This document outlines the format of an application form which includes sections for: 1) Applicant information such as name, father's name, date of birth, place of birth, community, examination details, roll number, and identity proof 2) Family income details and income certificate 3) Educational qualifications including examination name, board/university, year of passing, total marks, and marks scored 4) Bank account details for direct benefit transfer including account number, bank name, address, MICR code, IFSC code, and cancelled cheque copy. 5) Contact details including permanent address, temporary address, email, phone numbers and preferred correspondence address.

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: