1. FORMAT OF APPLICATION FORM
Application No./IDNo.(to be filled by Ministry)--------
1. Name of the Candidate------
2. Father’s/Mother’s Name--------
3. Date of Birth----
4. Place of birth/state
5. Community------
(please attach proof of Community certified by the Competent
Authority)
6. Name of the Examination Passed (Passing of Preliminary
Examination)-------- Year-------
7. Roll Number-----------
(Please attached roll number slip for proof)
8. Identity proof ------------ 8(i) UID No./Adhar no…………….
(Please attached documents for identity)
9. Annual Income of the family from all sources----------
(Income Certificate to be enclosed)
2. 10. Educational Qualifications:
Sl.
No.
Name of the
examination
Board/University Year of
passing
Total
Marks
Total
Marks
scored
%
1 Matriculation
Or equal level
2 Graduation
3 Post
graduation
4 Others( if any)
Attach duly attested mark sheet for each.
11. Bank Account Number(Nationalized Bank only)--------------------------
Bank Name--------------Address of the Bank------------------------MICR
Code----------IFSC Code-------- (Attach copy / photo copy of a
cancelled Cheque of Bank Account with the name of the beneficiary
under the Scheme.
12.Address of the candidates
Permanent Address: -----------------------------------------------------------
------------------------------------------------------------------------------------
Temporary Address:----------------------------------------------------------------
----------------------------------------------------------------------------------------
E-mail id:------- Phone (M) -------- - (Land Line) -------
Candidates need to indicate the address they want the Correspondence to be
sent to. Change in e-mail id; Phone number etc. to be made available.
Signature
Name of the candidate:
Place/Date:
