National Scholarship Form 2019
National Scholarship Form 2019
National Scholarship Form 2019
Fresh Renewal
REGISTRATION DETAILS:-
Paste or Staple
State Of Residence:-___________________________ your Recent
passport size
Name Of The Student:-_________________________ photograph
Date Of Birth
1
NATIONAL PRINTERS AND BINDERS
SHOP NO. 5, GATE NO. 1, INTEGRAL MAIN CAMPUS, LUCKNOW
CONTACT NO. 9721384005, 7800108501
CONTACT DETAILS:-
State District:-
2. Student Photograph
3. Affidavits
v Instructions:-
· Please check the details of your offline form.
· Use blue ball pen to fill the form.
· Please collect the form within 15 days after online submission from the shopkeeper
and submit the hard copies in the institute's scholarship counter otherwise you will
not be able to receive the scholarship amount in your bank account.
· Students have to verify their fees and Bonafide form from the institute after filing
the offline form.
2
SELF DECLARATION OF FAMILY INCOME UNDER POST MATRIC SCHOLARSHIP
(CLASS XI AND ABOVE)/MERIT-CUM-MEANS SCHOLARSHIP SCHEME
OF MINISTRY OF MINORITY AFFAIRS, GOVERNMENT OF INDIA
I, ____________________________Son/Daughter/of___________________________
Resident of (full address)__________________________________________________
______________________________________________________________________
do hereby solemnly affirm and declare as under :-
a) That I am citizen of India.
b) That annual income of my family from all sources is Rs ………………(in words
also) ……………………………………………………………………………………
c) I declare that my father/mother/both* is/are earning Member(s) in my family.
Signature of Candidate:__________________________
Name of Candidate: ____________________________
Name of School/Institution:_______________________
Academic Year:________________________________
DECLARATION
I, ____________________________Son/Daughter/of________________________
______________________________________________________________________
Date:__________
Place:_________
In case the information filled in these columns is not correct, then the institute
should indicate that separately.
___________________________________________________________________________
___________________________________________________________________________
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 which is not applicable).
Please ensure the information given by you is factually correct. In case of any
discrepancy noticed later, your application is likely to be rejected.
Place:
with official seal
Note:
(i) The verification by institution is mandatory for consideration of the
application.
(ii) Students are directed to take the print out of ‘Institution Verification
Form’ get it verified by their institution, scan & upload it”, in order to
apply for minority Scholarship.