guard died on (if applicable) : _______________________________________12. Cause of death & : _______________________________________Whether Attributable to military / coast guard service13. Particulars of dependent children:-Sl.Name Gender Date of BirthNo.1.2.3.4.5.6.It is certified that the above information is duly checked from the discharge book of Exservicemen/ Ex-Coast Guard and found to be correct.Office Seal:Date: ________________________Place: ______________________Dir RSB/ZSB/OI/C Record Office/ Coast Guard Headquarter

23IMPORTANT INSTRUCTION FOR RENEWAL FORM1. Minimum Marks for Renewal of Scholarship.The candidates should have secured a minimum of 50% marks, uninterrupted forcontinuation of scholarship in every year for the duration of course up to a maximum period of5 years as prescribed for that programme of study. A person granted scholarship for oneprogramme would not be entitled for scholarship for another programme.* Note:- 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, Coast Guard Headquarter & KSB will not be calculatingthe percentage of marks).2. Account Details.All candidates to open individual bank accounts in the nearest State Bank of India branchor Punjab National Bank which has “electronic clearance system” / Core Banking, tofacilitate transfer of the scholarship amount. Account number of the sister concern bank willnot be accepted. i.e State Bank of Travancore, State Bank of Bikaner & Jaipur, etc.Candidate to attach a attested photocopy of passbook, showing name and account numberof the individual. A cancelled leaflet of a blank crossed cheque will duly authenticate theaccount number. A joint account with parent will also fulfill the requirement.DOCUMENTS TO BE ATTACHED WITH RENEWAL FORM:(a)(b)(c)A Bonafide certificate from the College/Institute indicating that the candidate continuesto study in the subject course and showing his / her percentage of marks for which thePrime Minister’s Scholarship has been sought (As per the specimen attach).Photocopy of passbook showing name, account number with photograph ofindividual and cancelled leaflet cheque. (Scholarship will not be sent in absence ofphotocopy of passbook)Candidate to attach a self addressed envelope, duly stamped to receive theacknowledgement of renewal form by post.________________________________Full Name & Signature of the Candidate

24PRIME MINISTER’S SCHOLARSHIP SCHEMEACKNOWLEDGEMENT SLIPOFFICE COPYYour Renewal form dated_________ has been received on__________. Theapplication will be examined for eligibility. The dak receipt number ____________ is to bementioned for further correspondence with this office.Office Seal:(Signature of RSB / Coast Guard Headquarter)Tear offTear offACKNOWLEDGEMENT SLIPSTUDENT COPYYour Renewal form dated_________ has been received on__________. Theapplication will be examined for eligibility. The dak receipt number ____________ is to bementioned for further correspondence with this office.Office Seal:(Signature of RSB / Coast Guard Headquarter)Note: This copy duly stamped and signed by RSB / Coast Guard Headquarter is to begiven to the student by hand or by post.

25Selection Serial Number......................PROFORMA FOR RENEWAL OF SCHOLARSHIP UNDER PRIME MINISTER’SSCHOLARSHIP SCHEME(To be send only if selected for scholarship)1. Name of the applicant (Ward/widow):2. Put a tick mark (√)MaleFemale3. Selection serial No. given by KSB:4. Particular of ESM / Ex-Coast Guard:Name of ESM /Ex-Coast GuardRankService Number5. 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)House No.Street No. & NameTehsil & PostDisttStatePin Code6. 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 TOBE FORWARDED, EVEN IT IS SUBMITTED EARLIER).Name of account holderBank NameLEAVE BLANK SPACE BETWEEN WORDS

Branch Name26Branch AddressStateBank Tel. No.BranchCodeMICR (9 digit) No.(PLEASE ATTACH A PHOTOCOPY OF CHEQUE & PASS BOOK)Account No.REPEATAccount No.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

27Please Fill Properly Your Full Year (Both Semester’s) Marks1. It is certified that Ms. / Mr._____________________ is a Bonafidestudent of __________________________________ college. He / she isstudying in the I / II / III / IV / V year of the two / three / four / five years_______________ course. He / she had joined this college in theacademic year 20___ - ___ and the course will be completed in the monthof ____________ 20___ - ___.2. This is also certified that Ms. / Mr. _____________________________________ has successfully completed his / her 1 st / 2 nd / 3 rd / 4 th / 5 thyear and scoredYear Marks Obtained Out of Percentage1 st Year (1 st & 2 nd sem) ____________ ______ _________2 nd Year (3 rd & 4 th sem) ____________ ______ _________3 rd Year (5 th & 6 th sem) ____________ ______ _________4 th Year (7 th & 8 th sem) ____________ ______ _________5 th Year (9 th and 10 th sem) ____________ ______ _________3. He / she is continuing the course in 2 nd / 3 rd / 4 th / 5 th year.4. This is also certified that student is getting Rs _____ per month / year(If not getting write N/A) scholarship / stipend from this Institute / Collegeor any other sources.Office Seal:Date: ________________Place: _______________Signature of Principal / Dean / Registrar

28ADDRESS OF DEPTT OF SAINIK WALFARE / RAJYA SAINIK BOARDS &DIRECTORATE GENERAL OF COAST GUARDSl No Address of RSB For Detail, Pl contact RSB123ANDAMAN &NICOBARISLANDS (UT)ANDHRAPRADESHARUNACHALPRADESH4 ASSAM5 BIHAR6CHANDIGARH(UT)7 CHHATTISGARHSecretaryRajya Sainik BoardA & N Administration, SecretariatPort Blair - 744 101DirectorDeptt of Sainik WelfareBlock IV, II Floor, GruhakalpaPremises, MJ Road, Nampally,Hyderabad - 500 001DirectorDte of Relief, Rehabilitation &Settlement, Govt of ArunachalPradesh, New Itanagar-791110DirectorDte of Sainik Welfare, SainikBhavan, House No-74, LachitNagar, Guwahati - 781 007DirectorSainik Kalyan NideshalayaHome Deptt, Old SecretariatBarrack No.10, Patna – 800015Zila Sainik Welfare OfficerZila Sainik Welfare Office (UT)Opposite Aroma Hotel, Sector-21-D, Chandigarh - 160 022DirectorDeptt of Sainik Welfare, CGNear Collectorate Parisar, BehindHome Guard OfficeRaipur - 492 001Port Blair-03192-235621 (O)03192-235621(F)secretaryrsbandnic@gmail.comHyderabad040-24736890 (F)040-24747991 (O)apsainik@gmail.comItanagar-0360-2212282 (O)0360-2212282 (F)0360-2213615 (F)rsbaruna@gmail.comGuwahati-0361-2522229 (O)0361-2522229 (F)rsbassam@gmail.comPatna0612-2217301 (O)0612-2217301 (F)directorsknbihar@gmail.comChandigarh0172-2701947 (O)0172-2700317 (O)0172-2726325 (F)zsw_chd@yahoo.comRaipur0771-2445165 (O)0771-2427449 (O)0771-2420084 (F)dirsw.cg@gmail.com

8 DELHI9 GOA10 GUJARAT11 HARYANA1213HIMACHALPRADESHJAMMU ANDKASHMIR14 JHARKHAND15 KARNATAKA29SecretaryRajya Sainik BoardOpp Tis Hazari CourtNo.1, Rajpur Road, Delhi-110 054SecretaryDeptt of Sainik WelfareCollectorate BuildingPanaji - 403 001DirectorDirectorate Sainik Welfare &Resettlement, Gujrat StateGaurav Senani Bhavan,Shahibaug-Airport Road,Shahibag, Ahmedabad-380001SecretaryRajya Sainik BoardSainik Bhawan, Sector 12,Shaheed Capt Rohit KaushalMarg, Panchkula - 134 109DirectorDeptt of Sainik WelfareGovt of Himachal PradeshHamirpur - 177 001DirectorDeptt of Sainik WelfareAmbphalla, Jammu - 180005DirectorSainik Kalyan NideshalayaRanchi (Jharkhand)DirectorDeptt of Sainik Welfare &Resettlement,Fd Mshl KM Cariappa, Bhavan,No 58, Fd Mshl KM CariappaRoad, Bangalore - 560 025Delhi-011-23991876 (F)011-23969260 (O)rsbdelhi@nic.inPanaji0832-2227138 (O)0832-2227138 (F)secyrsbgoa@gmail.comGandhinagar079-22868347 (O)079-22868348 (O)079-22868346 (F)dir_sw@gujarat.gov.inrsb_guj@rediffmail.comPanchkula0172-2560462 (O)0172-2560462 (F))sainikparivar@yahoo.comHamirpur-01972-221854 (O)01972-224659 (O)01972-225643 (F)dir_sw_hp@nic.inJammu0191-2561547 (O)0191-2575362 (F)jkrsbsecy@yahoo.inRanchi-0651-2330178 (O)0651-2331434 (F)jharkhand_skn@yahoo.inBangalore-080-25589459 (O)080-25589459 (F)dirdswrblr@gmail.com

16 KERALA17MADHYAPRADESH18 MAHARASHTRA19 MANIPUR20 MEGHALAYA21 MIZORAM22 NAGALAND30DirectorDeptt of Sainik WelfareVikas Bhavan,Thiruvananthapuram - 695 033DirectorDeptt of Sainik WelfareSouthern Shopping CentreGuru Teg Bahadur Complex, TTNagar, New Market,P.B.NO 364, Bhopal - 462 003DirectorDeptt of Sainik WelfareMaharashtra State ‘Raigad’, OppNational War Memorial, SolapurRoad, Ghorpadi, Pune-411 001SecretaryRajya Sainik BoardSainik Rest HouseOpp. Lamphel Police Station, PO-Lamphel, Imphal-795004DirectorDte of Sainik WelfarePublic Service CommissionBuilding Beyond DC BuildingShillong - 793 001DirectorDeptt of Sainik Welfare & Res,Tuikual ‘A’, PB No. 119Aizawl - 796 001SecretaryRajya Sainik Board, Home Deptt,Home Br, Nagaland Civil Sectt.,Kohima - 797 001Thiruvananthapuram0471-2304980 (O)0471-2304980 (F)directordswkerala@yahoo.comBhopal-0755-2553992 (O)0755-2577209 (F)dswoffice@mp.gov.inPune-020-26332763 (O)020-26332764 (O)020-26334427 (O)mahasainik@dataone.indsw@mahasainik.comImphal-0385-2416228 (O)Shillong-0364-2225613 (O)0364-2225613 (F)rsbmegha@rediff.comAizawl-0389-2322732 (O)0389-2322732 (F)rsbmizoram@yahoo.inKohima-0370-2270029 (O)0370-2270029 (F)secyrsb-ngl@nic.in

23 ORISSA24PUDUCHERRY(UT)25 PUNJAB26 RAJASTHAN27 SIKKIM28 TAMIL NADU29 TRIPURA31SecretaryRajya Sainik Board, NageswarTangi, Lewis Road,Bhubaneshwar-751002DirectorDeptt of Sainik WelfareJawan Bhavan Complex, LawspetMain Road, Pakkamudayanpet,Puducherry - 605 008DirectorDte of Sainik Welfare, PunjabPunjab Sainik Bhawan, Sector21-D, Chandigarh - 160 022NideshakSainik Kalyan VibhagSecretariat Building, North Block,Jaipur - 302 005SecretaryRajya Sainik Board, Sikkim PaljorStadium Road, Gangtok-737 101Joint DirectorDte of Ex-Servicemen’s Welfare22, Raja Muthiah Salai, ChoolaiChennai - 600 003SecretaryRajya Sainik Board, Nehru OfficeComplex, Gorkhabasti, P.O.Kunjaban, Agartala - 799 006West TripuraBhubaneshwar0674-2432268 (O)0674-2435998 (F)secyrsbors@rediffmail.comsecyrsbbbsr@gmail.comPuducherry0413-2253107 (O)0413-2250575 (F)dswpuducherry@gmail.comChandigarh0172-2701845 (O)0172-2707345 (F)0172-2706014 (F)dswpb@rediffmail.comddhq@rediffmail.comddmpb@rediffmail.comJaipur-0141-2227897 (O)0141-2227650 (F)rajasthansainik@yahoo.comGangtok-03592-202534 (O)03592-221456 (O)03592-221456 (F)rsbsikkim@ymail.comChennai-044-26691747 (O)044-26691886 (O)044-26691886 (F)exweldte@tn.gov.inAgartala0381-2326507 (O)0381-2326507 (F)rsb_sainikboard@rediffmail.comrsb.tripura@gmail.com

30UTTARPRADESH31 UTTARAKHAND32 WEST BENGAL32DirectorDte of Sainik Kalyan EvamPunarvas, Kariappa Bhawan,Kaiserbagh, Lucknow - 226 001DirectorSainik Kalyan Evam PunarvasUttarakhand, 15C, Kalidaas Marg,PO-Haathibadkala,Dehradun - 248121SecretaryRajya Sainik Board, Block 'I'(First Floor), Writers’ BuildingKolkata - 700 001Lucknow-0522-2625354 (O)0522-2625354 (F)0522-2305107 (F)directorsainikkalyan@yahoo.comDehradun-0135-2744208 (O)0135-2743773 (F)0135-2741481 (O)dskddn@gmail.comKolkata-033-22141347 (O)033-22144643 (F)033-22143220 (O)rsbkolkata@yahoo.comrajyasainikboardwestbengal@gmail.comFOR EX-INDIAN COAST GUARDS ONLY01 COAST GUARDDirectorate General of CoastGuard HeadquarterNational Stadium ComplexNew Delhi-110001011-23074132 (O)011-23386766 (F)Note:Dadar Nagar Haveli:Daman & DivLakshadweep:ESM of these states can submit their Prime Minister Application form toGujrat RSB.ESM of this state can submit their Prime Minister Application form toKerala RSB.