Post Matric Application Form 13-14

APPLICATION FORM
(Post Matric Scholarship to SC/OBC 2013-14)

Closing Date:- 31.10.2013
Eligible students are advised to submit their application in the prescribed format to their respective schools/colleges/institutes Heads
along with the following documents.
Individual application of students will not be entertained.
1. One copy of the passport size photograph with signature of the students thereon.
2. One attested copy of certifications, diploma degree etc. in respect of the last examination passed.
3. Attested copy of caste certificate issued by competent authority should be attached with application,
Domicile Certificate of Delhi, if the caste certificate is not issued by the competent authority of
Govt. of N.C.T of Delhi.
Affix Passport
size photo of
student duly
Signed by
him/her
Signature
4. (i) For family income latest salary slip in the case of parent/guardian in government service and an
affidavit from notary regarding other source of family income.
(ii) Income declaration by way of an affidavit on non-judicial stamp paper in the case of parent/guardian
in private job/service.
5. Hostellers certificate from competent authority. (if hosteller)
6. Fee receipt Original & Fee structure from college.
APPLICATION FORM
(i)
Name & Roll No. of student:.
(ii)
Date of Birth of Student...
(iii)
Name of Father/Guardian:.
(iv)
Residential Address & Phone No..

Pin code
(v)
District.
(vi)
Aadhaar Card No..
(vii)
Yearly Family Income:................................................................
(viii)
Class in which he/she studying:.
(ix)
Hosteller/Day Scholar:.
(x)
Category (SC/OBC):...
(xi)
Whether availed this scholarship last year..
(xii)
Nature of disability in the case of handicapped students.
In case of handicapped students, particulars of additional allowance as per eligibility should be filled in and photocopies of supporting
documents/vouchers should be attached to the application form in an envelope.
(i) ....
(ii)
(iii)
(iv) ....
Certified that the information given above is true to the best of my knowledge & belief. If any state, it is found that the information
given by me is false, the scholarship granted to me could be withdrawn and legal action as deemed fit, may be taken against me.
Date:
Place:
Signature of the student
The concerned College/Institute Heads may for ward all the application received from the eligible students along with the
consolidated statement prescribed below. Consolidated Statement (Post Matric Scholarship) (SC/OBC) (2013-14)
1. Name & Address of the School/College/Institute___________________________________________________
2. Contact No._______________________
3. E-mail address:_______________________________________________________
___________________________________________________________________________________________
Sl.
Name & Roll No.
D.O.B. of
Class in which
Fathers/Guardians
No.
of the student
Student
presently studying
Name
1
2
3
4
5
--------------------------------------------------------------------------------------------------------------------------------------------------------
-------------------------------------------------------------------------------------------------------------------------------------------------------Family Income
Hostellers/
Rate of
Category
Date of
Remarks,
Per annum
Day Scholars
Scholarship
Admission
if any
6
7
8
9
10
11
--------------------------------------------------------------------------------------------------------------------------------------------------------
-------------------------------------------------------------------------------------------------------------------------------------------------------Certified that the above information particularly in respect of income of family and caste status of the students have been verified
on the basis of supporting documents produced by the parents/guardians of the student.
NOTE:1. Certified that the above particulars have been checked with the office record and found correct.
2. Certified that no eligible student studying in the school is left out for grant of scholarship and this list may be treated as final.
3. Certified that the SC/ST/OBC/certificates in respect of all the students have been issued by the competent authority along with
Domicile Certificate of Delhi, if required.
4. Certified that the scholarship or the stipend holders named above have been regular in attendance and have confirmed to the
rules under which their scholarship of their stipends are granted.
5. Certified that the scholarship drawn on the last time with the exception of those refunded by deduction have been paid to the
right persons and their receipt taken in acquaintance forms have been forwarded to Dy. Director SC/ST.
6. Certified that the amount has been disbursed to the eligible students in the presence of authorized person.
7. Certified that the eligibility of the student have been rechecked discrepancy is noticed/discrepancy noticed has been reported to
the department vide letter no..Dated
8. Certified that the student is not in receipt of the scholarship under the recently launched scheme by the Govt. of India i.e.
Central Sector Scholarship Scheme of Top Class education (June, 2009)
9. Certified that attested copy of fee structure (specify compulsory and noncompulsory fee) approved by Centre/state Govt. is
attached.
Signature with seal of The Principal/Head of the School
ELECTRONIC CLEARING SERVICE

Particulars of Student (To be submitted in duplicate)
1.
Name of the Student:..

(along with full postal address & PIN code)
2.
Name of the College/Institute:

3.
Telephone No. :.
4.
E-mail ID. :...
Particulars of Bank Account (Please attach a photo copy of cheque)

5.
Bank A/c operated by:
6.
Bank Name:..
7.
Branch Address:
8.
Bank Telephone No.:.
9.
M.I.C.R. (9 digit number):..
10. IFSC code of Bank..

10. Bank A/c type (Saving/Current):..
11. Bank A/c Number (Seeded with Aadhaar Card):..........
Signature of the Bank account operator
Dated:..
ELECTRONIC CLEARING SERVICE

Particular of College/Institute (To be submitted in duplicate)
1. Name of College/Institute:
2.College/Institute Code No. (New):...
3. College/Institute Telephone No.:...
4. College/Institute E-mail ID
Particulars of Bank Account (Please attach a photo copy of cheque)
5. Bank A/cooperated by (Whether Principal/D.D.O. may be specified)..........................
6. Bank Name:...
7. Branch Address:.
8. Bank Telephone No:.....
9. M.I.C.R. (9 digit number):.
10.Bank A/c type (Saving/Current):..
11. Bank A/c Number:
Signature of the Bank account operator with official seal..

Dated :

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APPLICATION FORM

(Post Matric Scholarship to SC/OBC 2013-14)

Name & Roll No. of student:.

Date of Birth of Student...

Residential Address & Phone No..

Aadhaar Card No..

Yearly Family Income:................................................................

Class in which he/she studying:.

Whether availed this scholarship last year..

Nature of disability in the case of handicapped students.

Signature of the student

ELECTRONIC CLEARING SERVICE

Name of the Student:..

Name of the College/Institute:

E-mail ID. :...

Particulars of Bank Account (Please attach a photo copy of cheque)

Bank A/c operated by:

Bank Telephone No.:.

M.I.C.R. (9 digit number):..

10. IFSC code of Bank..

Signature of the Bank account operator

ELECTRONIC CLEARING SERVICE

Signature of the Bank account operator with official seal..

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