fill this form

1. K. C. MAHINDRA EDUCATION TRUST
(Public Trust Act-Registration No. E 1245 - Bombay)
APPLICATION FORM FOR MAHINDRA ALL INDIA TALENT SCHOLARSHIP FOR 1ST
YEAR DIPLOMA.
Application No. *
(Above entry to be left blank by the Applicant)
Read this Form carefully. Incomplete Application Form will NOT be considered.
Applicant’s Name in full: _____________________________________________________________
Age _________ Date of Birth _______________________________
(as recorded in your School Certificate - Encl. attested copy) (*)
Address for Correspondence:
Pin code
Name of the District: Name of the State:
Telephone/Mobile, if any : e-mail id: ________________________
Father’s Name in full : __________________________________________________________
Permanent address : __________________________________________________________
Pin code
Name of the District: Name of the State:
Has anyone else in your family (brother/sister) received the Mahindra All India Talent Scholarship:
Yes No Give Details: ______________________________________
Affix
Passport size
Photograph with
your signature.

2. Family Information:
Number of family members: ____________________________
Parents Name Level of
Education
Employment /
occupation
Income per
Year
Father
Mother
No. of Brothers ________
No. of Sisters ________
Any other source of income or scholarship? Please state amount and number of years: ___________
TOTAL FAMILY INCOME PER YEAR: _________________________
Details of Applicant’s Educational record :
Name of School/
College
Name of
Board/University
Examination
Passed
Stream/
Subjects
Year Percentage
of marks / CGPA
obtained
XTH (SSC)
(mandatory)
XII (HSC)
(If applicable)
Proposed Course of Study
(Give full details of your Diploma Course)
Course duration in
years
Total College fees you have to pay
per year
Will you be living in a hostel? Yes/No
If yes, how much does it cost you every month?________________________________
Admission sought at:
Admission secured at:
(Name and full address of the Institute)
[Enclose copy of admission letter duly attested] *
Diploma Course Started from [Date]
No. of Years Course
CEEP (Common Entrance Exam) Rank (If applicable): _____________
Name and address of two referees (teacher/employer) - under at least one of whom the applicant has studied or worked.
1.
2.

3. Where did you hear about MAITS?
Ad in Newspaper ______________________ (Name of publication/newspaper)
College Notice Board Friends Others
Bank Details:
Name of the student as per bank account: ___________________________
Name of the bank: _________________________________________
Bank address: _____________________________________________
Account no. (Account no. for NEFT transfer): __________________________________________
IFSC Code (Mandatory): ___________________________________
Enclosures:
1. Testimonial (Recommendation letter) from any one of the two referees (teacher/employer) mentioned above.
2. A short statement as to your general aptitude and interest, the type of vocation you would like to pursue and your ambitions
and aspirations in life.
3. Attested copy of Certificate of Date of Birth as recorded in your School Certificate.*
4. Attested copy of Mark Sheets and Certificates of examinations passed. *
5. Attested copy of Letter from Institution where admission has been secured. *
* Candidates who have not secured admission will not be called for the final interview. Therefore candidates should
submit a copy of the admission letter as soon as they secure admission.
6. Family Income certificate copy.
7. Self-attested copy of first page of passbook or canceled cheque.
8. Aadhaar Copy. (Mandatory).
Please note that only students who have a bank account can apply for this scholarship.
I hereby declare that the entries in this form are true and if I am selected, I agree to abide by the terms and conditions of the K. C.
Mahindra Education Trust, Mumbai.
Date: Yours faithfully,
_______________________
[Name and Signature of
Applicant]
_______________________
Date: [Name and Signature of
Father/Guardian].
To the best of my knowledge, what is stated above is correct.
________________________
Date : [Name and Signature of the
Institution where you studied last/are studying)

4. ELECTRONICS FUNDS TRANSFER – MANDATE FORM
To
K.C.MAHINDRA EDUCATION TRUST,
Mumbai.
Sub: Receipt of Scholarship payment through NEFT
I am giving below the details of my bank account for receiving the scholarship
Instalment payment through NEFT.
(1) NAME __________________________________
(2) Bank Name ______________________________
(3) Bank Br. Address : __________________________________________
__________________________________________
(4) Savings Account No. _________________________________________
(5) IFS Code No: ____________________________
(6) Students Contact No. ____________________
(7) E-Mail Id. ____________________
(8) Aadhar No.___________________
I have enclosed the following document to this effect.
(a) Cancelled Cheque leaf or Bank passbook containing details of Bank accounts number,
IFS Code
___________________
Signature of the Student

5. Please submit the filled in form to the nearest centre in your area. Candidates must
submit their forms to ONLY ONE of the following addresses:
1 Ms Jayashree Payimpallai 7 The Coordinator
Mahindra & Mahindra Ltd Mahindra & Mahindra Ltd
34/1128 Balakrishna Menon Road Mahindra Tower, Automotive Sector
Edapally PO 1st Floor, 24,25,26 Durga Vihar Colony
Cochin 682024 Durga Pura, Tonk Road
Jaipur 302018
2 Mr V Suresh 8 The Coordinator
Mahindra & Mahindra Ltd Mahindra & Mahindra Ltd,
Mahindra Towers, 17/18 FES Swaraj Division
Pattulos Road Phase IV Industrial Area
Off Mount Road SAS Nagar
Chennai 600002 Punjab 160055
3 The Coordinator 9 The Coordinator
Mahindra & Mahindra Ltd Mahindra & Mahindra Ltd
Mahindra House, Auto Sector Mahindra Towers, 3rd Floor
T.S. Reddy Complex 2A Bhikaji Cama Place
1-7-1, Park Lane, SD Road New Delhi 110067
Secunderabad 500003
4 Mr. V Suresh 10 The Coordinator
Mahindra & Mahindra Ltd Mahindra & Mahindra Ltd
Raheja Chambers 3rd Floor, Mahindra Tower, Auto Sector
1st Floor, Museum Road Near HAL, Faizabad Road
Bangalore 560001 Lucknow 226016
5 The Coordinator 11 K.C. Mahindra Education Trust
Mahindra & Mahindra Ltd Cecil Court, 3rd Floor
Automotive Division Mahakavi Bhushan Marg
7 KYD Street Behind Regal Cinema, Colaba
3rd Floor Mumbai 400001
Kolkata 700016
6 The Coordinator
Mahindra & Mahindra Ltd.
Auto Sector
B/1, 701 to 707 & 712
7th Floor, Palladium, Corporate Road,
Near Divya Bhaskar Press, Makarba,
Ahmedabad 380051