Ali | Academic Term | Expense

Instructions: 1 – Fill in the form completely and do not leave any column blank.

If any column is not applicable to your case, specifically ‘Nil’. 2 – Attestations and other documents are not required at this stage; simply fill-in the form and submit via email. 3 – Any false statement or incomplete information will make you ineligible.

Guidelines: 1 – Personal Details: Your name must match with the exact name printed on your CNIC. Make sure that your CNIC number is absolutely correct. We’ll prefer to have your personal mobile number listed here.

2 – Course Details State the exact title of your programme like MBBS, BE Electrical, BS Information systems etc. Course beginning and completion dates mean the time period starting from your enrollment in university / college to your expected graduation. Let us know very clearly which semester or year you are currently enrolled in.

3 – Academic Records Examination Level means different stages of your programme like 3rd semester, 2nd Prof or 1st year etc.

List all semester / yearly / professional examinations that have been held since your enrollment and whether you have pas those or not.

4 – Guardian Details You are required to provide specific details of your guardian’s occupation. earnings and fee. e. then provide deta his farm / business in the relevant section of Household Details. If your guardian is engaged in a commercial activity or self-employed. quote the sum of yearly tuition fee and hostel charges (inca you were living in a hostel). mother. Do not provide vague statements like ‘Government servant’. Make sure to state your guardian’s yearly income from all sources. you should state h exact designation and organization. then you must state these other sources in the space provided here. 5 – Educational Expenditure If you possess sources of financing other than guardian’s monthly salary / income. As for the educational fee of the institutes previously attended. Whether employed or retired. Say ‘Nil’ for columns that do not apply. then say ‘Not declared yet’ in the results status column. You must state the yearly figures for all salaries.If the result has not been declared for your recent exam. If your guardian’s income can be broken down into fixed salary and other income. 6 – Household Details Family members include father. brothers and sisters. then you must state its amount in the relevant column.g. . if he is farmer or shopkeeper. such as rental income from property etc.

Rawalpindi Tel: 051-5859582. Hasan Street. Khayber pakhtunkhawa Tel: alikhan8833@yahoo.Khoso Deptt of P&G Tel: . Mobile: 0300-5322592 (Office Telephone Timings: 3:00pm to 5:00pm) This Form must be submitted via email to apply@diyapak.DIYA PAKISTAN REGISTERED 1304/474. New Lalazar. Permanent Address: vill. masti khan banda p/o khujaki kala tehsil takht-e-nasrati karak.org APPLICANT'S DETAILS Name: CNIC No: muhammad ali khan 14203-1721282-9 muhammad arif khattak Male Female Age: 23 Father's Name: Gender: Email: Domicile: karak. Defence Road.com Present Address: h#3 agha vilas chiltan housing scheme air port quetta. Applicant's Status: Orphan Disabled Poor & Deserving Orphan's Only: Mention year of father's death: Disabled Only: Indicate nature of disability: COURSE DETAILS Name of University / College: Title of Programme / Course: Roll No: 20 22-8-07 BUITEMS Quetta Bs Petroleum&Gas Engg 07F-Bs(P&G)-020 will complete on: Years: 4 22-8-2011 Semesters: 8 7th semester Reserved Seats Self Finance Programme started on: Total Duration of your Programme / Course: Currently Enrolled in Year / Semester: Mode of Admission: Open Merit Key person to be contacted in your department: Name: Designation: Dr.

1-Apr-08 1-Sep-08 5-Apr-09 5-Sep-09 20-Apr-10 1-Oct-10 2. Year 2004 2006 Roll No.65 2.00 Position 1st devision A grade Yes Yes No No Examination Level Month / Year when exam Results Declaration Date Average Percentage or (Mention Year.ACADEMIC RECORD Examination Matriculation Intermediate Bachelors Are you Hafiz-e-Quran? Do you retain Hifz? Current Academic Performance Provide complete details of all examinations that have been administered by your university / college so far. Prof or was conducted / Status GPA obtained Semester) 1st semester 2nd semester 3rd semester 4th semester 5th semester 6th semester 7th semester 8-Feb-08 8-Aug-08 10-Feb-09 10-Aug-09 15-Feb-10 11-Aug-10 in progress…. Marks Obtained 569 801 Total Marks 850 1100 % 67.34 2.00 73. including examinations for which the result has not been declared yet.A.33 3 2.55 2 GUARDIAN DETAILS Name: CNIC No: Guardian's Occupation: P.F Retd Exact Designation: Telephone: peshawar Address: muhammad arif khattak Relationship with Applicant: father Yearly Income: 100000 Organization: .

S Ahmed Abad Karak ahmed abad karak 500 .S Ahmed Abad Karak ahmed abad karak 200 Intermediate H. then please provide the details of this scholarship: Name of the Donor / Organization: Type of Scholarship: One-time Yearly Monthly If you have stated any amount for 'Income from other sources'.H.H.EDUCATIONAL EXPENDITURE Current Expenses on Education Yearly Tuition Fee 24000 Yearly Hostel Fee 15000 Yearly Messing Expenses 20000 Total Expenditure 59000 Sources of Educational Financing other than Guardian's Monthly Income Loan from Relatives / Friends Loan from some organization Scholarship from another organization Remission from College / University Income from other sources no no no no no If you are receiving scholarship from another organization. then provide complete details of all such sources: Tuition Fee of Institutes Previously Attended Matriculation Name of the Institute Location Yearly Fee Amount of any Scholarship / Remission Availed H.

Details of family members currently employed / retired Name Age Exact Designation Employer Yearly Salary Details of family members currently engaged in business / commercial activity Name Age Type of Business Location of Business Yearly Earnings Details of family members currently studying Name shuhab arif husnain Arif hina khan abdullah Age 20 18 15 14 Institute W.Note: For matriculation you should state the yearly expenses you had to incur in class Xth only. / Organization Family Owned If rented. brothers and sisters.S. HOUSEHOLD DETAILS Family Accommodation Details: Note: Family includes father. Type: Status: House Rented Flat Quarter Mud House Provided by Govt. annual rent: Average monthly electricty bills during the months April to Sept. for Intermediate you should state the yearly expenses of class XIIth only.S&C Karak GHS karak KSC karak GHS karak Yearly Fee 500 50 200 no . mother. Similarly.

Mukhtiarkar or Area Nazim . the undersigned solemnly affirm that the details/information provided are accurate and that we shall be responsible for any inaccurate or false information.Any other thing that you would like to add or say (related to this application): Sir I m very poor student and belong to poor family. Applicant's Signature Guardian's Signature Verification by Tehsildar or Competent Authority: I attest that the information contained in application form is accurate and the applicant deserves the grant of scholarship award. Tehsildar. Signature Stamp / Seal Note: Competent authority includes Area Magistrate. Declaration by the Applicant and his/her Guardian: We. I need financial add. Naib Tehsildar.

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For Diya's Office Use Only Decision Reason (if required) History Previous Folio Last Disbursement .

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