Indian Institute of Technology, Kanpur

Dear students, This to inform you that IIT-K offers a number of scholarships to its students. Many of these scholarships are awarded based on merit-cum-means basis. According to current Govt. of India (GOI) rules, students whose combined parental income is below Rs. 4.5 lacs per annum are eligible to be considered for these scholarships. It should be noted that the parental income limit is subject to change from time to time as per GOI order. Please note the following, very carefully, regarding the application process: 1. In order to apply for these awards you must bring the attached form (filled and duly signed by you and your parents) at the time of registration. This form must be submitted in person at the time of registration. 2. The processing of your application will begin on the basis of submission of the attached form (filled and duly signed by you and your parents). 3. However, you must submit one of the following supporting document as evidence for the stated income: A. Salaried person (both government and private): A copy of Form 16 or Income Tax Return Form (ITR) for the financial year 2012-13 and assessment year of 2013-14. B. Businessman: A copy of Income Tax Return Form for the financial year 2012-13 and assessment year of 2013-14. C. Agriculturist and others: Print/type the attached application form on a Rs. 10 stamp paper and have it signed by your parents, countersigned by a Notary public or government official of the rank of Tehsildar and above for the financial year 2012-13. 4. Your application will be considered complete only upon receipt of one of the documents mentioned in 3. In case supporting documents mentioned in 3 are not submitted at the time of registration, the last date for such document submission is August 25, 2013. 5. Income stated in the application form must be the same as in the supporting document. Any discrepancy can attract disciplinary action including but not limited to revocation of scholarship. 6. Failure to submit supporting document by August 25, 2013 will automatically make you ineligible to receive merit-cum-means based scholarships.

Essential document for all merit-cum-means scholarship applications

Parental Income certificate

INDIAN INSTITUTE OF TECHNOLOGY, KANPUR Format for declaration of parental income All the fields MUST be filled. Write N/A if Not Applicable. Incomplete document will not be accepted.

1. Name of the student 2. Full postal address

3. Home phone no. 4. Student Mobile no.5. IIT Kanpur Roll No. (to be filled at the time of registration) 6. Name of the Department/ Program 7. Category (GN, OBC, SC, ST, PH) 8. Parental details: a. Name of the father/ guardian b. Reasons for being under Guardianship, if other than fatherc. Fathers/ guardians occupation d. Designation e. Gross (pre-tax) annual income f. Name of the mother g. Mothers occupation h. Designation i. Gross (pre-tax) annual income -

9. Do you hold any scholarship from any other source at present (Yes/No)

Students signature

Fathers/Guardians signature

Mothers signature

10. In case your answer to line 9 is Yes please provide details of the scholarship
Name of the scholarship Value of the scholarship (In Rs.) Duration of the scholarship (From which date to which date) Example January, 2011 TO December, 2014

11. Declarations: (Please sign Declaration A if you have answered Yes in line 9 OR sign Declaration B if you have answered No in line 9. Also sign Declaration C) A. I hereby declare that I have provided accurate information about the scholarship(s) I hold at present in Line 10. Signature of the student B. I hereby declare that at present I do not receive any form of scholarship from any government or non-government source. Signature of the student C. I acknowledge that I have been informed that at IIT-Kanpur, no student can receive two scholarships simultaneously. Signature of the student UNDERTAKING I hereby undertake and certify that the information provided in this form is correct and true to the best of my knowledge and belief and nothing material has been concealed. I understand that in the event of any information being found false, misleading or incorrect, or ineligibility to receive the Merit-cum-Means Scholarship being detected during or after completion of my programme at IIT Kanpur, or any of the personal information furnished in support thereof is found incorrect, neither I nor my parents/guardian shall have any objection whatsoever against the action taken by the Institute in the matter, in accordance with provisions 9.3 and 12.2 of the Ordinance of IIT-Kanpur. I further undertake that during the course of availing the Scholarship, whenever there shall be any change in the income of my parents/guardian, I shall keep the Institute authorities informed and shall abide by its further decision on my eligibility to receive the Scholarship. Students signature Date: Counter Signed Fathers/Guardians signature Date: Mothers signature Date: