CHMS Renewal Scholarship 2020-21

Appendix I

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

Private Institution
Registration ID 020810320014
1) Name Of The Candidate MIZNA
2) Date of Birth 16/09/1998
3) Sex Female
4)Aadhhar Number 315896094030
5) Details of Father/Husband/Guardian
a)Name ABDUL RASHEED PARANGODATH
b) Permanent Address PARANGODATH
HOUSE,VALIYORA,VENGARA,VALIYORA,Kerala,Malappura
m,676304
6) Details of Communication
a) Correspondence Address PARANGODATH
HOUSE,VALIYORA,VENGARA,VALIYORA,Kerala,Malappura
m,676304
b)TelePhone Number with STD Code -
c)Mobile No 8606138198
d)Email ID RASHEEDPRG@HOTMAIL.COM
7) Nationality Indian
8) Details of previous annual Board/ University Examination Passed by the Candidate
a) Year of Passing 2018 - 19
b) Percentage of marks obtained in aggregate- 68.83%
9) Receiving any Other Scholarship NO
10) Details of Present Course and Institutions
i) Name of the Course Joined PROF-UG,MBBS
ii) Name of the Institution 20100,MES Medical College Perinthalmanna.
iii)Admission Number 180011853
iv)Whether Break in study No
11) Details of Bank Account
i) Account Number 12940100246217
ii)Name of the Bank THE FEDERAL BANK LTD
iii)Branch Code and Address UGM,P B NO. 18, OORAKAM,VENGARA, MALAPPURAM

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 Appendix I
CHMS Renewal Scholarship 2020-21

Registration ID 020810320014
Full Name MIZNA
12) Documents enclosed with the application
(i) One copy of passport size photograph pasted on the registration form.
(ii) Attested copy of first page of bank pass book in the name of the student., showing the Account Number,Name,Code.
(iii) Copy of Adhaar/Enrollment document.

(iv) Attested copy of Mark Sheet of University Examinations of the year 2019-20.
13) Declaration by the candidate
(i) Certified that the statement made by me in this form is correct.

(ii) I Hereby declare that I am not availing any other Scholarship.

Place:
Date: Signature of Candidate
14) 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:
15) Certificate by the Head of the Institution

1) This is to certify that the information furnished by Shri/Smt./Kumari ....MIZNA......... S/o,W/o,D/o

Shri/Smt..........ABDUL RASHEED PARANGODATH........... who is a student of ...Second Year..MBBS .....Course is
correct.
2) He/ She had more than 75% attendance in the academic year 2019-20
3) It is further certified that the student maintains good disciplinary standard.
4) I hereby recommend the student for the renewal of C H Muhammedkoya Scholarship.
5) I have APPROVED this application through Website

Place: office Seal

Principal
Date: 20100
MES Medical College Perinthalmanna.

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