1

PRIME MINISTER’S SCHOLARSHIP SCHEME ACKNOWLEDGEMENT SLIP
OFFICE COPY Your Application Form dated_________ has been received on__________. The application will be examined for eligibility. The dak receipt number ____________ is to be mentioned for further correspondence with this office.

Office Seal:

(Signature of RSB)

Tear off

Tear off

ACKNOWLEDGEMENT SLIP
STUDENT COPY Your Application Form dated_________ has been received on__________. The application will be examined for eligibility. The dak receipt number ____________ is to be mentioned for further correspondence with this office.

Office Seal:

(Signature of RSB)

Note: This copy duly stamped and signed by RSB given to the student by hand or by post.
(Envelope enclosed along with the application may be used.)

2

Selection Serial Number...................... PROFORMA FOR RENEWAL OF SCHOLARSHIP UNDER PRIME MINISTER’S SCHOLARSHIP SCHEME (To be send only if selected for scholarship) 1. Name of the applicant (Ward/widow):

2. Selection serial No. given by KSB: 3. Particular of ESM: Name of ESM Rank
Service Number

4. Present address (where you want your letter is to be sent) (To be filled up only in case of change from previous address or write N / A)
House No. Street No. & Name Tehsil & Post Distt RSB Pin Code

5. Details of Bank account of SBI or PNB for Electronic Clearing Services ( (PLEASE ATTACH A
PHOTOCOPY OF PASS BOOK, CROSSED BLANK CHEQUE SHOWING YOUR ACCOUNT NUMBER TO BE FORWARDED, EVEN IT IS SUBMITTED EARLIER).

Name of account holder and account number

Place:

________________________________

Date: Full Name & Signature of the ward / widow It is certify that the information submitted by my child / Self is correct. Place : _____________________________

3 Date : Full Name & Signature of the Parent

CERTIFICATE FOR RENEWAL OF PM SCHOLARSHIP

1.

It Is certified that Ms. / Mr ._____________________ is a Bonafide

student of __________________________________ college. His / Her roll number is __________ and he / she is studying in the I / II / III / IV / V year or ______ semester of the two / three / four / five years _______________ course in ____________________ branch (if any). He / she had joined this college in the academic year 20___ - ___ and the course will be completed in the month of ____________ 20___ - ___. 2. This is also certified that Ms. / Mr. ___________________________

__________ has successfully completed his / her 1st / 2nd / 3rd / 4th / 5th year and scored ________ % / Grade__________ (Total marks obtained were _____________ out of ____________) and he / she is continuing the course in 2nd / 3rd / 4th / 5th year . Office Seal: Signature of Principal / Dean / Registrar Date: ________________ Place: _______________

4

CHECKLIST FOR RENEWAL OF SCHOLARSHIP
DOCUMENTS TO BE ATTACHED:
(a) A Bonafide certificate from the College/Institute indicating that the candidate continues to study in the subject course and showing his / her percentage of marks for which the Prime Minister’s Scholarship has been sought (As per the specimen attach). Candidate to attach a self addressed envelope, duly stamped to receive the acknowledgement of renewal form by post.

(b)

________________________________ Full Name & Signature of the Candidate

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