From The Secretary, Rajya Sainik Board Haryana, Sainik Bhawab ...

-23-Application FormFORTHE AWARD OF STIPEND TO DEPENDENTS OF EX-SERVICEMEN OUT OF AMALGAMATED FUNDPART- I(To be filled in by the Father/Guardian of stipendiary after reading instructions carefully)1. Name of student (in Block letters) _____________________________2. Name of Institution where reading _____________________________3. Number, Rank and Name of Father _____________________________4. Regiment/Corps of the father _____________________________5. Date of Enrolment of the father _____________________________6. Date and cause of Discharge/Release _____________________________7. Character of the father _____________________________8. Whether father killed or disabled - _____________________________9. Home address : Village_______________ P.O.________________________10. Details of the family member Sr.No. Name Relation Age Occupationattach separate list of member 1. ___________________________________duly signed by the father/ 2. ___________________________________guardian , in case the number 3. ___________________________________is more than five4. ___________________________________5. ___________________________________11. Area of landed property, un-irrigated, owner, tenant etc. details to be given inthe affidavit.12. Present annual income from all source, i.e. land, pay including all allowances,pension, labour and other source.13. The above statement regarding landed property and annual income should besupported by an affidavit of the father/guardian and it should be attested bythe Oath Commissioner..Signature of the studentSignature of the father/guardianPART- II(To be completed filled by the Head of institution)1. Sr.No./R.No._____________________ Date of Birth ________________2. Name of student _____________________________3. Name of Father _____________________________4. Number, Rank and Name of _____________________________5. Class in which studying______________Date of admission _________________6. Boarder or day scholar _____________________________