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SITARAM JINDAL FOUNDATION

JINDAL NAGAR, TUMKUR ROAD, BANGALORE.56O 073.

PROFORMA
1. Full Name of the Head of the lnstitution

2. Designation

3. Specimen Signatures

a) FullSignature i)

b) ShortSignature ii)

4. NameoftheCollegewithSeat

5. \MrelherGovt/GovtAidedlPrivate

6. Emailaddress

7. Telephone No.

L TotalNo.ofstudentsinthecollege

lf any other person other than the Head of the lnstitution is authorized to
recommend I scrutinize the Scholarship cases, please furnish the following
information.

1. FullName of theAuthorised person :

2, Designation

3. Specimen Signature

FullSignature :
a) i)

b) ShortSignature : ii)

5. NameoftheCollegewith Seal :

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