You are on page 1of 2

eiliT)

sq1-< T<:xqqc f<lre ad{ ?rern ()E


flQn'r..q'l'r{TFI n& <tfi-la
a4\a +t?lft wa
s ?d ag|rFr {q4Ic 4,tsftB,4{4t.tt4t_)ooo

qo$

?llg' !.to-{-6bi&J JatJ l

ii-eb.o).oooo.l)e.tc ool lv

frsga qr{rqft-4
'IT{rqft-o

.5t1'{.13

-2] )

@
fts s ftrt'rsr ftY t'Fry sl*
6offin ftq1er
frTq cow<

)r.o8.to)u

8lS

y:"y'iy:*Te*

fiqis s{$r5l(ql t-d{a'


iqr,{ 'n-fiHfos liwq Ff{B <lts-{rt, ffinrqfi-{

lt6cq 4<nfif{4

F:.9

qqrr<
to)\Y-)c 'fr1fl{d rr-'sl<k
"nsl
q'iarJ
fillr'r'si?r<l
rrf4ro
ftsjld'
fTsr'Fl'
* ** *ftuq:"
qT<'rs
a1rqlfiFi .flnftr$rFd rrai
't<-'ns"q;F 4FrB;' q{qn?)Td
fi-sm qarq rlqt<:r'64 fu& 1g*sr;
trd,
*n"*'
s&,\
"ft,
{t{Fmfr{ GEBIF,
{(<r
ffirfi qfffis (q{cq-{ q4 '{<< t)/o8/{o)v tl'
u* u61q<1 vrcQ glftrq{ fr(lfiE w4 fifl1s'f,4TA
q-{ D1<i-ru ioq i{ftr(q (s1T<
*"", ri+n ,iftff.I ,$(xFFr.r<
,,au
q;rl Fr'f{s(! !'1r<T< 6fl 1r"{1
'ura', ffs') trftp {]TF
ufi}s<*. a, $fe aqa ?lFfln

frSBrf< {&Fmfr( firml

ltn

<E< ra-qtfi M Sc ls'FftTr-'fo

utuT.li'H;;*tr;#,il;

"fAo,

#\H*,.-,,

rs.

rq1a

6Ai{ ffir'Tq )
i{r4

'11-{l
\e {li-{Jl'J,m

T{{l,l{

Bilffi

tqan rq-qfiffi<
ti

or

li I : \!Li-\,71 4lait9!-cl14i
(\ t'7 41 1257'l 4

frs<qa

r r otfi-c md, allT, fi$l


I r mfrq Gid, filqfuli, Er6l
'o r ffiGr 1116. Frfuftfi, rrdl
s r .atF{ cd..........

lpvawtd q
:_ B"ffEI{,......................-.

{.

r5T1$8r4, (lril<l Wsl

ru-$-{Tnq'

e.
a.
g.
q.
u.

t6TF{'1',{' <i',f'ts' Elsl

frFt&fr, 6lol
ruqrfiird, Pi&ftR, tm
qq'ni 1dE-fr61-{). <l"r'r+'
,rq-riJ

1erfir"),

6Tsl

<1{'16'

',rs]
tq?, aq'm, rr+l
x. qii-<, al'r+, ut+t

qd

qd s <nqi' <i'f'FF,
)o. gl<efi qkor+o,

sl

$$Lc

vJ-l/ue;V

\) Ql4

a-J''zery

f^b 'nr( \rrG(w9

L ,q1',

#ltsD

Information Form for Scholarship in MEPhI Russian Federation


Name:
Gender:
Father's Name:

Mother's Name:
Date of birth and Age

(01.01.2016):
Nationality:
Permanent Address:
Present Address:
Present Working Place:
Job Title/Designation:
Passport

No.(If any):

Mobile No.:
e-mail:

Marital Status:

Education:
Diploma/Degree

Subject/Fie1d of Study

Year of Passing

Secured
GradelClass/Division

You might also like