Instructions:

1 – Fill in the form completely and do not leave any column blank. If any column is not applicable to your case, specifically
‘Nil’.

2 – Attestations and other documents are not required at this stage; simply fill-in the form and submit via email.

3 – Any false statement or incomplete information will make you ineligible.

Guidelines:

1 – Personal Details:

Your name must match with the exact name printed on your CNIC.

Make sure that your CNIC number is absolutely correct.

We’ll prefer to have your personal mobile number listed here.

2 – Course Details

State the exact title of your programme like MBBS, BE Electrical, BS Information systems etc.

Course beginning and completion dates mean the time period starting from your enrollment in university / college to your
expected graduation.

Let us know very clearly which semester or year you are currently enrolled in.

3 – Academic Records

Examination Level means different stages of your programme like 3rd semester, 2nd Prof or 1st year etc.

List all semester / yearly / professional examinations that have been held since your enrollment and whether you have pas
those or not.
If the result has not been declared for your recent exam, then say ‘Not declared yet’ in the results status column.

4 – Guardian Details

You are required to provide specific details of your guardian’s occupation. Whether employed or retired, you should state h
exact designation and organization. Do not provide vague statements like ‘Government servant’.

If your guardian is engaged in a commercial activity or self-employed, e.g. if he is farmer or shopkeeper, then provide deta
his farm / business in the relevant section of Household Details.

Make sure to state your guardian’s yearly income from all sources.

5 – Educational Expenditure

If you possess sources of financing other than guardian’s monthly salary / income, then you must state its amount in the
relevant column. Say ‘Nil’ for columns that do not apply.

If your guardian’s income can be broken down into fixed salary and other income, such as rental income from property etc,
then you must state these other sources in the space provided here.

As for the educational fee of the institutes previously attended, quote the sum of yearly tuition fee and hostel charges (inca
you were living in a hostel).

6 – Household Details

Family members include father, mother, brothers and sisters.

You must state the yearly figures for all salaries, earnings and fee.
 DIYA PAKISTAN REGISTERED
1304/474, Hasan Street, Defence Road, New Lalazar, Rawalpindi
Tel: 051-5859582, Mobile: 0300-5322592
(Office Telephone Timings: 3:00pm to 5:00pm)

This Form must be submitted via email to apply@diyapak.org

APPLICANT'S DETAILS

Muhmmad Imad yasir

CNIC No: 16202-0604022-3 Age: 20

Father's Name: Mukhtiar muhammad

Gender: ✘ Male Female Domicile: Swabi

Email: muhammadimadyasir@yahoo.com Tel: 0300-5511753

Present Address: chiltan super store almas chawk airport road Quetta

Permanent Address: H\N# C-57 Power Complex Colony Barotha,Attock

Applicant's Status: Orphan Disabled ✘ Poor & Deserving

Orphan's Only: Mention year of father's death:

Disabled Only: Indicate nature of disability:

COURSE DETAILS

Name of University / College: Balochistan University of IT Engineering & Management Science

Title of Programme / Course: BS Textile 3rd

Roll No: 9721 Registration No:

Programme started on: fall 2009 will complete on: 2012

/10/2013

Total Duration of your Programme / Course: Years: 4 Semesters: 8

Currently Enrolled in Year / Semester: 3rd

Mode of Admission: ✘ Open Merit Reserved Seats Self Finance

Key person to be contacted in your department:

Name: Zameer ahmad abro

Designation: Lecturer Tel: 0333-7311944

ACADEMIC RECORD

Marks
Examination Year Roll No. Total Marks % Position
Obtained

Matriculation 2007 714637 557 850 67.00 B

Intermediate 2009 540723 629 1100 57.00 C

Bachelors 2008

Are you Hafiz-e-Quran? ✘ Yes No

Do you retain Hifz? ✘ Yes No

Current Academic Performance

Provide complete details of all examinations that have been administered by your university / college
so far, including examinations for which the result has not been declared yet.

Examination Level
Month / Year when exam Results Declaration Date Average Percentage or
(Mention Year, Prof or
was conducted / Status GPA obtained
Semester)

2009 OCT March(2010) 3.6

2010 april september 3.6

2011

GUARDIAN DETAILS

Name: Mukhtiar muhammad

CNIC No: 15305-5195265-1 Relationship with Applicant: Father

Guardian's Occupation: Accountant Yearly Income: 150000

Exact Designation: Accountant Organization:

Telephone: 0301-5424956 Address:

H\N# C-57 Power Complex Colony Barotha,Attock

EDUCATIONAL EXPENDITURE

Current Expenses on Education

Yearly Messing
Yearly Tuition Fee Yearly Hostel Fee Total Expenditure
Expenses

23000 10000 40000 73000

Sources of Educational Financing other than Guardian's Monthly Income

Loan from Relatives / Friends Nil

Loan from some organization nil

Scholarship from another organization Nil

Remission from College / University nil

Income from other sources nil

If you are receiving scholarship from another organization, then please provide the details of this
scholarship:

Name of the Donor / Organization:

Type of Scholarship: One-time Yearly Monthly

If you have stated any amount for 'Income from other sources', then provide complete details of all
such sources:

nil

Tuition Fee of Institutes Previously Attended

Matriculation Intermediate

Name of the Institute Wapda Boys High School G D C Attock

Location Attock Attock

Yearly Fee 4000 10000

Amount of any
Scholarship / Remission
Availed
Note: For matriculation you should state the yearly expenses you had to incur in class Xth only.
Similarly, for Intermediate you should state the yearly expenses of class XIIth only.

HOUSEHOLD DETAILS

Family Accommodation Details:

Note: Family includes father, mother, brothers and sisters.

Type: House Flat ✘ Quarter Mud House

Status: Rented Family Owned ✘ Provided by Govt. / Organization

If rented, annual rent:

Average monthly electricty bills during the months April to Sept. 250

Details of family members currently employed / retired

Yearly
Name Age Exact Designation Employer
Salary

Nil

Details of family members currently engaged in business / commercial activity

Yearly
Name Age Type of Business Location of Business
Earnings

Nil

Details of family members currently studying

Name Age Institute Yearly Fee

Fozia 15 G G H S Attock 1500

Nazia 11 G G H S Attock 1000

M.Arsal khan 9 G P S Attock 730

Any other thing that you would like to add or say (related to this application):

Sir,my father is Govt. servant and our family expenditure is not fulfill by less pay.my brother and sisters

also studying and he cannot afford my educational expenditure,I am the position holder of my class.

I want to continue my study but it is possible when you support me plz Kindly support me for making

my future.Thanks…………….

Declaration by the Applicant and his/her Guardian:

We, the undersigned solemnly affirm that the details/information

provided are accurate and that we shall be responsible for
any inaccurate or false information.

Applicant's Signature Guardian's Signature

Verification by Tehsildar or Competent Authority:

I attest that the information contained in application form is accurate

and the applicant deserves the grant of scholarship award.

Signature Stamp / Seal

Note: Competent authority includes Area Magistrate, Tehsildar, Naib Tehsildar, Mukhtiarkar or
Area Nazim
For Diya's Office Use Only

Decision

Reason (if required)

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