Application form for the issue of Free books and Note books to

poor widow's school going children

1. Applicant's Name :

2. Name of the Mother / Guardian :

3. SC/ST/BC/MBC/OC :

4. Date of Birth and Age :

5. Annual income of the family :

(Income certificate should be
enclosed)

6. School Name :

7. Standard studying :

8. Tamil Medium / English Medium :

Required text book and Note book
Sl.No. Text Book Note Book

9. Is the applicant is receiving free : Yes / No

book from other Government's
department also

I assure that the above details are true.

Applicant's signature Mother's signature

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