STUDENT APPLICATION

Renewal

(MINORITY WELFARE SCHOLARSHIP SYSTEM)

For official use only

Sl No of application Year Course Whether approved

Temporary ID : T2014RpbS02333

Affix a self

Permanent ID : P2012pbS00920

attested passport

Admission No : 22121028

size photograph

1.Student name : MANVEER KAUR

2.Father's name/Husband's name : Iqbal Singh

3.Mother's name : Sukhwinder kaur

4. Domicile State/UT (State/UT which the

Punjab

student belongs to) :

5. Address for correspondence:

House No. & Street Detail HNo-60,Sarawan Part No 1,vill-sarawan,fardkot

City/Town/ Village & P.O.

District FARIDKOT

State Punjab

Pincode 151204

6. Permanent address(please enclose residential certificate from concerned state

government authority):

House No. & Street Detail HNo-60,Sarawan Part No 1,vill-sarawan,fardkot

City/Town/ Village & P.O.

District FARIDKOT

State Punjab

Pincode 151204

7. Date of birth (Please enclose certificate) : 18-Aug-1991

8. Whether male or female : Female

9. Religion : Sikh

10. Nationality : Indian

909*********

11. Adhaar No. :

NOTE: Scan each page of this application as separate PDF Files for upload after Signing from Institute.

Page 1 of 5

Printed Date: 03-Nov-14

12. Last Examination Passed Details:

Name of examination passed Year Marks Obtained Full marks % of marks

MCA( Master of Computer 2 454 600 75.6666

13. Total Annual course fee: 81380.00

(Break up of course fee such as tuition fee, library fee, examination fee etc. other than refundable

deposits):

Sl.No. Item Annual fee

47250.00

1. Tuition Fee

30.00

2. Library Fee

3700.00

3. Examination Fee

30400.00

4. Other Non Refundable Fee

Total 81380.00

14. Details of bank account of student:

Manveer Kaur

Name of the payee (as in the bank accounts)

Name of the Bank State Bank of Patiala

vpo bargari

Full address

Branch Code number

Bank Account Number 651********

Bank Account Number in words

IFSC code of the Bank STBP0000174

Mode of Electronic transfer available in the Bank –

ECS/RTGS/NEFT/CBS/code number (if any);-

15. Annual Income of parent/guardian of the student: Rs. 80000

(specimen form of declaration of annual income is given at Annexure which is to be signed by the

parent/guardian of the student and enclosed alongwith the application. In case parent/guardian are

employed, income certificate from the employer may also be enclosed)

NOTE: Scan each page of this application as separate PDF Files for upload after Signing from Institute.

Page 2 of 5

Printed Date: 03-Nov-14

INSTITUTION VERIFICATION FORM

Verification/information to be furnished by the Head of institution/college:

It is certified that the information provided below by MANVEER KAUR who is admitted in MCA Master of Computer

Application course for the for the academic session 2014-2015 in YADWINDRA COLLEGE OF ENGG AND

TECHNOLOGY - MCA BATHINDA college is correct. He/she is a hosteler/day scholar of the

Details provided in existing print out of form.(last year marks details) .

Details provided in existing print out of form. (Fee details current year).

In case the information filled in these columns is not correct, then the institute should indicate that

separately.

For Renewal of Scholarship:

It is certified that the student has not changed the course of study and/or the institution of the study

for which the scholarship was originally awarded /has changed the course of study and/or institution

with prior approval of the state government (Please strike out

Please ensure the information given by you is factually correct. In case of any discrepancy noticed

later, your application is likely to be rejected.

Date : Signature of the head of the

Place : with Official seal

NOTE :

The verification by institution is mandatory for consideration of the application.

NOTE: Scan each page of this application as separate PDF Files for upload after Signing from Institute.

Page 3 of 5

Printed Date: 03-Nov-14

DECLARATION OF FAMILY INCOME

I Iqbal Singh (Father /Mother /Guardian) of MANVEER KAUR (Name of

student) who is studying in MCA( Master of Computer Application ) III year hereby

declare that my annual income from all sources is Rs./ 80000.00 if at any stage,it

is found that the information given by me is false/not true,all benefits given to the

student under the scehme of Merit cum means based scholarship to the student

belonging to minority communities could be with dran and legal action as deemed

fit, may be taken against me or my ward.

Signature

Residential Address

HNo-60,Sarawan Part No 1,vill-sarawan,fardkot

Date:

FARIDKOT

(Father/Mother/Guardian)

Punjab

151204

NOTE: Scan each page of this application as separate PDF Files for upload after Signing from Institute.

Page 4 of 5

Printed Date: 03-Nov-14

Declaration of the Student

(i) I hereby declare that the information given in my application form (From 1 – 15) is correct.

(ii) I am not availing any other Scholarship for this purpose from Central Govt./State Govt.

sources.

(iii) I shall abide by the terms and conditions for sanction of the Merit cum Means based

Scholarship.

(iv) I have uploaded the desired documents in support of my claim.

(v) I undertake, that if at any stage, it is found to the satisfaction of the sanctioning authority in

the Ministry of Minority Affairs that the information given by me is false or if I violate the terms

and conditions of the scholarship, the scholarship sanctioned to me, may be cancelled and the

entire amount of scholarship will be refunded by me or recovered from me, apart from liability for

such penal action as warranted by law.

Date : Signature of the candidate

NOTE: Scan each page of this application as separate PDF Files for upload after Signing from Institute.

Page 5 of 5

Printed Date: 03-Nov-14

Contact this candidate