INDIAN INSTITUTE OF TECHNOLOGY BHUBANESWAR

APPLICATION FORM FOR MERIT-CUM-MEANS SCHOLARSHIP & PREESTUDENTSHIP FOR STUDENTS FOR THE SESSION 2016-17
Last date of submission:18th October,2016
STUDENT'S INFORMATION
Name of Applicant:

KANDANULU RAMIREDDY

Institute Roll No:

13ME01027

Category:

GEN

PWD:

No

E-mail ID:

rk24@iitbbs.ac.in

Mobile No.:

+918908230175

BANK DETAILS(Copy of the Bank Pass Book, Where A/c No. etc. mentioned)
1. Name of the Benificiary:

K RAMIREDDY

2. Bank Account No.:

33385829376

3. Name of the Bank:

STATE BANK OF INDIA

4. IFSC Code:

SBIN0001173

5. Address of the Bank:

GIDDALURU ROAD , CUMBUM

MERIT STATUS( For 2nd Year Students onwards)

1. CGPA:6.29
MEANS STATUS: ANNUAL INCOME OF FAMILY
1. Father's Gross Annual Income:

70000 (In Rupees)

2. Mother's Gross Annual Income(if any):

0 (In Rupees)

3. Annual Income from other source, if any:

(i.e. Investment in Bank/Post Office/UTI/LIC/Share/Debenture/Landed property Income in the name of students etc. if
any to be mentioned)

0 (In Rupees)

Total (1 + 2 + 3): 70000 (In Rupees)

PARENT'S INFORMATION
1. Name of Father:

K RAMA CHANDRA REDDY

2. Name of Present Guardian:

K RAMA CHANDRA REDDY

3. Father's/Guardian's Occupation:

AGRICULTURE

4. Name of Mother:

K NAGALAKSHMAMMA

5. Mother's Occupation:

HOUSEWIFE

6. Present Postal Address :

1-12/A , CHETTICHERLA VILLAGE , BESTAVARIPETA MADNAL , PRAKASHAM

DISTRICT , 5223334.

DECLARATION
I(KANDANULU RAMIREDDY) declare the following:
i. No disciplinary action has been taken against me by institute in the preceding session 2015-16.
ii. I am not in receipt of any other Scholarship/Stipend/Fin. Assistance etc. from any other source.
iii. I have no back-log subjects in the preceding year 2015-16 and cleared all the prescribed curriculum up to preceding session 2015-16.
Further I am aware that, if at amy stage the information/statement given above, are found false/incorrect, my candidature will automatically be
rejected and I shall be bound to refund the entire amount( if paid to me towards MCM Scholarship & Free studentship) to the institute
immediately.

SIGNAATURE OF THE FATHER/ GUARDIAN

WITH DATE

SIGNAATURE OF THE STUDENT WITH DATE

Submit this along all relevant documents in support of your Parental Annual Income Certificate for the year 2015-16 as per parents occupational status
(i.e. If Service then Salary Certificate, Annex- II Form A with other relevant enclosures / if Business , Agriculture etc. then Affidavit, Annex- III, Form-B
with other relevant enclosures / if Pensioner , then Pension Certificate Annex-I V , Form C with other relevant enclosures as applicable, as stated in
Annexure- I (List of Documents to be Submitted) as per guardians occupational status.