CENTRAL SECTOR SCHOLARSHIP 2010-11

Affix recent
passport size
Photo.
To be signed
by the head of
present Institution

Registration ID 030000006308
1) Name Of The Candidate JINCY.K.K
2) Date of Birth 22/01/1992
3) Sex Female
4) (a)Category OBC
(b)Physically Challenged No
5) Details of Father/Husband/Guardian
a)Name K.K.KANAKAPPAN
b) Permanent Address kunnuparambil House,,Aroor,Aroor,Kerala,Alappuzha,688534
6) Details of Communication
a) Correspondence Address kunnuparambil House,,Aroor,Aroor,Kerala,Alappuzha,688534
b)TelePhone Number with STD Code -
c)Mobile No 9947035959
d)Email ID jincykunnuparambilaroor@gmail.com
7) Nationality Indian
8) Annual Income 12000
9) Particulars of School/Institution last attended Class XII
a) Name Of Institution GOVT HSS, CHANDIROOR, ALAPPUZHA
10) Details of Class XII Examination Passed by the Candidate
a) Name Of Student JINCY K K
b) Plus two Register Number 6078191
c) Name Of Examination Passed HSC,History, Economics, Political Science, Sociology
d) Year of Passing 2010
e) Percentage of marks obtained in aggregate 83%
11) Receiving any Other Scholarship NO
12) Details of Present Course and Institutions
ii) Name of the Course Joined UG,B.A HISTORY
iii) Name of the Institution ST.TERESAS COLLEGE, ERNAKULAM
13) Details of Bank Account
i) Account Number 30927285912
ii)Name of the Bank STATE BANK OF INDIA
iii)Branch Code and Address 08639,CHIRAMMEL BUILDING P.B.NO.2 ALLEPPEY
ALAPUZA KERALA

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 CENTRAL SECTOR SCHOLARSHIP 2010-11

Registration ID 030000006308
Full Name JINCY.K.K
14) Documents enclosed with the application
(i) One copy of passport size photograph with signature pasted on the registration form.
(ii) Attested certificate of matriculation examination.
(iii) Proof of permanent residence/Nativity Certificate
(iv) Attested copy of first page of bank pass book in the name of the student., showing the Account Number,Name,Code.
(v) Annexure-II (Entitlement Card) [to be filled by the Principal].
(vi) Annexure-III (Income Affidavit): Parental income of the student as on March 2010 should be shown.
(vii) Non Creamy-Layer Certificate, Community Certificate, Disability Certificate in case of Physically Handicapped
applicants etc. should be produced in original wherever applicable.
(viii) Copy of the +2/ VHSC Mark list attested by a Gazetted Officer.
15) Declaration by the candidate
(i) Certified that the statement made by me in this form is correct.
(ii) I declare that in case I am selected for a scholarship. I shall devote my full time to the course of study.
(iii) I Hereby declare that I am not availing any other Scholarship.

Place:
Date: Signature of Candidate
16) Remarks by Verifying Officer
Verified online the details given by the candidate with supporting documents and found
Correct/ Incorrect (Specify)

Place: Signature of Verifying Officer

Date: name:
Designation:
17) Certificate by the Head of the Institution

1) This is to certify that Shri/Smt./Kumari ....JINCY.K.K......... S/o,W/o,D/o Shri/Smt..........K.K.KANAKAPPAN........... who

has passed the Plus Two Examination held in March/April 2010 conducted by ...HIGHER SECONDARY (STATE).... with
Roll No ....6078191.....and has been granted admission in this institution on ....24/06/2010.....for the.....B.A HISTORY
.....Course He/She has started attending the First Year class with effect from ……………………………………., 2010
2) It is further certified that the information furnished by the student is correct.
3) The completed Statement of Particulars (Annexure–IV) and the Income Affidavit Form (Annexure–III) are also
enclosed.

Place: office Seal

Principal
Date: ST.TERESAS COLLEGE
ERNAKULAM

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