Affix a

self-attested
passport size
photograph
Self Declaration

I........................................................................S/o…….........................................
R/o ......................................................................., Tehl. .........................., Distt.
.......................... do hereby solemnly affirm and declare as under:

1. That I am residing at said premises since………………………….…….

2. That my son/daughter ....................................is studying in ..................

................................................................................................ in ....th class.

3. That I and my above named son/daughter belong to Sikh Community,

notified minority community in India.

4. That I and my above named son/daughter are citizen of India.

5. That my annual income from all sources is Rs. ..................../- ( Rupees

................................................................. only)
6. That my son / daughter has not applied for any other scholarship from Govt
to persue the course/class from the above mentioned institute/school.
7. I shall abide by the terms and conditions for sanction of the Pre-Matric /
Post-Matric/ Merit-Cum-Means Scholarship.

I undertake that if at any stage, it is found to be the satisfaction of the

sanctioning authority in the concerned state Govt/Union territory Administration
that the information given by me is false or if I violate the term and condition of
the scholarship, the scholarship sanctioned to me, may be cancelled and the entire
amount of scholarship will be refunded by me, apart from penal action as
warranted by law.

Date:
Deponent
Verification
Verified that the contents of this declaration are true and correct to the best of my
knowledge and belief.

Deponent