F – 1
CENTRAL BOARD OF SECONDARY EDUCATION
MERIT SCHOLARSHIP SCHEME
[ For SINGLE GIRL CHILDREN who have passed Class X from CBSE
May 2011 & pursuing XI & XII from CBSE affiliated School ]
(PLEASE SEE ATTACHED INSTRUCTIONS)
(To be filled by
Name of applicant (as per Class X certificate) 2. Date of Birth
(DD/ MM/ YYYY)
3. Roll No. (Class X)
Mother’s Name 5. Address for correspondence 6. Year of Passing class X 2011
CGPA Obtained _______
(As per statement of subject-wise
performance issued by the Board.)7.
No. of Brothers ___ (excluding you)
No. of Sisters ____ (excluding you)
9. Category (TICK √ )
GEN/ OBC/ SC/ ST/ PH
10. Email Address
11. Phone Number (with STD code) _____/____________
Mobile No. ________________________
12. Particulars of Savings Bank Account
Name of the Bank &
Address (City and State)
Name and Address of the
School of Class XI
__________________District ________________ State ___________
14. School Code
of Class XI
Tuition fee charged by
the school mentioned
Class X____________ Per Month Class XI____________ Per Month
(Even if you have not studied in the present school)
(Affiliated with CBSE / any other Board) (TICK √ mandatory field)
1. Photocopy of mark sheet Yes/ No
2. Original Affidavit duly sworn in before the First Class
Judicial Magistrate/ SDM/ Executive Magistrate, as per
prescribed format from the Parents Yes/ No
(Photocopy of Affidavit will not be accepted)
17. Signature of Applicant _______________________ Date ________________________
Photograph of the
Applicant duly attested
by the Principal of
TO BE FILLED IN BY THE PRINCIPAL OF THE SCHOOL FROM WHERE
THE STUDENT IS PURSUING HER CLASS XI
The facts stated above are hereby certified to be true and correct. The
School is affiliated with the CBSE, Class _____________upto year 20 to
20 vide AFFILIATION NO. ________________
Signature of Principal
Telephone & Mobile No.
NOTE: Incomplete application will be treated as cancelled.
INSTRUCTIONS FOR FILLING FORM (F – 1)
The applicant should fulfill all the criteria given below for consideration and
award of scholarship:-
(i) should be an Indian national.
(ii) should be the girl child and only child of her parents.
(iii) should be a student of CBSE in Class X (i.e. passed class X from a CBSE
affiliated school) and having 6.2 or more CGPA in Class X
Examinations 2011 conducted by the Board and pursuing Class XI & XII
from CBSE affiliated Schools
(As per statement of subject-wise performance issued by the Board).
(iv) the tuition fees for Class X should not be more than Rs. 1,500/- per month
during the Academic year. In the next 02 years the total enhancement of
tuition fee shall not be more than 10% of the tuition fee.
Value of scholarship Rs. 500/- per month
Duration 02 years only (for Class XI & XII)
All the application must be signed by the applicant. Unsigned applications or signed by
the parents will be rejected.
All the applications must be certified along with signature/ stamp of the Principal of the
present school where the student is studying. In case applications are not attested the
same will be rejected.
Documents to be sent with the APPLICATION
An attested copy of Mark sheet of Class X 2011 issued by CBSE.
An affidavit from the parent that the candidate is the only child of her parents on
a non-judicial stamp paper of Rs. 10/- duly sworn in before First class Judicial
Magistrate/ SDM/Executive Magistrate should be submitted along with the
application. Photocopy of affidavit will not be accepted.
Where to send Duly filled up Application Form
The duly filled in proforma be sent in an envelope superscribing “APPLICATION FOR
MERIT SCHOLARSHIP FOR SGC X 2011 (F-1)” should be sent to the “SECTION
OFFICER (SCHOLARSHIP) CBSE, SHIKSHA KENDRA, 2, COMMUNITY CENTRE,
PREET VIHAR, DELHI–110 092”. Change of address must be intimated
Scholarship will be sent to the correspondence address of applicant
mentioned in application form. List of eligible applicant who is being sent
scholarship will be displayed / updated on website regularly.
Jurisdiction of Courts/ Tribunals
a) A Scholarship once cancelled shall not be renewed under any circumstances.
b) The decision of the Board shall be final and binding in all such matters.
c) Any resultant dispute arising out of this scholarship scheme shall be subject to
the sole jurisdiction of the court situated in Delhi/ New Delhi only.
FORMAT OF AFFIDAVIT TO BE ATTACHED WITH THE
(ON NON-JUDICIAL STAMP PAPER OF RS.10/- SWORN BEFORE
FIRST CLASS JUDICIAL MAGISTRATE/SDM/EXECUTIVE MAGISTRATE
FROM THE PARENTS)
I ___________________ s/o / d/o _____________ r/o __________________ do
hereby solemnly affirm and declare as under:-
1) That ____________is my only one daughter and her date of birth is _________.
2) That I am the father/mother and Ms. ________________ is my only daughter.
3) That I have no other child except my above named daughter.
VERIFIED AT ON THIS ______________ DAY OF ____________ AND THE
CONTENT OF THIS AFFIDAVIT ARE TRUE AND CORRECT AND NOTHING
MATERIAL HAS BEEN CONCEALED.
(Strike off whichever is not applicable)