POSTMATRIC SCHOLARSHIP TO MINORITY STUDENTS

RENEWAL OF SCHOLARSHIP – 2010-11

APPLICATION FORM
NAME
PARENT/
GUARDIAN NAME
PERMANENT
ADDRESS

PIN 6

ANNUAL INCOME OF THE PARENT/GUARDIAN Rs.

Savings Account Number of Student/Father/Mother :
Name of the Bank: Branch Code

Fresh Scholarship Name of the Course Year of Name of the

Sanctioned during Study Board/Instt./University

200 - 0

Annual Course Fee Paid

Main & Ancillary Subjects Total % of
(Attested copy of mark sheet No.of Marks Tuition Fee Rs.
should be enclosed) Marks Library Fee Rs.
Obtained/ Exam Fee Rs
Other
out of Non refundable fee Rs.
/ Total Rs.
/
/
/
/
/
DECLARATION
I, … . . . . . . . . . . . . . . . . . . . . . . . . . hereby declare that the informations given above are correct and I am
not availing any other scholarship for this purpose from any other source. I shall abide by the terms and
conditions for the sanction of Postmatric Scholarship and undertake that if at any stage, it is found to the
satisfaction of the Government of Tamil Nadu 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/recovered from me apart from such penal action as
warranted by law.
Encl: Attested copy of marksheets

Date : Signature of the student

Place:

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 RENEWAL Format

Information to be furnished by the Head of School/College/Institute

It is certified that the information filled in the above mentioned columns by
Shri/Kumari . . . . . . . . . . . . . . . . . . . . . . . . . . . . . S/o (or) D/o . . . . . . . . . . . . . . . .
Who is admitted in .. . . . . . . . . . . . . .. . . . . . . .Course for the academic session . . . . . . . .
in our School/College/Institute is correct.

ii) He/She is a hosteler/day scholar of the School/College/Institute

iii) He/She has been promoted from to or passed all subjects in
the semester/non-semester examination(s) and secured 50% of marks in the
academic year . . . . . . . . .
iv) The scholarship will be disbursed after satisfying the yardstick of attendance
in the current year of the student.

Date: Signature of the Correspondent/Principal/Dean/Registrar

Place with Official Seal

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 SELF DECLARATION OF PARENT/GUARDIAN’S ABOUT INCOME
(on Non-Judicial Stamp Paper of Rs 10/-)

I, . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . .. . . . . (Parent/Guardian)
of . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (Name of the Student) who is
studying in . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . hereby declare that my
annual income from all sources is Rs.. . . . . . . . . . . .. . .(Rs. .. .. . . . . . . . . . . . . . . . . .. . . . .
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . .only).

I, . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . declare that the above

information given by me is true to the best of my knowledge to avail the benefits given
to my son/daughter/ward and it is found that the information given by me is false, the
scholarship amount sanctioned could be withdrawn or recovered from me and legal
action as deemed fit, may be taken against me or my ward.

Signature of Parent/Guardian
Residential Address
Date:

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