FORM

F-3

CENTRAL BOARD OF SECONDARY EDUCATION MERIT SCHOLARSHIP SCHEME FOR UNDERGRADUATE STUDIES
[For single girl !il"ren #!o !$%e &$sse" Cl$ss 'II (ro) CBSE in M$* +,,.Ple$se see $//$ !e" ins/r0 /ions1

Regis/r$/ion No2 .To 3e (ille" 3* CBSE

N$)e o( $&&li $n/ .$s &er 'II er/i(i $/e1

D$/e o( Bir/! (DD/MM/YYYY)

'II Roll No2

1.
Mothers name .

42254254444
A""ress (or orres&on"en e
Ye$r o( P$ssing l$ss 'II .Firs/ (i%e s036e /s1

2. 3. 4. 5. ..
a& b& "& d& e& Fathers name . No. of Brothers----------- e!"#udin$ %ou&
No. of 'isters ---------------- e!"#udin$ %ou&

Marks obtained. Out of 500

N$)e o( /!e Bo$r" .CBSE5ICSCE5STATE BOARD1 (Tick)

7 $ge ----------------------S/$/e Pin o"e Se8 (Tick)

M$le $/egor*9

Fe)$le

GEN5OBC5SC5ST5PH (Tick)

(mai# )ddress****************************

'+, "ode of "it%&. -hone Number

&

Mobi#e No. ..&

Particulars of Savings Bank Account (Mandatory; Application will be rejected if all the columns are not filled
Account !umber (of applicant only !ame of the Bank " Address (#ity and State Bank #ode !umber M$#% #ode %&'S(!)*&($*S# #ode (++ digit #ode of the Bank

/. 9. :. 10.

N$)e $n" A""ress o( &resen/ College5Ins/2 :!ere $")i//e" (or Un"ergr$"0$/e S/0"ies N$)e o( Co0rse

,istri"t..'tate
0s the 0nstitution affi#iated 1ith 2345)04+(54entra#5'tate 3o6t.57ri6ate et".& 8es5No (Tick) Duration of Course ____________years

--------------------------------En los0re $//$ !e" ;2 Co&* o( )$r< s!ee/ Yes5No +2 A((i"$%i/ "0l* s#orn in 3e(ore /!e Firs/ Cl$ss =0"i i$l M$gis/r$/e5SDM5E8e 0/i%e M$gis/r$/e> $s &er &res ri3e" (or)$/ Yes5No Sen" (res! origin$l $((i"$%i/ e%en i( $lre$"* sen/ (or SGC.'1 S !ol$rs!i&1 NO+(; NOTARY ATTESTED AFFIDA?IT :OULD NOT BE ACCEPTED2 --------------------------------------------------DATE --------------------------

Sign$/0re o( A&&li $n/@

+he fa"ts stated abo6e in"#udin$ fee b% the a77#i"ant are hereb% "ertified to be true and "orre"t. +he "hara"ter and $ood "ondu"t of the a77#i"ant are a#so "ertified.

11.

<e"ent 4o#or -hoto$ra7h of the )77#i"ant attested and stam7ed b% -rin"i7a# of '"hoo#50nstitution 1here student is 7resent#% stud%in$

'i$nature of -rin"i7a# ----------------------------Name5,esi$nation---------------------------------Name of 0nst. --------------------------------------+e# = Mobi#e No.---------------------------------(mai# 0,-------------------------------------------)ffi#iation No. 0nstitution------------------------'ea#--------------------------------------------------

12

CBSE Re(2 No2 ---------------

0nstru"tions for fi##in$ form F 3&

CBSE Single Girl C!il" Meri/ S !ol$rs!i& S !e)e (or Un"er-gr$"0$/e s/0"ies Eligi3ili/*9 All on"i/ions $re reA0ire" /o 3e (0l(ille" 3* /!e $&&li $n/2 i&+he a77#i"ant shou#d be an 0ndian nationa#. and ii& +he a77#i"ant shou#d be a sin$#e 3ir# "hi#d and iii& +he a77#i"ant shou#d be the on#% "hi#d of her 7arent. )nd ii& )77#i"ant shou#d be a student of 4B'( Board in "#ass >00 and iii& s"ored .0? or more marks in 4#ass >00@ 200: e!aminations "ondu"ted b% the 4B'( and i6& 4urrent#% -ursuin$ under $raduate "ourse non-medi"a#5non-en$ineerin$& in an% 4entra#5'tate 3o6ernment 2ni6ersit% or those re"o$niAed b% 2345)04+( No2 o( S !ol$rs!i&s 9 550 on#% ?$l0e &er )on/!; D0r$/ion9 Sign$/0re9 )## the a77#i"ations must be si$ned b% the a77#i"ant. 2nsi$ned a77#i"ations 1i## be reBe"ted. A//es/$/ion9 )## the a77#i"ations must be "ertified b% the -rin"i7a# of the 7resent 0nstitution 1here the admission has been obtained a#on$ 1ith his5her si$nature and stam7. <s.5005-

+hree %ears to be rene1ed subBe"t to e#i$ibi#it%&

B$n< A o0n/ De/$ils9 )77#i"ants shou#d 1rite their Bank )""ount number 1ith detai#ed address of the Bank a#on$ 1ith the Bank 4ode@ M04< 4ode and <+3'5N(F+ "ode of the Bank. )77#i"ant shou#d o7en Bank )""ount in their name on#%. '"ho#arshi7s 1i## be sent b% (4' mode dire"t#% to Bank )""ount of the se#e"ted "andidates. 0n "ase the Bank detai#s as mentioned abo6e are not "om7#ete and in 7res"ribed format the a77#i"ation 1i## be reBe"ted.
Do 0)en/s /o 3e sen/ #i/! /!e A&&li $/ion9 1. 2. F-3 Form@ and an attested "o7% of 12th "#ass mark sheet. )n affida6it from the 7arent that the "andidate is the on#% "hi#d of her 7arents on a non-Budi"ia# stam7 7a7er of <s.105- du#% s1orn in before First "#ass Cudi"ia# Ma$istrate5',M5(!e"uti6e Ma$istrate shou#d be submitted a#on$ 1ith the a77#i"ation. )77#i"ations 1ith )ffida6it attested b% Notar% 1i## be reBe"ted summari#% and no "orres7onden"e 1i## be entertained in this re$ard. )n additiona# 7hoto$ra7h mentionin$ the name of student and name of father5mother on its ba"k shou#d be sent 1ith )77#i"ation form. 0t shou#d be sta7#ed on a -#ain 7a7er and 7inned 1ith the a77#i"ation form.

3.

:!ere /o sen" /!e A&&li $/ions +he du#% fi##ed in 7roforma be sent in an en6e#o7e su7er s"ribin$ BA&&li $/ion (or UG SCHOLARSHIP-F-3C to the DD*2 Se re/$r*.AD?1> CBSE> S!i<s!$ Een"r$> + Co))0ni/* Cen/re> Pree/ ?i!$r> Del!i-;;,,-+C b% <e$d -ost. C!$nge in A""ress )n% "han$e in address must be immediate#% re7orted to D,%. 'e"retar% )=E&@ 4B'(@ 'hiksha Fendra@ 2 4ommunit% 4entre@ -reet Eihar@ ,e#hi-1100:2G

Last Date of Receipt of Application: 30th September, 2009

FORMAT OF AFFIDA?IT .ON NON-=UDICIAL STAMP PAPER OF RS2;,5- S:ORN BEFORE I CLASS =UDICIAL MAGISTRATE5SDM5E'ECUTI?E MAGISTRATE1

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DEPONENT ?ERIFICATION ?ERIFIED AT ON THIS FFFFFFFFFFFFFF DAY OF FFFFFFFFFFFF AND THE CONTENT OF THIS AFFIDA?IT ARE TRUE AND CORRECT AND NOTHING MATERIAL HAS BEEN CONCEALED2

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