PART-II

CENT VIDYARTHI

BASIC INFORMATION

Sl Particulars Details
a. Proposed course of Study PGP IN MANAGEMENT

b. Duration of Course Years Full time Part time

2 Full time x
c. Name and address of the College / IIM ,AHMEDABAD
Institution in which the student
intends to join.

d. Name of the University/Recognised IIM ,AHMEDABAD

Authority to which the college/
institute is affiliated.

e. Has the student been admitted into the YES,ATTACHED

above College /Institute / University
or accepted for the Course? If so,
certified copy of admission/
acceptance Letter should be attached
f. Is the applicant attending any college NO
or Institute at present? If so, furnish
full particulars.
g. No. of earning members in the Family
& their total income.
h. Whether the student has any working No
experience? If yes, please give details.
i. Whether the student will take up any No
part-time employment during study?
If yes, please give details.
i. Year of retirement of father Guardian N/A
(if in service only)

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 CENT VIDYARTHI
STUDENTS ACADEMIC RECORD:
Name of the examination from SSC or equivalent onwards
Name of the
School/ College
Medium of
instruction
Examination
authority
Month & year of
passing
Whether passed in
the first attempt
Aggregate marks
first attempt
Out of total marks
Percentage of
marks
Rank/Class/Div
obtained
Scholarship/ Prizes
won for academic
distinction.
(Certified copies of the list of marks of all the above exams should be enclosed)

PARTICULARS OF FINANCIAL REQUIREMENT OF THE COURSE

Studies in India Fig..in Rupees Studies in abroad N/A
Admission fee 100000.00 Total fees for ______ per year N/A
Term Fee for two 2200000.00 Books, stationery, instrument N/A
years & equipment
Books, stationery, 60000.00 Boarding & lodging @ N/A
instruments, ___________ per year for
equipment _____________ years
examination fees
Boarding & loadging 240000.00 Total i.e. Equivalent in Rs. N/A
@ Rs.10000 per
month for two years
Others & foreign 500000.00 Air passage (one way only) N/A
exchange
Total (enclose 3000000.00 N/A
evidence)

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 CENT VIDYARTHI
SOURCE OF FINANCE:
1. Non repayable scholarship(s) at Rs._____________ p.a. for Rs.___NIL______________
____________ years
2. Loan scholarship(s) and or other repayable financial Rs.____NIL______________
assistance from other sources
3. Contribution of Parent/ Guarding and /or other Members of Rs._____NIL_____________
the family / relatives towards total expenses
4. Amount of loan required from the bank Rs.3000000.00
5. Earning of the student(if any) Rs.______NIL____________
Total Rs.3000000.00

Particulars of Insurance Policy (ies) (In the case of father/ guardian/ applicant only)
Names of the insured Policy No Date Date(s) of Amount of Date of last
Maturity yearly premium
premium paid

NIL NIL NIL NIL NIL NIL

ADDITIONAL INFORMATION TO BE FURNISHED BY STUDENTS

UNDERTAKING STUDIES ABROAD
a. Amount of foreign exchange required. N/A
b. Foreign currency N/A
c. Rupee equivalent N/A
d. Have you obtained the necessary passport, N/A
/visa etc? Yes/No.(if yes, give reference)
e. Do you intend to take up any part time N/A
employment during the course of studies
abroad? If so, give particulars.
f. What are your likely Prospects on your N/A
return to India?

DECLARATION: We hereby declare that the information furnished against the foregoing
items is true to the best of our knowledge and belief.
We also undertake to inform the bank immediately any change in our
employment details, address, telephone number including mobile no. etc. for both local
and permanent address,

Place Ahmedabad Signature of student

Date /0 /201