gmrat Ames Ronigelalabrd 8, w/b A008 2.9 de OUD eerste exes, dain dade bajo “wt, 1Bae Ge, Ab dt, soepd0, tarieadet2. aot [(-w-2012. Bead og, HiahS Hodie.o vOAA comod, ms ae sed, daldeo aso “Central Sector Scheme Scholarship For Colleges and University Students" war ates gata gatos 20128 deekeng, cof mysto, soatoetsd dds, Gortands way, 600 cedrfen anoaiandst cutoff wobriety vain eclips fc, worlds, dds Soyoil & OORBr Medd, ete mi eared. 600 wosKOn anHsDAdds (Cut off marks) wosrido: Cutoff marks fixed for Submi Application ont Science Commerce Arts Category | ~Boys | Gite | Boys | Gitis“itoys | Girls sc am | ass | sen | 490 avs | as st 415 461 48 | 42409 | 479 oR sis [sts | so | a6 a6 | sn GM 545 suo | sm | se sot | 52 % BREGOS wosdD, AAS cake Omer OMEF dedU, LEI, ERSTE. eyperlty mah edict Snebyphs méeeate agenabrdvied dead eMeridhy Agfler Bwok: 25102012 Gately emoteanchds. ~~ Humaie dries, OoAorrin ROMA earridsy Keeton ddA, do Sopra 4h, eeidg GHGA OoyR auochdonds of are edd ch ooer deddd evden smd Adadd moot OSdRGA, ZOREL mess dato gAcboodia Aged vend soeyVOSA toh shaot OmokT1402012d wen KeLrbaden Herds. ciate mdnta, Au amerc’ odds wohgintd OmAeh aoe ded estoinrided doakadys emugS epincrdeandas. Howos Sup AnkSN biog, Hdeonh Seght mtotek, KodlerdeD sarod, BHI Basle Be renatets Website: worw.pue. kar-nic.inpess wero, / sntsat, dibchdadzatch, u . aa asap bys net, Bee Kas: cenciah sodan shed cine sowMotyle stones Derban Ssh TT adder Sea geries Aptviendch. mle & round Age Sie maa Hn Aetonss mbkatyasdd Bidg AndiRdDA BeKt, erm, BOSE Howiorsidooon wEAstesd/horockd -es,O sinaécodk: cinabde eletirids Hors, ‘ede, Houndehy, SmyprHicdpenéce Katiworhas, inte aagldoAle decmedd 08 wa ,Nasd Seainypye tou mndg, dadde cwatlals Mass, dde> KorteGOVERNMENT OF KARNATAKA No, PUE/Aca/C.S.8.C.U.8.2012/2012-13 Office of the Director, , of Pre-University Education, Cross, Sampige Road, ‘Malleswaram, Bangalore-12. Date: {S -09-2012. NOTIFICATION Subject:Central Sector Scheme of Scholarship for March/April 2012 pass out Il P.U, Stodents of Karnataka Reference: M.H.R.D. Letter No. F.1-40/2009-NS.1 1:13-07-2012. Applications are invited from the students who have passed second year P.U. Examination in 2012 March/April and obtained the cutoff marks indicated in the tabular colurm stream wise/ gender wise and category wise or more than that for a total of 600 marks. They shall have joined a minirum of three year degree course. Students who have joined any Diploma courses are not eligible for this. They should not apply for this. o S F APPLICATION FOR ‘600 MARKS (CATEGORY WISE/GE} Science ‘Commerce Arts Category | Boys | Girls | Boys | Girls Boys | Girke sc am | ass | 42 | 490 are | aan st 415 ast | 438 42469 | 479 oR 518 sis_| 503 su 486 | so cM 54s sso | 93 sae St 312 * Based on the above criteria the List of the eligible candidates has been hosted on the website. + Asset of application formates ( pages + 3 pages Instruction sheet) is hosted on ‘the website, This can be down loaded. . Ir can also be obtained from the District Deputy Directors of P-U. Education or Head Office. Duly filled in application forms should be submitted to the Principals of the colleges where the students have joined for Higher Education on or before Date: 25-10-2012.THE FILLED IN APPLICATION FORM. MHRD SCHOLARSHIP 2612 — FRESH BATCH C/O Assistant Director(Academic), . of Pre-University Education, 18" Cross, Malleshwaram, Bangalore-560 012. ‘Telephone No.080.23361856(8S7/858 Last date for Principals to submit the consolidated application forms Date:31-10-2012. Department of Ped“ Education.emrud ded Rosh rtH.a/8 mm Re she Zoek Oke 201201215 adersdd deko, BO Hane ayy wens, 18de set, aoeps,co, storiéiade-s60 012. Banot: (5-09-2012. BOR, Bodmer, Best DmdELAA sid bmdaed! dod shmompovudnteed smomoab. AnH, Deois Wk Bg ORG, HS OAD ERR, aboead, aaded ak meen ah, axamposbd SEEKER 2a,9° teddy, Odd Sack, wdeore saoot ericridsdy ddbbitods Boe. weeeaete sheeppd naladé, soneqede’s aves 20128 Qgeah aaina, coefedo, atosiaadbs Coto undid wae wrlies eh, odrida, ddd Steere Inde MORE, tod, Jacds (ands ade epg domem, sits) omer ded, ete mde warodeg. shout egpdd shed eabyladgss amQerion eco shed Said stor, Sart, dee da10000/e omer Seddaieh, arctowrbwich. GF Omgr eddie) om,grch toy, DelZISD) SaNGNAEA siorbaitalngs, wou, Byford edt: sielerle maori, diet, Bem W0.20,000-Ndos do,Oe deddelay, aeclewrbabeh, azn sdb, dae 60% wodridah, readekmrbap. snere 20128 A_ecds Bator soehedg, ANGLAKS Cut off wattessy, eda edipd srk, vosrlddy adc dab, weedde, del derecho, Luchbhs den,gerie oF Base coger Wedd eur dihadehd, edeNd, ech, omerHe dosh caorheasoh thovet, SinGk Giles, O20h Ab dail. Asef acinkaisg, arindancs Cut off wotriesisy, vale welded seh, voddde, aid Oey domaPerieA enteriesy, AOKI. gr OMEF Aedsd OAc Aagys anak ese amwed Om Or & omer dedteod deudmriendts. ucinde, Ge omer ded oor, ded, Bindath, meee, aecbsyeh, Omg aed, oer AGZekeod wl, And, desde, meenso, ambaye. OME Beast, AOfeleRs Ler Sched 09 grid abd Omgere Reredess 03 guacho sensed abs. wee acai: RERBeReR wetroiody, dome sariedar 03 xyerids. BELL eda 2 kD Aasie Beso wead arin Aeneas wer Hees (Data sheet roa, 4 tod tmed(MHRD) adsnates ete Ssise8(Annexure-TV). 45.6 Joining Report (Asmexure-V) #86, 7 sod, & Income Affidavit (Annexure-ITD. 14 Declaration form (Annexure-VI} H ete Acaedabh, actos Sefgerae amsemd. io dade deo endtdly Website:www.puckar.nic.inss verobéy download anategeabc> mrs sowtcinky dchbagsrisc, mptaubrdsita, Agger AGH) werd, Haoobalnh eet,alo Bmorois Jeb, mdetdg, mwan deayme dwortondsl wn, eto Usd oF armor edad exdgsop md S000 mew OabMdy zdbER Dus dOntgord geotocdde, aedow sewt epee wots chews OmotSLIOINS Lon suatsacien boeod, cine MOREA, ae ampees dodés eohpindl DaGeA tmygr dedd eduatancod ambos EmMP @UMbCSADIIS. gt tog Mey Haba tor, sBtOod Aes mae, AowEraen Leeds. AMPEG wreath, axptmnd Hie ane woh dektsSAend Ooyor Sesh Spon ta, SOoh BRIA, / eOmooki, seckersmomoetsn deoxy welo ghee eameyp sod teed, OMBere ebeTtedy Bond keds tocinn adouendoh coc dOwAL kot, Aitoksee. de warang, i) Anmexure-V £Qg0x Joining Report motsmod> tempeh tte Anatiedd. fi) eeoth, kenedts oete(Annerure- TV)ots Sado mBd? vourdss amprats weettct dors motets tempeh th dam edit Beatdh, wedded, meohrd tte dmdOeky, vost weerideh, sdepraarbeeh. Hit) Annexure-TII Income Affidavit sah, exit, ampere £ExrSets. iv) SCISTIOBC/P.H. aontdt, tod foapenies mbfdowndta, gains adaiely EpSeeD. V)— Rybreds aason wotaeyete ekpetoadd abectialy, dalsie Leyfateto, vi) Annexure-VIN0, te6 ofc amp Stsdiday, doimapsods Seprots Me ERB, sarooterdod cLpedOd LGzztebo. dr ctéritrh, crlgzemga Gexb das woReErehc, — extenteRe, onkoKp, weirrideh, BSIphewoRED. mde, OBE clots. kodd og, Deapere eilrrivy Gages amapeTS Shy on oe, vierieek, edeTeachh DERN wae ORY woikess coaed Oro TTIO20828 LerEA oh BRS CMMs, doiuten doce, MBRD SCHOLARSHIP 2012- FRESH BATCH C/O Assistant Director(Academic), of Pre-University Education, Cross, Matleshwaram, Bangalore-S60 012. ‘Telephone No.084.223618568S 7/858. edad msobrh Smprid aap och decdah, 3m, we watered. aio RECO, wecdH Amchyhd gsendes amgerleh & omer Sess Mdbid Swedes sgaloabd, ddd dpate Skye cremalchooaA dorwraah Awe wax, sacdeand. sib, amr, aan 6p) ent. Sta Leuk: wenslet eden ced clase AoPlMoRAG Samo Saks aechelean udos ASHWEEROR omperlty Apaviewican, & found wowAoRten ake male ao Aatorkd Snatodysehinds naka Sade merle wodss KoqiaK/fecodh Sgsleadidaade waO adoodd afnaide etigaies Aotiadg, ecls, Hounifahy, SmOrHeLdeedéde — atbrooromfecs —OoygeAeA — aiircldes peddsijeh, exarla, oimefide How fRoAN slaciecs sr Oc8 exf.ctend detatepnats tod wodQ, todd cuenah Habit, doen Round.GO KI Department of Pre-University Education, Malleswaram, Bangalore-560 012 Central Sector Scheme Scholarship for College students 2012 (Karnataka) INSTRUCTION SHEET denpe dsc welroiorka Sone AtPeneA sorickow |. Semper cshik, SOs ede eed 09 eer, HH, OMPNNE oviedod (INSTRUCTION SHEET) 03 ayatier, deondy?, dsrirdeuzba$ earabyh, Roo Homehdeds axfpécnes doenties, Demprries witrakdy Aone certo Ghats ake) eer Beads pul sed Hala apie Bip end seins ampech wee Sead Mata sheet 23 sok, doch Mewes MERD) sciviantess et dxzort(Annemrel¥), gas Joining Report (Amesare-V) yas, 7 so¥, & Income Affidavit (Annexure-fHN). oe Declaration Form (Armexure-VI) eres Gnyf, ANAK Amape Bea toMy riebecigghyteod teckeccatamt, ortasts, myHOsods cutoll wotiiteh, Masintenndt. thed shed mpriorien, toctarasinion, tmotsactobOn wed ied wedrido Arasinhd. omprricy diol tenepRees dees om BEGsoo9, Qari ackoe AehebO, 600 eAMHOR, & HOEK, og “Usps chek, codridth, dO A, shed, oh Rompe ACKSE, wai tQteo URCEARD, “bpd dob oat ABSA, extr sexeodcs 00 eodhen Arigzaaddes (Cut off marks) eoehds, (Cutoff marks fixed for Submission of Application only) Science Commerce Arts, Category | Boys | Girls | Boys | Girls | Boys | Girls} sc 476 466 | 462 ago | 476 | 483 st 475 | an | 458 | 462 | 469 | 479 Bc S18 sis | 503 526 | 486 | 501 oM 345 540 | 523 S44 | Sor siz ver wmtesaes seb, drmR say, HmplorsN eVRS dyag, HhoochdDAG ew, Koa 03 Seeds ida AURA comenhdetee. Diploma in Education / Diploma in Technical Courses / Diploma in Pharmacy Courses / Diplome in Hotel Management / Chartered Accountancy / Diploma In Nursing 3a ddaatoh mtands amgrie or amor Sedst, vardy, DERPERG smpiah eUleedoy, ambendc, code OmQeHe wera adxpienrsyt lo t0a,irleod uf cinwde aieaish seem dacsod pecdexrbaog, 20128 Orage sedis, endo eeiratwh, ome dadrdgate tow ompete seas war Mepdap. odd orriddy, dondtomdoy, dd wf Bg, otmd Smctdedtts nods Smmgeiids dict Roxen vitrohey eazhaids sabaandss ese 2AEgeHeS Re DN Aiphd ESQ cweNNd ows Bias mdeEd sBodesoood Joining Report (Annexure-V)A xo cnaxitens, ee tetobe, feos, dardct euro dade daxsd, (Annexurel¥) cane omerod emp milugd axe arte ariodand atde, aomavot) kta dan mdectd Saute, teagan sddes: Joining Report sonde See ohaty, SeR PRCA, Joining Report sods 1011201280, eviphs Add Add dete edad momanoned! SCISTIORC srirt, ton amr saghan satenpiésond deeds es gone gdh, cetrahanst onagddes PHodo cede) wag, etter mdssicids domopacs Bpeed suine kSdky ona —-JSko ag, HAASHA, SRS, Seg BarcbAcarbays. amgerid Bacaitd « mte dR Heo, UGS alselod) A450 Of axodendci(Creamy LayerA stodendc). otnofo seine adit, Income Afffidavit (Annesure-II]) 20k empha LOzkels. wre Hivw wogade, excrery sdaptooroshe. be od BELA, Nitin Dabo AMET debt se, od mRoHidE, stot Séedsns. actos amped Sivedss cdsilg, des eridbcierbyddA, ered, AMOrris 2, Babak BLOG evososy Savings Accoun amdoiy, eA satyeod ainiencideods masks eaperEd, sed Woiuled, o Sabtotdly Gxbahe OoygeTiO & Gon Seoaanes empha, Sade ear ee cinayele cmokriee, ws Sender toc ocd, weds So Brie wertiésh Sad, dadewinie, a. State Bank of India (SBD, State Bank of Mysore (SBM), State Bank of Hyderabad(SBH) OR other Banks belonging to SBE Group (Ex: SBBISBT etc.) b. Vijaya Bank. «Canara Bank, Heo ERPwEG, ernie amd Lecody, wd, Kedtadc, amperi ath, dodo ediim saddohsld Sdodedad eqow eveaniy (Savings Accoun!) =x3 dosteinty, Aedemtcs, amygerito dea, cow mntoisy mde’ Extension Countersa, wodyeRp Sobendes, eS emperidg, aad sdnayla, tx AREF Sess Succ Snobs Hea Ged emperid sad Most Aoi, Backend Ope Heddy impr shed Daeim OmPCHe sabes msl ets Sndeietcoeibod Dmgrrié and Stolod esees oad wyseonces. odd egret, On Fine sizes ec ctnctedescl, OAroky mud Hontioho 09 dots 16 digits endriedo(Core banking 9 to 16 digits }. mrto enow adenvdy, voce Bank Name, Branch Name, Branch Code, IFSC Code(11 digits), Bank Accounts No(Core Banking ic, % to 16 digits) dmowd wot dosjteeh, souaptd cor wpsoréeh xoserA cipeinnsaod HooinA deewseds amet wossowye sma, Amor aiid, mre momen, ogi he ams rurcinigintos mg anedds. maps AINE far Asad shed HowoKd ioe eOREAE chaos Data sheetse, arigainnss 49c9, tt ard, Seslod.andt doysbenn eeedostiet,-3- Anenpiies mow auday eoteosmn omeerich md AES toot ncttowrs AaLSA mead Somdud deeds ddeo gaofed, arto deta soch ets (Single cancelled cheque leaf) sacisy, extgroeich, 4% BOTTI) Med cid OEE Sedat, Bolt soc gato Paces ef (Annemre-VIEE, Hh Smade mle ddd ddd, gimabrocd ApeiDL see Deyoe Bede 80080, Bed Dmype Seas edohendC. UoOa, me, sinks DEORE dd,de, todd Uo, Refsadorad mites oeaah ¥ab Frtagenticjcd, 9. Omari my Lebighd dee ots Of empocds ae eedadds oxen DAAMDLAY sic Sey OwEdoonH AMEE HEE, Emptean dchoorabd>, 10, omerris vetrobd, sotodat ey dnbaladdds, dosionesen Pic subst, eater Babwoddaly, otri’s, sdiplenmes, 3d a Smdmp mle mkt dodéeden Saeed Sy, Swloly mmaho newt csi, cadseh dodvetsdy dele eatealA, dahatvbabel, H1. Gers menrivg, tox wodiidah, Mahodeens. omgriiey eindswd dosh, smd ddeiod mo srl ost add Ba ula sole omiday ate ade exdensteh ctocbystehy doc taohdpl, sddod omarvived ariod Arbobde, demd stublohcy ddahes ma,wriy, arte Sngs Aabobd ao wd ARdo morn, edede, Omer’ ude, cdot Hoshohe, tow aria mor aiorieny ahi, aafoh ewidi, saphinn odes sadoden OS, eae, maieg, eMAbeE Kp, do ous ral’, Joss sch aoAkaeyles Seygere eameRpatendsdss, 12 OMGerIeS dod ewiedidi, acy, uaseoon(Enclosures) ahs egjohd aindsys wees specimeed OmowlS1AII2A0eN KOBdNe ddd dari ayo woud sebbedsos soedgeta, BRIN eokeMOT AGS 09 david eee ay ede Lech dé ggaidy choad SsbereNoeeds found Ach, UP andoryse. adem apbmow amErnond tnd 9e, werridty Agenetoe zcdo alate bya ada & tvmekad Outs, BmosT1.t0.2012406rmn Speed Post witss shout Regd, Post with Ack. due shtaterbieh, noc Se0 wetrotsy, Brmcie ds aay Qolee weotacdgfanoatiinhad UQLOdy well omgriids DeyBr Seda Sdlainiitibod Sodas mE SMPOES. ad, MoLoday, Bde BOSE eID. Ameer ond eErHvs, das rats Anehids mdeld mmoled comeds esd Aettdccoodh wut dedmnatndide vesttaich emis gis eniphd anabapsd metess wBemabed centile erirotsly seas sided. Yee and Hed, Keele OWL t MHRD SCHOLARSHIP 2012 -FRESH BATCH C/O Assistant Director(Academic), Dept. of Pre-University Education, 18" Cross, Malleshwaram, Bangatore-560 012. Telephone Noata2ss6tasqs7ss BB AAwe: sede Sadan se6 cine Mop/dolle dames anks oeduyRA ede ORME ETON GoyGerics Yocmeadd marke A Has ROW MHOANEN ee als Sma AatedtS Stokawaciveds Osta, Aedes son. era wos RophtoRNeoodt aga,slead/Ameoces aR,O atmaé.oods oinaile wdgiditds sorfRciG, ds, Kongai, Ooorridvepedide RoR. atnaile zeglLogyle eco 8 08 WifstaRd cebctnscsefey vor woe, KatiSE emia Habs, aden sets,-Ee ‘Stream (Tick the relevant box): Science Commerce | Arts| GOVERNMENT OF KARNATAKA Department of Pre-University Education, Malleswaram, Bangalore-560 012. Central Sector Scheme of Scholarship for College students who have secured the fixed cutoff marks or more in Il PUC examination held in March 2012 DATA SHEET OF THE CANDIDATE FOR SELECTION 0} TT PUC Examination Reg. No. of the candidate 02 ‘Name and Permanent Address of the candidate: 03 ‘Name of the Father Phone No: or Mobile No: 4 Category to which the candidate belongs: {Tick the relevant box) sc ST OBC GM PH 15 | 0S Gender (Tick the refevant box) Male: CT Female: C1 Marks obtained by the candidate in I PUC for 600 marks (attested copy of the marks ccard must be attached) 07 Parent’s Income: (Affidavit—income certificate must be Attached - Annexure-IiI) 08 ‘Name of the College where the student is stadying in the academic year 2012-13 with full Address, Telephone No. Fax No. and emai) id (loining report signed by the Principal in Annexure-V must be enclosed) Name and Address of the University in which your college comes under, with ‘Telephone No. Fax No. and email id. Certificate Centified that the particulars given above are truc and correct. Date: Place: Signature of the Principal with College Seal.-2- Particulars of Savings Bank Account of the candidate in the Prescribed Nationalized Bank: 1) Name of the Bank and place D)IESC Code (11 digits) 3) Branch Name 4) Branch Code 3) Bank Account No. (Core Banking ie., 09 to 16 digits) ©) Phone No. of the Bank 7F) Attestation by the Bank official 10 Tist of enclosures: (Tick the relevant box) 1. Joining report. Yes No 2 Attested copy of the Marks card} Yes No of IPUC. % Allested copy of oBCISCisTPH| Yes L__] No certificates. 4, Income Affidavit Yes No[ 5, Cancelled Cheque leaf of the Yes No candidates cheque book. 6. Xerox copy of the candidates) Yes No[ | Bank pass book’s first page. 1. Castificate of not receiving any} Yes Nef other scholarships. : Certificate Certified that the particulars given above are true and correct. Date: Place: ‘Candidates signature.ANNEXUREAV GOVERNMENT OF INDIA MINISTRY OF HUMAN RESOURCE DEVELOPMENT ‘DEPARTMENT OF HIGHER EDUCATION CENTRAL SCETOR SCHEME OF SCHOLARSHIP FOR COLLEGE AND UNIVERSITY , STUDENTS STATEMENT OF PARTICULARS: 1. Statement of particulars, Income Affidavit and Jolning ‘epart duly filled {n thould be handed aver to the Head of ‘the Institution, witere the student has Joined UG Coarse. 2. Each itens should be read carefully before the form Is filled. No change will he permitted after tt has been submitted. 1 any entry is found to be incorrect the scholarship, if avrarded, {s liable to be cancelled forthmith. Incomplete statement ot statement received after the prescribed date will not be considered. 4. Stadents uray ensure that the completed Forms are forwarded by the Head of the Institution in time. Name of the Candidate (in block letters) (As por 11 PUC Marks Card) Date of Birch (DDMMIYY) (As per Class X Certificate) Sex Male/Female #8) 8) = ‘Category: SC/ST/OBC/ General = (Pt, attach prood) Physically Handicapped (Pl, attach proof) 8 ‘Details of Father / Gardian / Husband as the case may be a | Name Permanent Home Address || Brofession / Designation with address 06. ‘Detals for Communication “Adavess for Correspondence b | Tel No. with STD Code: ¢ | Mobite No. @ | E Mell 1D 97. | Whether fateriguardian is a tizen of india: 08. | Total annual income of both parentsguardian or husband's income in case of marriedGOVERNMENT OF INDIA ANNEXURE-TV MINISTRY OF HUMAN RESOURCE DEVELOPMENT ‘DEPARTMENT OF HIGHER EDUCATION CENTRAL SCETOR SCHEME OF SCHOLARSHIP FOR. COLLEGE AND UNIVERSITY , STUDENTS STATEMENT OF PARTICULARS Note: 1 Statement of particulars, Income Affidavit and Jotning report duly led the Institution, where the student has joined UG Course. 2. Each item should No change will be pernaitted after ft has been submitted. If any entry is found to be incorrect the scholarship, awarded, ts able Incomplete statement or statement received after the prescribed date will not be considered. Students may ensure fhat the completed Forms are ‘n should be handed over to the Head of ‘be read carefully before the form is fUNted. to be cancelled forthwith. Recent Colour Photograph of the Applleaut attested and stamped by Principal of where student is presently studying forwarded by the Head of the Institution in tae. i. | Nanre of the Candidate (in biock tetters) {As per Hl PUC Marks Card) [Date of Birch CODIMMIYY) (As per Class X Certificate) 63. | Sex: Male/Female Of. | Category: SC/ST /OBC/Gonerat = (PA, attach prood) Physically Handicapped (Pl., attach proof) 0. ‘Dotalls of Father / Gardian / Husband as tlie case muay be 2 | Name Permanent Home Address Profession / Designation with address Detalis for Communication ‘Aadvess for Correspondence B | Tet No. with SID Code: ¢ | Mobite No. @ | EMail 1D 07. | Whether fateriguardian Is a citizen of Indla: 08. [Total annual Income of ‘both parents/guardian case of married or hushand’s income in4 ‘Tuenployed girl student An Income affidavit as per Annemre-TIl should be attached In support Particulars of SchooVinstitution — fast — attended - [{PUC Name of SchooVinstitution Date of entry (DDIMMIYY) Date of leaving DD/MM/YY) Romrark, if any. (QF THIS SPACE 15 NOT SUFFICIENT SEPARATE SHEET MAY BE ATTACHED) an ofp 10. Details. of Class Examination by the ndidate: ‘Name of the Examination passed TW PUC Faanination Roll Number. | Year of Passing, 2012 (MarchiApril) Name of the Board which conducted the | Department of Pro-University Education, examination passed by the candidate | Bangalore. together with its head quarters, e | Total ageregate marks obtained in the examination for 600 marks 1 | Percentage of marks obtained in agereeale Te is the Candidate in receipt of any other | Yes/No scholarship from State Government or ‘other institution oF person, If Yes, particulars should be given induding the monthly rate and date from which the scholarship fs being drawn, iz Particulars of Savings Bank Account of the Candidate: ‘@ | Name and address of the Bank © @ | RTGS:NEFT:IESC Code (ii digit Code of the Bank) 13. | List of Ruclosures sent with this statement (without enclazures application will wat be considered) _| a | Income Affidavit (Annexure-Iil) b | Attested Copy of Marks Card of IPUC Examination 2072 Of Dept,, of PU Education © | Attested Copy of SC/STIOBC Certificate @ | Joining Report (Anmeare-V) Ta. | Certified that the statement made by nye in this form Is correct. I decare that in case I amt selected for a schotarshtp. 1 shall devote my full time to the ‘course of stady and that I shall not receive another stipend/scholarchip from any other source. Date pes Signature of Candidate,-5- ANNEXURE-V GOVERNMENT OF INDIA MINISTRY OF HUMAN RESOURCE DEVELOPMENT DEPARTMENT OF HIGHER EDUCATION (CENTRAL SECTOR SCHEME OF SCHOLARSHIP FOR COLLEGE AND ‘UNIVERSITY STUDENTS JOINING REPORT 1. This is to certify ——Ssthat Shri/Snut./Kumari . .. Passed the Second Year Pre- University Examination in March 2012 conducted by the Department of Pre-University Education, Bangalore, Karnataka State with Reg No. _ and has been granted admission in this institution on day of wae forthe . ... course. He/she has started attending, the Firsy Year class with effect from Date:............0.2012. This institution is affiliated to University. 2. The completed Statement of Particulars (Annexure-IV) and the Income Affidavit Form (Annexure-Il) are also enctosed. Telephone No: Principal. With STD Code: (with Seat of the Institution) To, MHRD SCHOLARSHIP 2012— FRESH BATCH C/O Assistant Director(Academic), Dept. of Pre-University Education, 18" Cross, Malfeshwaram, Bangalore-560 012. ‘Telephone No.08o-25361856RSTRSS-6- ANNEXURE-IE INCOME AFFIDAVIT. ‘Declaration of income of Parent/Guardian for the year (ending on 31% March 2012) {Enter relevant year} for purpose of scholarship granled under the “Central Secote ‘Scheme of Scholarship for College and University Students”. 1 ae institution). ‘That my annual income in the proceding year ending the 31% March 2012 in RBar va as per details furnished in the Scheduled here under written. T also affirm that particulars of property held by me is as shown in the Schedule ‘and that 1 have correctly indicated the amount on various taxcs/cosses and land fevenue paid by me. 1 make myself personally responsible for the accuracy of the facts and figures furnished. ‘That the aatements made in the foregoing paragraphs are true to my knowledge. “That 1 further undertake that in the event of the particulars given in this declaration being, found false. [shall refund to the President of India DOUBLE the amount of the scholarship to the said scholar(s) and the Government's decision om ‘whether the declaration of pasticulas is false shall be final and binding on me. Signature > ‘Name in full: ‘To be singed in the presence of Notary Public or 2 Magistrate/Ist Class Magistrate Executive/Rovenue Officer/sho would also affix his signature and seal » SCHEDULE (a) Independently as ‘(b) Jointly as © Independently omer anmer astenant @ Area (Gi) Viltage_ (i Survey No. Go) Land Revere ||P asressment (¥) Annual Income Rs Rs. Rs.(a) House No. (ob) StreetRoad ©) VillagerTown/City @ — Araof Site (©) Rentderived ifany (® — Howse Tax (@) Sanitary cess or other Rs.~ (@) Not Anmmal Inoome — R-———————— “Whether the whole or part of ind has been given out to tenants, if “yes” particwWars: IL, Income from shops: @ Address of shop Gi) Neture of trade (ii) Sales Tax, Inoome Tax Paid Re. Gv) Licence No,” (¥) —Anmual Inoome IV, Salaries Drawn, by self/ spouse = @ Name of the Employer i) Office/Unit in which ‘Working end designation (ii) Address of Office (@) Annual Basie Pay for... (Yeas) without Deduction of Inoome Tax (Certificate from the employer/Income Tax “Auuhory/Revenue Authority may be attached) (t) Special Pay/Boaus (© Deputation allowance and ‘Honoraria including NCC honoraria (@) Tota of (), ©) and () (6) Amacunt of contribution to Provident Fund (® Payments towards LICICTD @) Total of (e)and V. Incace of Govt, Servants, Certifioate may be given ‘That you do not belong to “creamy-layer”, a8 Der Extant govt, instructions. Vi. Other benefits like house rent allowance, froc house and other perquisites —-—VIL. Other source of Income: @) Income from subsidiary industries Part-time occupation Gi) Amounts drawn as wages ii) Any other Income VII. Annual Income of wifefhusband and of the ‘Scholar's Income from any source (@) Anmual Bosic Pay fee ———— (Year) without Deduction of incoae Tax (Certificate from the emplayer/Income Tax, “Authority/Revenue Authority may be attached) (b) Special Pay/Bonus, Ree {(¢) Deputation allowance and honoraria Including NOC honeraria, (8) Total of (2), (b) end (©) (© Amount of Contribution to Provident Fund (® Payment towards LICICTD (g) Total (¢) and (f) Siguauture of Parent! Guardian of the Scholar NB. (2) Tota income of the family should include income only of father & mother of the Scholar and of no other members though they may be earsing, Q) if father dead, mother’s incomes wal be shown aloug with the inoue, i eny, inthe Scholar ‘ov name from shares, property ele, 2) Wot father end mother of the scholar are Geceaed the income, if any he scholar’s name Taly l be shown, and othe income ofthe guardian who may be supporting the scholar (4) Income forthe purpose of Means Test ir defined as under: (a) the cae of slsied cas, base pay ps income if any form cher souroes and woul at include allowance like Deamess Allowance, Cily Cempensatory Allowance (@) In the case of income fiom source liable to income tax, ‘income computed (after deduction te te able items) forthe purpove of afsessment of income fx, per none Tax Rules for the year : (inthe cate of noone not able 1 income tax, such as income from Agrcutar, eo, he met eons that is arrived at after deduction expenditure incurred for eaming that income-9- ANNEXURE - VI GOVERNMENT OF INDIA MINISTRY OF HUMAN RESOURCE DEVELOPMENT DEPARTMENT OF HIGHER EDUCATION CENTRAL SECTOR SCHEME OF SCHOLARSHIP FOR COLLEGE AND UNIVERSITY STUDENTS: DECLARATION CERTIFICATE, This is to certify that 1! am Mr/Miss .. isa student of this Institution/College, {eourse) during the academic year ck the relevant Y ear of Course). Tam not receiving any other Scholasships. ‘Signature of Candidate, Attestaion by the Principal that Shri / Smt, / Kumari . is a student of this Institution/College, . “(course) during the academic year ¢ relevant Year of Course). This to certify (Tic He/She is not receiving any other Scholarships. ‘Telephone No: : Principal. With STD Code: (with Seal of the Institution) To, MBRD SCHOLARSHIP 2012 - FRESH BATCH C/O Assistant Director(Academic), Dept. of Pre-University Education, 18% Cross, Malleshwaram, Bangalore-560 012. ‘Telephone No.080.21361856857858