fresh - sc, st & scc (bc-adi dravidar christian ... sc fresh application form (first year... ·...
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Fresh - SC, ST & SCC (BC-Adi Dravidar Christian) Scholarship - Application Form (First Year Students only)
IMPORTANT NOTE:
The following documents (Photocopy / Xerox Copy) should be enclosed along with the
Scholarship Application Form otherwise the application will be liable to be rejected.
1). Attested Photocopy of Student Community Certificate.
2). Attested Photocopy of Student Income Certificate. (2019 - online copy only allowed)
(Income certificate period should not exceed 6 months at the time of admission)
UG Students:
(Income limit for SC/ST Candidates – Below Rs. 2,50,000/-)
(Income limit for SCC (BC - Adi Dravidar Christian) Candidates – Below Rs. 2,00,000/-)
(Income limit - above Rs. 2,50,000 to Rs. 9,99,999/- Eligible for Free Education Scholarship)
PG Students:
(Income limit for SC/ST Candidates - Below Rs. 2,50,000/-)
(Income limit for SCC (BC - Adi Dravidar Christian) Candidates - Below Rs. 2,00,000/-)
(Income limit for PG Girls only - above Rs. 2,50,000 to Rs. 9,99,999/- Eligible for
Free Education Scholarship)
3). Attested Photocopy of Student Savings Bank Pass Book Front Page copy. (any Nationalised Bank) (*Linking Bank A/c. No. to Aadhaar is mandatory)
(Clearly mention Name, A/c No., IFSC Code & MICR Code)
4). Attested Photocopy of SSLC (10th) Mark Sheet(s).
5). Attested Photocopy of Hr. Sec. (12th) Mark Sheet(s).
6). Attested Photocopy of UG, PG Consolidated Mark Sheets, Provisional / Degree Certificate. (for PG, M.Phil. & Ph.D Students only)
7). Attested Photocopy of Aadhaar Card. (*Linking Aadhaar No. to Bank A/c. is mandatory)
(The Students those who want to submit an application in the College office for claiming
scholarship are requested to take printout on both sides from 2nd page onwards in A4 size
paper (except 1st page).
(PLEASE READ THE INSTRUCTIONS FULLY AND THEN FILL UP THE APPLICATION)
[
APPLICATION SUBMISSION LAST DATE : Before 16th August 2019.
College Main Office – Scholarship Section (Opp. Counter No.3)
*******
DEPARTMENT OF ADI DRAVIDAR & TRIBAL WELFARE
FRESH - Application form for ADW Scholarship Scheme (Tamil Nadu e-District) --------------------------------------------------------------------------------------------------------
INSTITUTION NAME : SACRED HEART COLLEGE (Autonomous), Tirupattur - 635601, Vellore Dt.
-------------------------------------------------------------------------------------------------------- for office use only (Student ID) -------------------------------------- ACADEMIC DETAILS :
Academic Year : 2019 - 2020
Course Name : Year : I / II
Studying Course Type : Self Support / Regular (Aided) Lateral Entry : Yes / No
Date of Admission : ___ / ___ / 2019 Student Reg. No.:
-----------------------------------------------------------------------------------------------------------------------------
PERSONAL DETAILS :
Name of the Applicant : (Block Letters - as per 12th Mark sheet)
Father / Guardian Name : Mother Name :
Occupation : Date of Birth : ___ / ___ /_______
Community : SC / ST / SCC (BC - Adi Dravidar Christian) Caste :
Gender : Male / Female Religion : Hindu / Christian
Annual Family Income : Rs. _______________ Admission Mode : Govt. / Payment (Income Certificate period should not exceed 6 months at the time of admission)
First Graduate : Yes / No 10th Reg. No.: _____________ 12th Reg. No.: _____________
---------------------------------------------------------------------------------------------------------------------- Email ID: Mobile No. :(1) (2) ---------------------------------------------------------------------------------------------------------------------- Address for Correspondence : Door No. :
Street / Nagar :
Village :
Post :
Taluk :
District :
Pin Code :
Aadhaar No.: (12 Digit No.) * Linking Aadhaar No. to Bank A/c. is mandatory
---------------------------------------------------------------------------------------------------------------------- BANK DETAILS :
Student Bank Account Number : (*Linking Bank A/c. No. to Aadhaar is mandatory) (Please enter the full digits of Account Number)
Name of the Bank : Branch Name :
IFSC Code: MICR:
(IFSC Code should be 11 Digit.) (MICR Code should be 9 Digit.)
HOSTEL DETAILS : Hosteller : Yes / No If Yes : Paid Hostel / Free Hostel
Hostel Name :
Date of Joining : / / 2019 Date of Leaving : 31/05/2020
----------------------------------------------------------------------------------------------------------------------
Date : ___ / ___ / 2019 Sign. of the Hostel Warden Signature of the Applicant
2 0 1 9 0 4 0 1 0 A D W 0 0
0
1 M.jp.g.e. 73---1>000---2016----m.fp.m.> GJif.
jkpo;ehL muR
GOVERNMENT OF TAMIL NADU
Mjpjpuhtplu; kw;Wk; goq;Fbapdu; eyj;Jiw
ADI-DRAVIDAR AND TRIBAL WELFARE DEPARTMENT
kj;jpa / khepy muR fy;tp cjtpj; njhif jpl;lk; - gs;sp ,Wjp Nju;Tf;F Nkw;gl;l gbg;gpw;Fupa cjtpj; njhif ngWtjw;fhd tpz;zg;gk;
FORM TO APPLY FOR THE GRANT OF GOVERNMENT OF INDIA / STATE GOVERNMENT
POST MATRIC SCHOLARSHIPS.
SACRED HEART COLLEGE (Autonomous),
TIRUPATTUR - 635 601, VELLORE DT.
REG. NO.:
CLASS : I -
YEAR : 2019 - 2020
1. khztu; ngau; : (njspthd vOj;Jf;fspy;) jpU / jpUkjp / nry;tp. Full Name of the Student (in Block letters)
Thiru / Thirumathi / Selvi.
2. jha; / je;ij / ghJfhtyu; ngah; : Name of the Mother / Father / Guardian.
3. njhopy; / Occupation. :
4. epue;ju Kftup / Permanent Address. :
5. m. khztu; gapYk; gbg;Gg; gpupT : Course of Study of the applicant.
1. Nky;epiy tFg;G / Higher Secondary Class.
2. gl;lg;gbg;G / Degree Course.
3. gl;l Nkw;gbg;G / Postgraduate Course.
4. njhopw;gbg;G / Professional Course.
5. gl;lag; gbg;G / Diploma Course.
6. rhd;wpjo; gbg;G / Certificate Course.
M.jp.g.e. 73---1
khztupd; Gifg;gl efy; ,izf;fg;gl
Ntz;Lk;
STUDENT ID :
201904010ADW00
2
5. M. gapYk; Kiw / Category of Study.
1. gfy; Neuk; / Day Time
2. khiy Neuk; / Evening Time
3. gFjp Neuk; / Part-Time
4. mQ;ry; top / Correspondence
,. gbg;G Kiw fhy msT / Duration of Course
3 Years, 2 Years, 1 Year
6. gapYk; epWtdj;jpd; ngaUk; mjd; KOikahd mQ;ry; Kftup. Name of the Institution where studying and its
complete Postal Address.
SACRED HEART COLLEGE (AUTONOMOUS)
TIRUPATTUR - 635 601, VELLORE DIST.
7. fy;tp epiyaj;jpy; Nru;e;j ehs; Date of Joining the Institution
ehs; Date
khjk; Month ;
Mz;L Year
2019
8. gj;jhk; tFg;G nghJj; Nju;tpy; Nju;r;rp ngw;w Mz;L / gjpT vz;. Year and Register No. of Passing of the10
th
Public Examination.
Mz;L Year
gjpT vz;. Registration No.
9. gl;bay; ,dj;jtu; / goq;Fbapdu; / fpwp];jt ,dj;jpw;F khwpa gl;bay; ,dj;jtu; (tl;lhl;rpau; toq;fpa epiyahd rhjpr; rhd;wpjopd; Gifg;gl efy; ,izf;fg;gl Ntz;Lk;). goq;Fbapdu; ,dj;ijr; Nru;e;jtu; vdpy; tUtha; Nfhl;lhl;rpau; rhd;wpjo; my;yJ 11-11-1989-f;F Kd;du; ngw;w tl;lhl;rpau; rhd;wpjopd; Gifg;gl efy; ,izf;fg;gl Ntz;Lk;. Cgrhjp ngau; Fwpg;gpLjy; $lhJ. Scheduled Caste / Scheduled Tribes / Scheduled
Caste Converted to Christianity. A xerox copy of the
Community Certificate issued by the Tahsildar in
respect of SC / SC Christian and certificate issued by
the R.D.O. or the certificate issued by the Tahsildar
before 11-11-1989 in respect of S.T. should be
attached Sub Caste should not be mentioned.
1.
2.
3.
gl;bay; ,dj;jth; Scheduled Caste fpwp];jt kjj;jpw;F khwpa gl;bay; ,dj;jtu; Scheduled Caste Converted to
Christianity.
goq;Fbapdu; Scheduled Tribe.
10. tpz;zg;gjhuupd; ngw;Nwhu; (jha; / je;ij) ghJfhtyu; / fztupd; gy;NtW tifapy; <l;ba nkhj;j Mz;L tUkhdk; (tpz;zg;g ehSf;F Ke;ija MW khjq;fSf;Fs; ngwg;gl;l tl;lhl;rpau; rhd;wpjo; ,izf;fg;gl Ntz;Lk;). Gross annual income of the parent / guardian /
husband from all sources to be furnished (income
certificate issued by the Tahsildar and obtained
within Six months period to date of application
should be attached).
Rs.
.
3
11. gj;jhk; tFg;Gf;Fg;; gpd;du; gapd;w gbg;Gfspd; tptuk; / ,ilepWj;jk; ,Ug;gpd; mjd; tptuk;. Details of Postmatric Courses after 10
th standard in
which applicant studied / Details of break of study
should be furnished.
gapd;w Mz;L gbg;G tptuk;
fy;tp epiyaj;jpd; ngau; Name of the Institution
fy;tp cjtpj; njhif ngwg;gl;ljh?
tUif tpOf;fhL nrd;w Mz;Lf;F
kl;Lk.; Details of study
undergone together
with year of study.
Whether obtained
Scholarship.
Mk; / ,y;iy Yes / No
Percentage of previous
year attendance.
(1). (2). (3). (4).
12. khzthpd; tq;fp fzf;F vz;. Student Bank Account Number. :
1. tq;fp ngah; / Bank Name :
2. tq;fp fpis / Bank Branch :
3. MICR FwpaPL / MICR Code :
4. IFSC FwpaPL / IFSC Code :
5. kpd;dD jPh;it gw;W chpikf; fl;lis gbtk; my;yJ tq;fp fzf;F Gj;jfj;jpd; Kjy; gf;f efy; ,izf;fg;gl;Ls;sjh? Whether ECS credit
mandate form enclosed? or enclosed Bank Pass Book
First Page Copy.
Mk; / ,y;iy
Yes / No
6. kpd;dD jPh;it / Njrpa kpd;dD epjp ghpkhw;wk; /
RTGS Kiwapy; fy;tp cjtpj; njhifis Nrkpg;Gf; fzf;fpy; Nrh;f;f khzthpd; Nrkpg;G fzf;F guhkhpf;fg;gLk; tq;fp Core Banking
solution trjp mspf;fg;gl;l tq;fpah? To Facilitate ECS / NEFT / RTGS Transactions
whether the Bank is CBS enabled?
Mk; / ,y;iy
Yes / No
7. khzthpd; njhiyNgrp / miyNgrp vz;. Student Phone / Cell Number.
:
,lk;: khztu; / khztpah; ifnahg;gk; Station: Tirupattur, Vellore Dt. Signature of Applicant
ehs;: Date: / / 2019.
M.jp.g.e. 73---2
4
cWjpnkhop DECLARATION
vdJ Foe;ijfspd; tptuq;fs; kw;Wk; mtu;fs; ngw;w fy;tp cjtpj; njhif tptuq;fs; Details of my Children and the details of Scholarships received by them for
Postmatric studies.
njhlu; vz;>
ngau; ,Wjpahfg; gbj;j kw;Wk; jw;nghOJ gbf;Fk; fy;Y}upapd;
ngau;.
ngwg;gl;l my;yJ tpz;zg;gpj;Js;s njhiff;Fupa
Mz;L.
ngwg;gl;l gbg;Gjtpj; njhif.
Serial
Number
Name
Name of the
Educational Institution
last studied and now
studying
Year of which
scholarship
received or
applied for
Amount of
Scholarship
received
1. 2. 3. 4. 5.
Fwpg;G:- ngw;w midj;Jf; fy;tp cjtpj; njhiffisg; gw;wpAk; Fwpg;gpl Ntz;Lk;. Details of all Scholarship received by your children should be furnished.
,t;tpz;zg;gj;jpYk; Nkw;fz;l cWjpnkhopapYk; mspf;fg;gl;Ls;s tptuq;fs; rupahdit vdTk;> mit rupahditay;y vd;W fz;lwpag;gl;lhy; jw;NghJ tpz;zg;gpj;Js;s jpU / jpUkjp /
nry;tp ……………………………………. mtu;fSf;F xg;gspf;fg;gl;l gbg;G cjtpj; njhif KOtijAk; muR tpjpf;Fk; ve;j topapYk; jpUg;gpaspf;f ,irfpNwd; vdTk; kdkhu cWjp mspf;fpNwd;.
I solemnly declare that the particulars furnished in the application as well as in this declaration are
correct and if they are found to be false later on, I agree to refund the entire amount of scholarships paid to
Thiru / Selvi / Thirumathi ……………………………………. who has now applied for Scholarship
through whatever means the Government deem proper and fit.
,lk;: ngw;Nwhh; /fhg;ghsupd; ifnahg;gk; Place: Signature of Parent / Guardian.
ehs;: Date: / / 2019.
5
fy;tp epiyaj; jiytuhy; epiwT nra;ag;gl Ntz;baJ
TO BE FILLED BY THE HEAD OF THE INSTITUTION
fy;tp epiyaj; jiytu; Heads of the Institution.
1. khztu; tFg;gpy; Nru;e;j ehs;. Date of which the applicant joined the class this year.
- - 2019
2. ,e;j Mz;by; Nju;T KbAk; khjk;. Month in which the annual examination in the
current year will be over. April / May - 2020
3. khztu; tpLjpapy; jq;fpg; gapy;gtuh? Where the applicant is residing in the hostel?
m. tpLjpapd; ngau; / Name of the Hostel.
M. tpLjp fy;tp epiyaj;Jld; ,ize;Js;sjh? Whether the hostel is attached to the institution?
,. jdpahu; tpLjpah? ,ytr czT> ciwtplk; toq;fg;gLfpwjh? Whether the hostel is run by the private
management and whether free boarding and
lodging is provided.
<. muR tpLjpah Mk; vdpy; tptuq;fs; mspf;fTk;. Whether the student is staying in the Govt. Hostel.
If so indicate details there for.
(i) Mjp jpuhtplu; eyj;Jiw. Adi-Dravidar Welfare Department.
(ii) gpw;gl;Nlhu; eyj;Jiw. Backward Class Welfare Department.
- - -
(iii) kpfg;gpw;gl;Nlhu;> rpWghd;ikapdu; eyj;Jiw. Most Backward Class and Minorities Welfare
Department.
- - -
4. khztu; tpLjpapy; Nru;e;j ehs;. Date on which the student joined the hostel. - - 2019
5. tpLjp fhg;ghsupd; ifnahg;gk;. Signature of the Warden.
6. khztu; ngw;Ws;s tUif tpOf;fhL. Percentage of Attendance obtained by the student.
7. khztu; elj;ij Fwpj;J rhd;wpjo;. Character of the student.
8. khztUf;F fy;tp cjtpj;njhif toq;f gupe;Jiu. Recommendation of the Head of the Institution for
the grant of Scholarship.
6
kj;jpa muR Ngh];l; nkl;upf; fy;tp cjtpj; njhif ngWk; khztu;fSf;F kl;Lk;. cly; CdKw;w ,e;J Mjp jpuhtplu; / goq;Fbapdu; khztu;fSf;fhf $Ljy; rYif.
tpz;zg;gjhuu; cly; CdKw;wtuh? Mk; / ,y;iy
Mk; vdpy; gpd;tUtdtw;wpy; nghUj;jkhdij bf; ( ) nra;aTk;
1. ghu;itf; FiwT / Low Vision ( )
2. fhJ Nfl;gjpy; FiwAs;sth; / Deaf ( )
3. njhO Nehapy; ,Ue;J kPz;ltu;fs; / recovered from
leprosy.
( )
4. kdNehahy; ghjpg;gile;jtu;fs; / Physcholagically affected. ( )
5. if> fhy;fs; tsu;r;rpapd;wp topj;Jizahsh;fspd; cjtpAld; fy;Y}upf;Fr; nry;gtu; / Orthopedically
handicapped going to college with the help of a guide.
( )
6. if> fhy;fs; tsu;r;rpf; Fiwthy; CdKw;W fy;Y}upAld; ,ize;j tpLjpapy; jq;fpapUg;gtu;fs; / Orthopedically
disabled studying in institution run for physically challenged
person as hosteller attached to the institution.
( )
7. %is tsu;r;rp Fd;wpatu;fSf;fhd rpwg;G gapw;rp ngWgtu;fs; / Special coaching for mentally retarded person.
( )
NkNy tupir vz; (5)-y; Fwpg;gpl;Ls;s topj;Jizahsh;fs; cjtpAld; fy;Y}hpf;F nry;gth;fshf ,Ue;jhy;.
1. topj;Jizahshpd; ngah; / Guide Name 2. Kfthp / Address
topj;Jizahsupd; ifnahg;gk; / Guide Signature
Nkw;fhZk; nghUs;fspy; nghUj;jkhdtw;Wf;F cjtp kUj;Jt mYtyu; (Civil Assistant
Surgeon) epiyf;F Fiwahj muR kUj;Jt mYtyuplkpUe;J rhd;wpjo; ngw;W ,izf;f Ntz;Lk;.
NkNy tupir vz; (5) kw;Wk; (6)-y; nra;jpUe;jhy; tpz;zg;gjhuupd; jw;Nghija KO cUt
epow;glj;jpid FwpaPl;Lj; jhspy; ,izf;f Ntz;Lk;.
7
rhpghh;g;G gl;bay; / Check List
Gifg;glk; / Photocopy ,ilepWj;jk; ,Ug;gpd; ,ilepWj;j rhd;wpjo; / Break Certificate
rhjprhd;W / Community Certificate kjpg;ngz; rhd;Wfs; / Mark
Certificate
tUkhdr;rhd;W / Income Certificate tq;fp fzf;F Gj;jf Kjy; gf;f efy; / kpd;dD jPh;it gw;W chpikf; fl;lis gbtk; / Whether ECS credit
mandate form enclosed? or enclosed
Bank Pass Book First Page Copy.
tUifr; rhd;W / Attendance Certificate
REG. NO. : ________________________ 8 M.jp.g.e. 74 & 75-1>000-2006-m.fp.m.> GJif
CLASS : I - jkpof muR YEAR : 2019 - 2020 GOVERNMENT OF INDIA Mjpjpuhtplh; kw;Wk; goq;Fbapdh; eyj;Jiw
ADI-DRAVIDAR AND TRIBAL WELFARE DEPARTMENT fy;tp cjtpj; njhif
GjpaJ / GJg;gpj;jy; FwpaPl;Lj;jhs;
1. fy;tp epiyaj;jpd; ngah;> Kfthp
Institution Name and Address. :
SACRED HEART COLLEGE (AUTONOMOUS),
TIRUPATTUR - 635 601, VELLORE DIST.
2. (1) gl;bay; ,dj;jth;. Scheduled Caste.
:
(2) fpwpj;Jt kjj;jpw;F khwpa gl;bay; ,dj;jth;. Scheduled Caste Converted to Christianity.
:
(3) goq;Fbapdh; Scheduled Tribes (rk;ke;jg;gl;l FwpaPl;L vz;izf; Fwpg;gpl Ntz;Lk;) (mentioned the correct serial numbers)
:
3. Mz; (M) / ngz; (ng). Boys / Girls
:
4. (m) khztp / khzth; ngah; Students Name
:
(M) gj;jhk; tFg;gpy; Njh;r;rp ngw;w Mz;L Year and Register No. of passing of the 10
th
Public Examination.
:
(,) gjpT vz; Registration Number.
:
5. jha; (m) je;ij / ghJfhtyh; ngah; Name of the Mother / Father / Guardian
:
(a) FLk;g Mz;L tUkhdk;. Family yearly income.
:
6. epue;ju Kfthp Permanent Address.
:
7. nrd;w Mz;L gbj;j tFg;G, cjtpj; njhif ngw;w gbg;Gg; gphptpd; tptuk;:- Class studied in previous year particulars of
the course for which scholarship received.
(m) (1) Nky;epiyg; gbg;G /
Higher Secondary Class
:
STUDENT ID :
201904010ADW00
9
(2) gl;lg;gbg;G / Degree Course. (3) gl;l Nkw;gbg;G / Post Graduate Course. (4) njhopw;gbg;G / Professional Course (5) njhopy;El;gg; gbg;G / Polytechnic Course (6) rhd;wpjo; gbg;G / Certificate Course.
(M) nrd;w Mz;L gapd;w gbg;G. (1) 1Mk; Mz;L / 1
st Year
(2) 2Mk; Mz;L / 2nd
Year (3) 3Mk; Mz;L / 3
rd Year
(4) 4Mk; Mz;L / 4th
Year (5) 5Mk; Mz;L / 5
th Year
(,) nrd;w Mz;L tpLjpapy; Nrh;e;j ehs;. Date on which the applicant joined the
hostel last year.
8. ,e;j Mz;L gbf;Fk; gbg;G kw;Wk; Mz;L. Course studying at present and the year of study.
(m) ghlg;gphpT (Kf;fpag; ghlg;gphpT Fwpg;gpLf) / Subject
(M) gapYk; Mz;L (1) 1Mk; Mz;L / 1
st Year
(2) 2Mk; Mz;L / 2nd
Year (3) 3Mk; Mz;L / 3
rd Year :
(4) 4Mk; Mz;L / 4th
Year (5) 5Mk; Mz;L / 5
th Year
9. ,e;j Mz;L fy;Y}hp Jtq;fpa ehs;. College re-opening date for the year
khjk; / Month
Mz;L / Year
10.
tpLjpapy; Nrh;e;j ehs; / Joined the Hostel.
khjk; / Month
11 tpLjp tifg;ghL / Classification of Hostel.
(1). mq;fPfhpf;fg;gl;l jdpahh; tpLjp (,ytr czT kw;Wk; ciwAs;). approved or recognized private hostel (free food and accommodation).
(2). mq;fPfhpf;fg;gl;l jdpahh; tpLjp (czT kw;Wk; ciwAs;Sf;fhf fl;lzk; tR+ypf;fg;gLfpwJ).
recognized private hostel (fees collected for food & accommodation).
(3). Mjpjpuhtplh; eyj;Jiw tpLjp Adi Dravidar Welfare Department Hostel.
(4). gpw;gl;Nlhh; eyj;Jiw tpLjp Backward Department Hostel.
2019 - 2020
1 7
2 0 1 9
0 6
1st Year
10
(5). kpfTk; gpw;gl;Nlhh; kw;Wk; rpWghd;ikapdh; eyj;Jiw tpLjp. (MBC and Minority Welfare Department Hostel).
(6). fy;tp epWtdj;Jld; ,ize;j tpLjp (nghUj;jkhd vz;fis Fwpg;gplTk;) cly; CdKw;w ,e;J Mjpjpuhtplh; / goq;Fbapdh; khzt / khztpah;fSf;fhd $Ljy; rYif. (Note appropriate number). Additional connection for
Physically disabled HAD / Tribal Boys / Girls.
12. Njh;T KbAk; khjk; / Exam closure Month
Mz;L / Year
13. fle;j Mz;L fy;tp cjtpj; njhif ve;j khjk; tiu toq;fg;gl;lJ. Till which month last year Scholarship was sanctioned.
14. cjtpj; njhif ,e;j Mz;by; ve;j khjj;jpypUe;J toq;fg;gl Ntz;Lk;. / From which month this year
Scholarship has to be sanctioned.
15. khzth; Njitahd tUif tpOf;fhL ngw;Ws;shuh? Does the student attained needed attendance percentage?
Mk; ,y;iy
16. tpz;zg;gjhuh; cly; CdKw;wtuh? Whether the applicant of physically disabled.
Mk; ,y;iy
Mk; vdpy; nghUj;jkhdtw;iw bf; ( ) nra;aTk;. if yes tick ( ) the suitable
(m). ghh;itf; FiwT / Low vision
(M). Nfl;Fk; jpwd; Fiwte;jth; / Deaf
(,). njhONehapy; ,Ue;J kPz;lth; / recovered from leprosy
(<). kdNehahy; ghjpg;gile;jth; / Physcholagically affected
(c). if> fhy;fs; tsh;r;rpFd;wp topj; Jizahsh; cjtpAld; fy;Y}hpf;Fr; nry;gth; / Orthopedically
handicapped going to college with the help of a guide.
(C). if> fhy;fs; tsh;r;rpf; Fiwthy; CdKw;w fy;Y}hpAld; ,ize;j tpLjpapy; jq;fp gapy;gth; /
Orthopedically disabled studying in institution run for
physically challenged person as hosteller attached to the
institution
(v). %is tsh;r;rp Fd;wpath;fSf;fhd rpwg;Gg; gapw;rp ngWgth; / Special coaching for mentally retarded person.
17. khzthpd; tq;fp fzf;F vz;. Student Bank Account Number. :
1. tq;fp ngah; / Bank Name :
6
0 4
2 0 2 0
0 4
0 6
11
2. tq;fp fpis / Bank Branch :
3. MICR Code / MICR FwpaPL :
4. IFSC Code / IFSC FwpaPL :
5. tq;fp fzf;F Gj;jfj;jpd; Kjy; gf;f efy; / ,izf;fg;gl;Ls;sJ my;yJ kpd;dD jPh;it gw;W chpikf; fl;lis gbtk; / enclosed Bank
Pass Book First Page Copy or ECS credit mandate form
enclosed?
Mk; / ,y;iy Yes / No
6. kpd;dD jPh;it / Njrpa kpd;dD epjp ghpkhw;wk; / RTGS Kiwapy; fy;tp cjtpj; njhifia Nrkpg;Gf; fzf;fpy; Nrh;f;f khzthpd; Nrkpg;G fzf;F guhkhpf;fg;gLk; tq;fp Core Banking solution trjp mspf;fg;gl;l tq;fpah?
To Facilitate ECS / NEFT / RTGS Transactions
whether the Bank is CBS enabled?
Mk; / ,y;iy Yes / No
7. khzthpd; njhiyNgrp / miyNgrp vz;. Student Phone / Cell Number :
khzth; ………………………………………………….. ghjpg;gpdhy; cly; CdKw;wth; vd;Wk; khzth; fy;Y}hpAld; ,ize;j tpLjpapy; jq;fp gapy;fpwhh; / topj;Jizahsh; cjtpAld; fy;Y}hpf;F te;J nry;fpwhh; / %is tsh;r;rp Fiwe;jth;fSf;fhd rpwg;Gg; gapw;rp ngWgth; vd;Wk; rhd;wspf;fpNwd;. chpa rhd;Wfs; ,izf;fg;gl;L rhpghh;f;fg;gl;lJ.
Certified that the students ……………………………………………..……….. defect is physically
challenged and is studying in the institution as hosteller attached to the institution coming to
institution with the help of a give / receiving special training for mentally retarded person. Due certificate
are enclosed and verified.
18. fy;tp epiyaj; jiyth; ghpe;Jiu: kj;jpa / khepy muR cjtpj; njhif toq;Fk; tpjpKiwfSf;F cl;gl;L khzth; / khztpah; GJg;gpj;jy; cjtpj; njhif ngw jFjp cilath; vdTk; khzth; / khztpaUf;F cjtpj; njhif GJg;gpj;J toq;fyhk; vdTk; ghpe;Jiu nra;fpNwd;.
18. Recommendation of Head of Institution:- Certified that the student is eligible for renewal
scholarship amount subject to central / State Government rules and the students in recommended for
sanction of renewal scholarship.
fy;tp epiyaj; jiythpd; ifnahg;gk; mYtyf Kj;jpiu.
Principal Signature with Seal