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SELF DECLARATION OF MINORITY COMMUNITY

BY STUDENT
Profrma For Declaration Or Minority Community To
Be Uploaded Along With The Mandatory Documents
For Claiming Scholarship.

DECLARATION
I,

Son/Daughtor/Ward

of

Heredy declate that I

Delong

to

the

(Muslims/Sikhs/Christians/Buddhists/Jains and Zoroastrians (Parsis) which is a
noyified minority community as per Section 2 © of National Commission for Minorities
Act. 1992).

Date:
Place:
Signatuee of Candidate:
Name of Candidate:

Declaration of the Student
(i)
(ii)
(iii)
(iv)
(v)

I hereby declare that the information given above is cored.
I am not availing any other scholarship for this purpose from
any other Central Govt/ State Govt. sources.
I shall abide by the terms and conditions for sanction of the
PreMatric/Post Metric Means com Means based Scholarship.
I have uploaded the desired documents in support of my claim
I undertake, that if at any stage, it is found to the satisfaction of
the sanctioning authority in the Minority Affairs that the
information given by me is false or if I violate the terms and
conditions of the scholarship, the scholarship sanctioned to me ,

then the institulte should indicate that separately. For Renewat of Scholarship: It is certified that the student has not changed the course of study and/or of the study for wich the scholarship was onginally awarded /has changed the course of study and/or institution with prior approval of the siate govemment (Please strke out which is not applicable). in case of any discrepancy noticed later. INSTITUTION VERIFICATION FORM Verification/information at be furnished by the Heed of institution/college: It is certified that the information provded delow by Who is admitied in coures fo the academic session In is correct He/ She is a hosteller/day scholar s of the college. apart from liability for such penal action as warranted by law. Your applicationis likely to be rejected. Last year marks details: Fee details current year: In case the information filled in these columms is not correct.may be cancelled and the entire amount of scholarship will be refunded by me or recovered from me. Please ensure the information given by you is factually correct. Date: Place: .

Students are directed to take the print out of ‘Institpon Verifcetion From’ get it verified by their instition. . scan & Upload it. in order to apply for minority Scholarship.Signature of the head of the institution/college with official seal Note: (i) (ii) The verification by insyition is mandatory for consideration of the application.