Specimen Copy (For Educational Institution use only)

POSTMATRIC SCHOLARSHIP(FRESH) FOR MINORITY STUDENT FOR THE YEAR 2010-11

List of students recommended by the Educational Institutions to the DBCWO of their respective District
Course fees ( per annum) for Bank Det
(Specify year
Religion(Christian-C;Muslim-M ;

physically handicapped

Day Scholar/Hosteller
2010-11 the Stud

Whether student is
Sikh-S;Buddhist-B;Parsi-P)
Class/Std./UG/PG

Name of the

Other Non-refundable
fee (Details specify)
Gender (F/M)

Name of the Bank

Branch Code No.

% of marks Annual

(Yes or No)
Student with

Admn.Fee Rs.
of Study

Name of the secured in Income of

Library Fee
Tuition Fee

Exam Fee
Sl. contact No.

D/H
Parent/ the exam the Parent/
No. (Pl. do not put Total

Rs.

Rs.

Rs.

Rs.
Guardian held during Guardian
initial of the Rs.
Courses

2009-10 Rs.
student)

Total
Rs…….( in words)
Certificate
I It is Certified that
1 The above students have secured not lessthan 50% of marks and no arrears in the previous year examinations
2 The annual Income of the student's Parent / Guardian does not exceed Rs.2.00 lakhs
3 The above students have not obtained any other scholarships from the Central / State Govt. / Welfare Boards in Tamil Nadu.
4 The course fee mentioned are verified with our record, Bank details furnished by the Institutions are verified and found correct.
5 The above students have satisfactory progress, conduct and character
6 Fresh application received from the students are kept in the Institution's custody and are subject to verification / Audit by the officials concerned.
II Bank account details of the Institution :-
e) MICR Code (9
a) Name of the Payee : c) Branch Code No. : digit) :
b) Name of the Bank & Branch : d) Bank Account No. (SB/Current) : F) IFSC/RTGS CODE NO.
Institution: Contact No:

Seal of Educational Institution Signature of the Correspondent/Principal/Dean/Re

with Designation Seal
tails of
dents

Bank A/c No.

egistrar