1

PRIME MINISTER’S SCHOLARSHIP SCHEME

ACKNOWLEDGEMENT SLIP
OFFICE COPY

Your Application Form dated_________ has been received on__________. The

application will be examined for eligibility. The dak receipt number ____________ is to be

mentioned for further correspondence with this office.

Office Seal: (Signature of RSB / Coast Guard Headquarter)

Tear off Tear off

ACKNOWLEDGEMENT SLIP
STUDENT COPY

Your Application Form dated_________ has been received on__________. The

application will be examined for eligibility. The dak receipt number ____________ is to be

mentioned for further correspondence with this office.

Office Seal: (Signature of RSB / Coast Guard Headquarter)

Note: This copy duly stamped and signed by RSB / Coast Guard Headquarter is to be
given to the student by hand or by post. (Envelope enclosed alongwith the
application may be used.)
 2

MINISTRY OF DEFENCE
Department of Ex-Servicemen Welfare

PM’S SCHOLARSHIP SCHEME

FOR
DEPENDENT WARDS / WIDOWS OF EX-SERVICEMEN
AND EX-INDIAN COAST GUARD

Brochure-Cum-Application Form
For Academic Year 2010-11

Application Form consists of Col No 1 to 19, Renewal Form and list of RSB / Coast
Guard Headquarter at state and UT level. (Brochure-Cum-Application form consists of
32 pages)

KENDRIYA SAINIK BOARD

West Block-IV, Wing-VII, 2nd Floor
R K Puram, New Delhi-110066
Website: www.mod.nic.in
E-Mail: jdpmscholarshipksb@gmail.com

Note: This application form (page number 13 to 19 alongwith required documents only) is to be
deposited by individual to respective RSB / Directorate General of Coast Guard. Applications
duly recommended by RSB’s / Directorate General of Coast Guard shall only be considered by
 3
KSB. Therefore, candidates are advised not to forward applications directly to KSB as the same
shall not be considered and will be returned unactioned to individual.

PRIME MINISTER’S SCHOLARSHIP SCHEME

1. Introduction.

Prime Minister’s Scholarship Scheme has been introduced from the Academic year
2006-07. To encourage higher technical and professional education for the dependent
wards of Ex-Servicemen / Ex-Coast Guard and their widows (below officer rank only)
and dependent wards / widows of Ex-Servicemen / Ex-Coast Guard who died in
harness due to causes attributable to military service / Coast Guard Service,
irrespective of the rank.

2. Scholarships Available.

A total number of 4000 scholarships will be allotted.

3. Students eligible for the scholarship.

(a) Dependent wards of ex-servicemen / Ex-Coast Guard and their widows (below
officer rank only)
(b) Dependent Wards / widows of Ex-servicemen & Ex-Coast Guard who died in
harness due to causes attributable to military service / coast guard service,
irrespective of the rank.
Note: (i) The candidate irrespective of his marital status is eligible for PMSS. However,
an earning / serving candidate is not eligible.

(ii) For dependent wards of widows and widows of personnel died in

harness due to causes attributable as at (b), there will be no rank restriction.

4. How to Apply For Scholarship.

One candidate to submit only one application form for one course, if any
candidate submit two application for more than one course, both the
applications will be rejected. Forms are to be downloaded from the website
www.mod.nic.in. Application forwarded on any other format will not be considered.

Application to be forwarded on plain A4 size paper (typed or handwritten) in the

prescribed format duly completed in all respects with superscription on the envelope
“Prime Minister’s Scholarship Scheme for the Academic Year 2010-11.”

Documents to be attached alongwith PMSS application form are as follows:-

(a) Photocopy of Ex-servicemen / Ex-Coast Guard valid I card duly certified by

RSB / ZSB / Coast Guard Headquarter as applicable.

(b) Extract of Ex-servicemen / Ex-Coast Guard discharge book as per specimen.

(Refer page number 22)

(c) Matriculation certificate duly attested.

 4

(d) Minimum Entry Qualification certificate duly attested. (10+2 Marksheet or full
Graduation Marksheet which ever is applicable)

(e) Bonafide studentship certificate from Collage in original as per specimen. (Refer
page number 21)

(f) Postal Order of Rs. 30/- not issued before 01st January 2011.

Note: Failure to attach above mentioned documents / certificate will lead to rejection.

5. Selection Procedure.

Applications will be short listed based on Ex-servicemen / Ex-Coast Guard category

(as given in para 6) and percentage of marks obtained in minimum entry qualification
(MEQ).

6. PRIORITY for Grant of Scholarship.

Order of preference for allotment of scholarships will be as under:-

Category 1 Wards/ widows of defence / Coast Guard personnel killed in

action.

Category 2 Wards of Ex-servicemen / Ex-Coast Guard disabled in action and

boarded out of service with disability attributable to Military / Coast
Guard service.

Category 3 Wards / widows of defence / Coast Guard personnel who died

while in service for causes attributable to Military / Coast Guard
service.

Category 4 Wards / widows of ESM / Ex-Coast Guard personnel disabled in

service with disability attributable to Military / Coast Guard service.

Category 5 Wards of ex-servicemen / Ex-Coast Guard in receipt of gallantry

awards.

Category 6 Wards of ex-servicemen / Ex-Coast Guard (PBOR).

7. Eligible Courses.

First year professional degree programme in BE, B Tech, BDS, MBBS, B Ed, BBA,
BCA, B Pharma, etc. duly recognized by the respective government regulatory bodies,
such as All India Council for Technical Education, Medical Council of India, UGC etc
(master degree course are not eligible to apply for Prime Minister’s Scholarship
except MBA, MCA). The scheme is open for courses mentioned above in recognized
institutions (in India only). Students studying abroad are not eligible for this
scheme. Students getting stipend for the professional degree course are also not
entitled. The candidates may avail only scholarship for first degree course
(Professional) i.e. graduate level only under PMSS.
 5

8. Scholarship for Integrated Courses.

The facility under PMSS is restricted for professional courses only, such as B Ed but
not for BA+B Ed, also for LLB not for BA+LLB duly recognized by the respective
Government regulatory bodies such as All India Council for Technical Education,
Medical Council of India etc.

9. Minimum Eligible Marks in 10+2 or Graduation.

(Minimum Educational Qualification for Entry) should be 60%.

Minimum educational qualification (MEQ) for entry to different professional course is

different e.g. for MBBS and B E it is 10+2 where as it is graduation for B Ed and MBA.
A candidate must have minimum 60% marks in MEQ to be considered for scholarship.

10. Duration of Scholarship.

Two to five years as approved by the concerned regulatory body (Except one year for
B Ed).

11. Amount of Scholarship.

a) The amount of scholarship would be as follows:

(i) Rs. 1250/- per month for boys Paid after successful completion of each
academic year.
(ii) Rs. 1500/- per month for girls

12. Renewal of Scholarship.

Candidate shall submit new Renewal Form alongwith two acknowledgement slip, Bonafide
Certificate (as per Specimen) duly signed by the Principal / Dean / Registrar of the institution
/ college and Photocopy of Passbook to the respective RSBs / Coast Guard Headquarter
either in person or by post for renewal of scholarship for the subsequent academic year.
RSBs / Coast Guard Headquarter will scrutinize and check the application forms and
forward the same complete in all aspects to KSB immediately. RSBs / Coast Guard
Headquarter will issue acknowledgement slip to the candidates at the time of submission of
the application in person or by post. Candidate to attach a self addressed envelope, duly
stamped to receive the acknowledgement of renewal form by post. For easy
comprehension an illustration has been given below:-

Student admitted in B Tech. September 2010

Marks in 10+2. 61%
Applied for PMSS. Before 31 December 2010
Finds his name in the list of 4000 successful candidates June 2011
selected for grant of PMSS.
Applied for first renewal of Scholarship by submitting first October 2011
year / first two semester result.
Granted first installment. December 2011
 6

Applied for second renewal of Scholarship by submitting October 2011

second year / second two semester result.
Granted second installment. December 2011
Applied for third renewal of Scholarship by submitting third October 2012
year / third two semester result.
Granted third installment. December 2012
Applied for fourth renewal of Scholarship by submitting October 2013
fourth year / fourth two semester result.
Granted fourth installment. December 2013

* Dates given above are to illustrate an example for easy comprehension and the same
may not be quoted as authority.
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IMPORTANT INSTRUCTIONS FOR PM’S SCHOLARSHIP SCHEME

Incomplete form / pages / column / documents will lead to rejection or

returned to RSB / Coast Guard Headquarter unactioned.

(a) Checklist duly signed by student & parent is to be attached on the top of the
application form.

(b) Applications alongwith relevant documents & certificates are to be deposited to

respective Rajya Sainik Board / Coast Guard Headquarter “latest by 28th February
2011. Incomplete application form and non submission of required document is
liable to be rejected and will be returned unactioned. The application will be
received by the RSBs / Coast Guard Headquarter and will be acknowledged with a
seal and date of receipt.

(c) The concerned RSBs / Coast Guard Headquarter to scrutinise / check the
application forms with regard to their eligibility criteria prior to forwarding the
same to KSB.

(d) Candidates and RSB’s / Coast Guard Headquarter to note that all
applications received after the due date will not be considered and returned
unactioned.

(e) List of selected candidates will be forwarded to RSBs / Coast Guard

Headquarter after the merit list is finalized by the BOO at KSB.

(f) Two stamped (Rs. 5 each) blank window envelopes of 27x12 cms are to be
attached with each application so as to facilitate correspondence with the candidate by
KSB / RSB / Coast Guard Headquater.

(g) The scholarship is admissible for only two children of ESM / Ex-Coast
Guard. Particulars of all children should be indicated in column 16 of application form.
This should be in uniformity with the Discharge Book / Certificate of the Ex-servicemen
/ Ex-Coast Guard.

(h) The amount of scholarship, including any other scholarship or financial

assistance from any other source will not exceed the total grant of assistance available
under this scheme.

(i) The payment of scholarship will be granted after the successful completion of
each academic year and on the submission of the renewal form (in original), as per the
percentages mentioned in ‘Criteria for eligibility’. In case, KSB ask a student to submit
the mark sheet for the full year, a student is liable to produce the same, failing which
the scholarship will be held up. On receipt of renewal for at KSB it may take
approximately two months for processing the form and completing the payment
procedure.

(j) Candidature of a student shall stand automatically rejected if, at any

stage, it is discovered that he / she has secured scholarship fraudulently by
 8

making false statement or misrepresentation of facts. Candidate shall have to

refund the amount already given, if any.

(k) The attached photocopies of the supporting documents should be duly attested
by gazetted officer (unattested documents will not be considered). In case of
legally adopted son / daughter or child born after retirement, the certificates are to be
attached with the application form duly attested by Secretary, RSB / ZSB / Coast
Guard Headquarter.

(l) In case of change of any address, course, college, it is to be intimated

immediately to Kendriya Sainik Board & Rajya Sainik Board / Coast Guard
Headquarter in writing. Always mention selection serial number, name of applicant
and ESM / Ex-Coast Guard particular for any correspondence with KSB & RSB /
Coast Guard Headquarter after getting selected for the scholarship.

(m) The Ministry of Defence, Government of India can suitably modify these
instructions to remove anomalies, if any, for successful implementation of the
scheme, as may be necessary from time to time and will be applicable to all
students under the scheme.

(n) Ex-servicemen entitlement will be governed as per the existing definition of

ex-servicemen, as amended from time to time. The definition is available in the guide
book available with the RSB / ZSB, also applicable to Ex-Indian Coast Guard
personnel as per the rules of DGCG.

(o) The application form should be downloaded from the official website of MOD,
i.e. www.mod.nic.in. The application form should be submitted to the respective
Rajya Sainik Board / Coast Guard Headquarter, (List of RSBs / COAST GUARD
HEADQUARTER is attached along with the brochure) duly completed, along with
a Postal Order (Repeat) Postal Order only for Rs.30/- in favour of Secretary,
Kendriya Sainik Board, payable at New Delhi. In case of any difficulty in obtaining
the form, the same can be obtained from the Secretary / Director Rajya Sainik Board /
Coast Guard Headquarter.

*Note: - The Postal Order should not be issued before 01st January 2011 (the
Postal Order is not refundable in any case).

(p) While filling the application form, leave 1 (one) box blank between 2 (Two)
words. Column wise guidelines are explained further for filling up the application form.
 9

IMPORTANT INSTRUCTIONS FOR RENEWAL FORM

(a) A Bonafide certificate from the College/Institute indicating that the candidate
continues to study in the subject course and showing his / her percentage of marks for
which the Prime Minister’s Scholarship has been sought (As per the specimen attach).

(b) Photocopy of passbook showing name, account number with photograph of

individual and cancelled leaflet cheque. (Scholarship will not be sent in absence of
photocopy of passbook)

(c) Candidate to attach a self addressed envelope, duly stamped to receive the
acknowledgement of renewal form by post.
 10

COLUMN WISE GUIDE LINES FOR FILLING UP OF APPLICATION FORM

(i) Column -1. Fill your name as in matriculation certificate only:-

(Not to be filled in any other format.)

1st Name A J A Y
Middle Name S I N G H
Surname R A N A

(ii) Column -2. Put a tick (√) mark as shown.

Male √ Female

(iii) Column – 3. Date of Birth as shown in matriculation certificate only.

For Example:- (10 June 1982)

D D M M Y Y Y Y
1 0 0 6 1 9 8 2

(iv) Column – 4. Mention your Rajya Sainik Board and Zila Sainik Board name,
from where your father / mother have registered and have obtained ex-servicemen /
widow identity card (Not for Ex-Coast Guard).

(v) Column – 5. Write your permanent address and correspondence address in

block letters.

(vi) Column – 6. Write phone number along with STD code and email ID for any
query (email ID is must).

(vii) Column – 7. Category as per para 6 to be written (attach the required

document, if any). Category 1 (One).

Category - 1 O N E

(viii) Column – 8. Full Particulars of Father/ Ex-Serviceman / Ex-Coast Guard is

to be mentioned as per the discharge book. A blank space to be provided
between names. (Example: - KAMLESH CHANDRA CHOUDHURY)
K A M L E S H C H A N D R A C H O U D H U R Y

1 4 5 2 3 6 K

S E R G E A N T

A I R F O R C E

(ix) Column – 9. Details of 10+2 or MEQ. Leave blank space between words.
Marks to be shown in words and figures.

a. Total Marks O N E T H O U S A N D
 11
(in words) T W O H U N D R E D
(in figure) 1 2 0 0

b. Marks obtained N I N E H U N D R E D
(in words) F O R T Y
(in figure) 9 4 0

c. % of marks scored S E V E N T Y E I G H T
(in words) P O I N T T H I R T Y
T H R E E
(in figure) 7 8 . 3 3

(x) Column – 10. Tick as applicale.

Yes √ No

(xi) Column – 11. The student is to specify the course which he / she is presently
studying. (Example:- B TECH)

B T E C H

(xii) Column – 12. Duration of the course both in numbers and figures to be
mentioned (without Internship). For example 4 years 6 months.

(In figure)
Y Y M M
0 4 0 6

(In word)
F O U R Y E A R S A N D S I X
M O N T H S

(xiii) Column – 13. Write date of commencement & completion of course as shown
below:

(Course Commencement / Date of Admission)

D D M M Y Y Y Y
0 1 0 7 2 0 0 7
(Course completion)
D D M M Y Y Y Y
3 1 1 2 2 0 1 2

(xiv) Column - 14 Write the full name and address of the college with email ID and
phone number of principal.
Name of Student A J A Y S I N G H R A N A

Roll No. 0 8 E A T I T 0 4 3

Name of College A J M E R I N S T I T U T E
O F T E C H N O L O G Y
 12

Full Address P U S H K A R B Y P A S S A
of college J M E R

State R A J A S T H A N

Pin Code 3 0 5 0 0 4

Tel No. (with STD Code) 0 1 4 5 - 2 3 0 0 6 2 8

E-Mail ID (if any) a i t _ a j m e r @ r e d i f f m a i

l . c o M

College Website w w w . a i t a j m e r . c o m

(xv) Column - 15 Write the regulatory body of your college.

A I C T E

(xvi) Column – 16. Furnish the particulars of your all children as per specimen
given:-

Sl. No. Name of Child Gender Date of Birth Age

1 Prakash Singh Rana M 10/10/1982 27 Years
2. Satish Singh Rana M 12/05/1984 25 Years
3. Ajay Singh Rana M 03/07/1987 22 Years
4. Komal Rana F 14/02/1989 20 Years

(xvii) Column – 17. Given details of the scholarship availed by your brother /
sister in the past, if not availed write Not Applicable.
Sl. Selection Name of the Course of Academic year Amount
No. Serial No. brother/sister Study in which received so far
given by KSB applied
1. 6359 Satish Singh Rana B Tech 2007-09 15000

(xviii) Column – 18. Fill up attached Postal Order particulars.

Postal Order No. 0 2 3 1 5 0

Issue D D M M Y Y Y Y
Amount (Rs.) in figure 3 0 Date 1 4 1 2 2 0 1 0

Amount (Rs.) in word T H I R T Y

 13
Note: Application form from page number 13 to 19 alongwith required documents
only to be forwarded.

CHECK LIST OF DOCUMENTS TO BE ATTACHED WITH

THE APPLICATION FORM

1. Candidates / ESM / Ex-Coast Guard are to ensure that the following documents
are attached (as applicable) along with the Application Form (non submission of these
certificate will lead to rejection and application will be returned unactioned).

(a) Attested copy of Ex-Serviceman / Ex-Coast Guard & Widow I-card issued by
RSB / ZSB / Coast Guard Headquarter.
This is an important document to be attached.

(b) Extract of ESM / Ex-Coast Guard discharge book as per specimen.

(c) If child born after discharge then affidavit is to be submitted by ESM / Ex-Coast
Guard, that child is dependent on him and he / she is a ward of ESM / Ex-Coast Guard.

(d) Additional Certificates – Attested copy of following documents.

(i) Category 1: Part II Order Equivalent of other

(ii) Category 2: Part II Order services i.e. Army /
(iii) Category 3: Part II Order Navy / Air Force / Coast
(iv) Category 4: Part II Order Guard
(v) Category 5: Award Certificate
alongwith gazette
notification
(e) Attested photocopy of matriculation or equivalent examination certificate for
verification of date of birth.

(f) Attested photocopy of mark sheet of MEQ as applicable (e.g. 10 plus 2,

graduation / diploma etc). In case the MEQ is graduation / diploma, then complete mark
sheet is required to be submitted.

(g) In case of MBA / MCA applicants, attested copy of minimum entry qualification
certificate. i.e Graduation

(h) Bonafide studentship certificate to be issued by Registrar / Dean / Principal of

College / Institution pertaining to course for which scholarship is claimed (As per specimen
attach).

(i) Postal Order of Rs. 30/- (Rupees Thirty only) attached. (Application form without
Postal Order will not be processed and Postal Order should not be made before 01st
January 2011.)

Date: _____________________

_______________________________
Place: ____________________ Full Name & Signature of Candidate
 14

_______________________________________
Checked / counter singed by ESM / Ex-Coast Guard / Widow

FOR OFFICIAL (KSB) USE ONLY

Signature of Supervisor/ IC PMSS Remarks of Supervisor

___________________________ _______________________________

_______________________________

_______________________________

RECOMMENDED / NOT RECOMMENDED

Remarks of JD PMSS

_______________________________

Signature of JD PMSS _______________________________

____________________ ______________________________

__________________________________________________________________________

Selection Serial Number

(To be allotted by KSB) ......................
APPLICATION FOR PRIME MINISTER’S SCHOLARSHIP FOR THE YEAR 2010 - 11 ___.
Recent
Photograph
Note: 1.) Please read column wise guide lines carefully before filing the application Of Student
2.) Application Form to be filled in Capital letters except email ID. (Write your name &
3.) Checklist must be attached on the top of application duly tick marked. ESM/Ex-Coast
4.) One candidate to submit only one application form for one course. Guard/widow
particular on
reverse)

1. NAME:-
First Name

Middle Name

Surname
 15

2. Put a tick mark (√) Male Female

LEAVE BLANK SPACE BETWEEN WORDS

3. Date of Birth (please attach proof of age) (i.e : Matriculation certificate)
DD MM Y Y Y Y

4. Your Rajya Sainik Board or Zila Sainik Board (Where ESM is registered and obtained Ex-
servicemen Identity card)

(Only for ESM)

RSB

ZSB

5. Full Address:

a) Present Correspondence Address: - (Where you want your letter to be sent in case of
selection / rejection)
House No.

Street No. & Name

Tehsil

District

State

Pin Code
 16
b) Permanent Address :-

House No.

Street No. & Name

LEAVE BLANK SPACE BETWEEN WORDS

Tehsil

District

State

Pin Code

6. Telephone Number.

STD Code

Land Line No.

Mobile No.

E-Mail (mandatory)

7. Ex-servicemen / Ex-Coast Guard Category - (Mention category as per Para 6 of the brochure
and attach supporting documents duly attested).

8. Ex-serviceman’s / Ex-Coast Guard’s Particulars:-

a) Name of ex-serviceman /
Ex-Coast Guard

b) Service No.

c) Rank

d) Type of Service (Tick one) Army Air Force Navy Coast Guard

9. Details of MEQ / course for qualifying examination for scholarship (10+2/equivalent

or minimum entry qualification)
 17
a. Name of Course/MEQ

b. Year in which exam passed

c. Total Marks (in words)

(in figure)

LEAVE BLANK SPACE BETWEEN WORDS

d. Marks obtained (in words)

(in figure)

e. % of marks scored (in words)

(in figure)

10. Whether the applicant is in receipt of any other financial assistance/scholarship/ fellowship
from any govt. / Private source for the course to which the scholarship applied for. If yes, then
state the amount and source

Yes No Rs (per month / year)

11. Name of the Course

(as per specimen)

12. Duration of Course in Years in figure

and months
in words

13. Date of Commencement and Approximate Date of Completion.

D D M M Y Y Y Y
a) Course commenced on

D D M M Y Y Y Y
b) Course completion date
approximately

14. Details of College / Institute.

Name of Student

Roll No.

Name of College
 18

Full Address
of college

LEAVE BLANK SPACE BETWEEN WORDS

State

Pin Code

Tel No. (with

STD Code)

E-Mail ID (if any)

College Website

15. Regulatory bodies/ Council. (For example all engineering degrees and management
degree courses are recognized by AICTE & UGC and all medical degree are recognized
by Medical Council of India or Dental Council of India, specify as per case).

16. Furnish particulars of all children in order of age, as reflected in the discharge
book or attached a certificate in case child born after discharge, by the RSB / ZSB /
Record Office / Coast Guard Headquarter, as applicable.

Sl. No. Name of Child Gender Date of Birth

17. Details of brother/sister availing the PM’s Scholarship, if any. (Including yourself if
granted earlier)

Sl. Selection Name of the Course of Academic year Amount

No. Serial No. brother/sister Study in which received so far
given by KSB applied

18. Details of Postal Order.

Postal Order No.

Issue D D M M Y Y Y Y
 19
Amount (Rs.) in figure Date

Amount (Rs.) in word

LEAVE BLANK SPACE BETWEEN WORDS

19. Declaration: “Certified that the particulars given by me in the application are correct
and any false statement made by us will disqualify me / my ward for award of PM’s
Scholarship Scheme, besides recovery of scholarship already paid. I also undertake to
abide by the conditions mentioned in the general instructions of the scheme.”

Place: (Signature of ward) _____________________________

Date: (Full Name of Ward) _____________________________

Place: (Signature of Parent) ____________________________

Date: (Full Name of Parent) ___________________________

 20

CERTIFICATE FROM RSB / ZSB /

DIRECTORATE GENERAL OF COAST GUARD

“It is certified that PM Scholarship application form for academic year 2010 - 11 in

respect of Mr. / Ms. __________________________________________________________

S/o / D/o Ex -____________________________________________________ has been

checked, found correct as per check list provided by KSB and the applicant is eligible to apply

as per rules of the scheme”.

Office seal: Secretary / Director

RSB / ZSB / Coast Guard Headquarter

Place: ________________

Date : ________________
 21

CERTIFICATE FOR PM SCHOLARSHIP

1. It is certified that Ms. / Mr._____________________ is Bonafide

student of __________________________________ college. His / Her
roll number is __________ and he / she is studying in the I / II / III / IV /
V year or ______ semester of the One / Two / Three / Four / five years
_______________ course in ____________________ branch (if any).
He / she has joined this college in the academic year 20___ - ___ and
the course will be completed in the month of ____________ 20___
-___.

2. This is also certified that _____________ course is a professional

degree course and this college is approved by
________________________________________________.

3. This is also certified that student is getting Rs._____________ per

month / year (If not getting write N/A) scholarship / stipend from this
Institute / College or any other sources.

Office Seal: Signature of Principal / Dean / Registrar

 22

Date:- ______________

Place:-_____________

SPECIMEN COPY OF EX-SERVICEMEN / EX-COAST GUARD CERTIFICATE

EX-SERVICEMEN / EX-COAST GUARD CERTIFICATE
(In lieu of Discharge Book)

1. Type of :
_______________________________________
Service (Army, Navy, Air Force or Coast Guard)
2. Service No. :
_______________________________________

3. Rank :
_______________________________________

4. Name & Initials :

_______________________________________

5. Trade :
_______________________________________

6. Date of enrolment :
_______________________________________

7. Date of Discharge :
_______________________________________

8. Reason for Discharge :

_______________________________________

9. Duration/Length of Service :
_______________________________________

10. Regular :
_______________________________________
Reserve

11. ESM / Ex-coast Guard died on (if applicable):

_______________________________________

12. Cause of death & :

_______________________________________
 23
Whether Attributable to military / coast guard service

13. Particulars of dependent children:-

Sl. Name Gender Date of Birth
No.
1.
2.
3.
4.
5.
6.

It is certified that the above information is duly checked from the discharge book of Ex-
servicemen / Ex-Coast Guard and found to be correct.

Office Seal:

Dir RSB/ZSB/OI/C Record Office

/ Coast Guard Headquarter

Date: ________________________

Place: ______________________

IMPORTANT INSTRUCTION FOR RENEWAL FORM

1. Minimum Marks for Renewal of Scholarship.

The candidates should have secured a minimum of 50% marks, uninterrupted for
continuation of scholarship in every year for the duration of course up to a maximum period of
5 years as prescribed for that programme of study. A person granted scholarship for one
programme would not be entitled for scholarship for another programme.

* Note:- If the marks in the qualifying examination are expressed in grades only,
then equivalent percentage (100 point scale) duly certified by the concerned college /
Board must be furnished (RSB, Coast Guard Headquarter & KSB will not be calculating
the percentage of marks).

2. Account Details.
All candidates to open individual bank accounts in the nearest State Bank of India branch
or Punjab National Bank which has “electronic clearance system” / Core Banking, to
facilitate transfer of the scholarship amount. Account number of the sister concern bank will
not be accepted. i.e State Bank of Travancore, State Bank of Bikaner & Jaipur, etc.
Candidate to attach a attested photocopy of passbook, showing name and account number
of the individual. A cancelled leaflet of a blank crossed cheque will duly authenticate the
account number. A joint account with parent will also fulfill the requirement.
 24
DOCUMENTS TO BE ATTACHED WITH RENEWAL FORM:

(a) A Bonafide certificate from the College/Institute indicating that the candidate continues
to study in the subject course and showing his / her percentage of marks for which the
Prime Minister’s Scholarship has been sought (As per the specimen attach).

(b) Photocopy of passbook showing name, account number with photograph of

individual and cancelled leaflet cheque. (Scholarship will not be sent in absence of
photocopy of passbook)

(c) Candidate to attach a self addressed envelope, duly stamped to receive the
acknowledgement of renewal form by post.

________________________________
Full Name & Signature of the Candidate

PRIME MINISTER’S SCHOLARSHIP SCHEME

ACKNOWLEDGEMENT SLIP
OFFICE COPY

Your Renewal form dated_________ has been received on__________. The

application will be examined for eligibility. The dak receipt number ____________ is to be

mentioned for further correspondence with this office.

Office Seal: (Signature of RSB / Coast Guard Headquarter)

Tear off Tear off

ACKNOWLEDGEMENT SLIP
 25

STUDENT COPY

Your Renewal form dated_________ has been received on__________. The

application will be examined for eligibility. The dak receipt number ____________ is to be

mentioned for further correspondence with this office.

Office Seal: (Signature of RSB / Coast Guard Headquarter)

Note: This copy duly stamped and signed by RSB / Coast Guard Headquarter is to be
given to the student by hand or by post.

Selection Serial Number......................

PROFORMA FOR RENEWAL OF SCHOLARSHIP UNDER PRIME MINISTER’S
SCHOLARSHIP SCHEME
(To be send only if selected for scholarship)

1. Name of the applicant (Ward/widow):

2. Put a tick mark (√) Male Female

3. Selection serial No. given by KSB:

4. Particular of ESM / Ex-Coast Guard:

Name of ESM /
Ex-Coast Guard
Rank
Service Number

5. Present address (where you want your letter is to be sent)

(To be filled up only in case of change from previous address or write N / A)
 26
House No.

Street No. & Name

Tehsil & Post

Distt
State

Pin Code

6. Details of Bank account of SBI or PNB for Electronic Clearing Services ( (PLEASE ATTACH A
PHOTOCOPY OF PASS BOOK, CROSSED BLANK CHEQUE SHOWING YOUR ACCOUNT NUMBER TO
BE FORWARDED, EVEN IT IS SUBMITTED EARLIER).

Name of account holder

Bank Name

LEAVE BLANK SPACE BETWEEN WORDS

Branch Name

Branch Address

State

Bank Tel. No.

Branch Code

MICR (9 digit) No.

(PLEASE ATTACH A PHOTOCOPY OF CHEQUE & PASS BOOK)

Account No.

REPEAT

Account No.
 27

Place:_____________________ ________________________________

Date:______________________ Full Name & Signature of the ward / widow

It is certify that the information submitted by my child / self is correct.

Place :_____________________ _____________________________

Date :_____________________ Full Name & Signature of the Parent

LEAVE BLANK SPACE BETWEEN WORDS

Please Fill Properly Your Full Year (Both Semester’s) Marks

1. It is certified that Ms. / Mr._____________________ is a Bonafide

student of __________________________________ college. He / she is
studying in the I / II / III / IV / V year of the two / three / four / five years
_______________ course. He / she had joined this college in the
academic year 20___ - ___ and the course will be completed in the month
of ____________ 20___ - ___.

2. This is also certified that Ms. / Mr. ___________________________

__________ has successfully completed his / her 1st / 2nd / 3rd / 4th / 5th year
and scored
Year Marks Obtained Out of Percentage

1st Year (1st & 2nd sem) ____________ ______ _________

 28
nd rd th
2 Year (3 & 4 sem) ____________ ______
_________
3rd Year (5th & 6th sem) ____________ ______ _________
4th Year (7th & 8th sem) ____________ ______ _________
5th Year (9th and 10th sem) ____________ ______ _________

3. He / she is continuing the course in 2nd / 3rd / 4th / 5th year.

4. This is also certified that student is getting Rs _____ per month /

year (If not getting write N/A) scholarship / stipend from this Institute /
College or any other sources.
Office Seal:

Signature of Principal / Dean /

Registrar
Date: ________________
Place: _______________
ADDRESS OF DEPTT OF SAINIK WALFARE / RAJYA SAINIK BOARDS &
DIRECTORATE GENERAL OF COAST GUARD

Sl No Address of RSB For Detail, Pl contact RSB

Port Blair-
Secretary
ANDAMAN & Rajya Sainik Board
03192-235621 (O)
1 NICOBAR A & N Administration, Secretariat
03192-235621(F)
ISLANDS (UT)
Port Blair - 744 101
secretaryrsbandnic@gmail.com
Hyderabad
Director
Deptt of Sainik Welfare
ANDHRA 040-24736890 (F)
2 Block IV, II Floor, Gruhakalpa
PRADESH 040-24747991 (O)
Premises, MJ Road, Nampally,
Hyderabad - 500 001
apsainik@gmail.com
Itanagar-
Director
0360-2212282 (O)
ARUNACHAL Dte of Relief, Rehabilitation &
3 0360-2212282 (F)
PRADESH Settlement, Govt of Arunachal
0360-2213615 (F)
Pradesh, New Itanagar-791110
rsbaruna@gmail.com
 29
Guwahati-
Director
0361-2522229 (O)
Dte of Sainik Welfare, Sainik
4 ASSAM 0361-2522229 (F)
Bhavan, House No-74, Lachit
Nagar, Guwahati - 781 007
rsbassam@gmail.com
Patna
Director
0612-2217301 (O)
5 BIHAR Sainik Kalyan Nideshalaya
0612-2217301 (F)
Home Deptt, Old Secretariat
Barrack No.10, Patna – 800015
directorsknbihar@gmail.com
Chandigarh
Zila Sainik Welfare Officer
0172-2701947 (O)
CHANDIGARH
6 Zila Sainik Welfare Office (UT) 0172-2700317 (O)
(UT)
Opposite Aroma Hotel, Sector-21- 0172-2726325 (F)
D, Chandigarh - 160 022
zsw_chd@yahoo.com
Raipur
Director
Deptt of Sainik Welfare, CG 0771-2445165 (O)
7 CHHATTISGARH Near Collectorate Parisar, Behind 0771-2427449 (O)
Home Guard Office 0771-2420084 (F)
Raipur - 492 001
dirsw.cg@gmail.com
Delhi-
Secretary
Rajya Sainik Board 011-23991876 (F)
8 DELHI
Opp Tis Hazari Court 011-23969260 (O)
No.1, Rajpur Road, Delhi-110 054
rsbdelhi@nic.in
Panaji
Secretary
0832-2227138 (O)
Deptt of Sainik Welfare
9 GOA 0832-2227138 (F)
Collectorate Building
Panaji - 403 001
secyrsbgoa@gmail.com
Gandhinagar
Director
Directorate Sainik Welfare & 079-22868347 (O)
Resettlement, Gujrat State 079-22868348 (O)
10 GUJARAT
Gaurav Senani Bhavan, 079-22868346 (F)
Shahibaug-Airport Road,
Shahibag, Ahmedabad-380001 dir_sw@gujarat.gov.in
rsb_guj@rediffmail.com
 30
Panchkula
Secretary
Rajya Sainik Board
0172-2560462 (O)
11 HARYANA Sainik Bhawan, Sector 12,
0172-2560462 (F))
Shaheed Capt Rohit Kaushal
Marg, Panchkula - 134 109
sainikparivar@yahoo.com
Hamirpur-
Director
01972-221854 (O)
HIMACHAL Deptt of Sainik Welfare
12 01972-224659 (O)
PRADESH Govt of Himachal Pradesh
01972-225643 (F)
Hamirpur - 177 001
dir_sw_hp@nic.in
Jammu
Director
JAMMU AND 0191-2561547 (O)
13 Deptt of Sainik Welfare
KASHMIR 0191-2575362 (F)
Ambphalla, Jammu - 180005
jkrsbsecy@yahoo.in
Ranchi-
Director
0651-2330178 (O)
14 JHARKHAND Sainik Kalyan Nideshalaya
0651-2331434 (F)
Ranchi (Jharkhand)
jharkhand_skn@yahoo.in
Director Bangalore-
Deptt of Sainik Welfare &
Resettlement, 080-25589459 (O)
15 KARNATAKA
Fd Mshl KM Cariappa, Bhavan, 080-25589459 (F)
No 58, Fd Mshl KM Cariappa
Road, Bangalore - 560 025 dirdswrblr@gmail.com
Thiruvananthapuram
Director
Deptt of Sainik Welfare 0471-2304980 (O)
16 KERALA
Vikas Bhavan, 0471-2304980 (F)
Thiruvananthapuram - 695 033
directordswkerala@yahoo.com
Bhopal-
Director
Deptt of Sainik Welfare
0755-2553992 (O)
Southern Shopping Centre
MADHYA 0755-2577209 (F)
17
PRADESH
Guru Teg Bahadur Complex, TT
Nagar, New Market,
P.B.NO 364, Bhopal - 462 003
dswoffice@mp.gov.in
18 MAHARASHTRA Director Pune-
Deptt of Sainik Welfare
Maharashtra State ‘Raigad’, Opp 020-26332763 (O)
National War Memorial, Solapur 020-26332764 (O)
Road, Ghorpadi, Pune-411 001 020-26334427 (O)

mahasainik@dataone.in
 31

dsw@mahasainik.com

Secretary
Rajya Sainik Board Imphal-
19 MANIPUR Sainik Rest House
Opp. Lamphel Police Station, PO- 0385-2416228 (O)
Lamphel, Imphal-795004

Shillong-
Director
0364-2225613 (O)
Dte of Sainik Welfare
0364-2225613 (F)
20 MEGHALAYA Public Service Commission
Building Beyond DC Building
rsbmegha@rediff.com
Shillong - 793 001
Aizawl-
Director
0389-2322732 (O)
Deptt of Sainik Welfare & Res,
21 MIZORAM 0389-2322732 (F)
Tuikual ‘A’, PB No. 119
Aizawl - 796 001
rsbmizoram@yahoo.in
Kohima-
Secretary
0370-2270029 (O)
Rajya Sainik Board, Home Deptt,
22 NAGALAND 0370-2270029 (F)
Home Br, Nagaland Civil Sectt.,
Kohima - 797 001
secyrsb-ngl@nic.in
Bhubaneshwar
Secretary
0674-2432268 (O)
Rajya Sainik Board, Nageswar
23 ORISSA 0674-2435998 (F)
Tangi, Lewis Road,
Bhubaneshwar-751002
secyrsbors@rediffmail.com
secyrsbbbsr@gmail.com
Puducherry
Director
Deptt of Sainik Welfare 0413-2253107 (O)
PUDUCHERRY
24 Jawan Bhavan Complex, Lawspet 0413-2250575 (F)
(UT)
Main Road, Pakkamudayanpet,
Puducherry - 605 008
dswpuducherry@gmail.com
25 PUNJAB Director Chandigarh
Dte of Sainik Welfare, Punjab
Punjab Sainik Bhawan, Sector 0172-2701845 (O)
21-D, Chandigarh - 160 022 0172-2707345 (F)
0172-2706014 (F)
 32

dswpb@rediffmail.com
ddhq@rediffmail.com
ddmpb@rediffmail.com

Jaipur-
Nideshak
Sainik Kalyan Vibhag 0141-2227897 (O)
26 RAJASTHAN
Secretariat Building, North Block, 0141-2227650 (F)
Jaipur - 302 005
rajasthansainik@yahoo.com
Gangtok-

Secretary 03592-202534 (O)

27 SIKKIM Rajya Sainik Board, Sikkim Paljor 03592-221456 (O)
Stadium Road, Gangtok-737 101 03592-221456 (F)

rsbsikkim@ymail.com
Chennai-
Joint Director
044-26691747 (O)
Dte of Ex-Servicemen’s Welfare
28 TAMIL NADU 044-26691886 (O)
22, Raja Muthiah Salai, Choolai
044-26691886 (F)
Chennai - 600 003
exweldte@tn.gov.in
Agartala
Secretary
Rajya Sainik Board, Nehru Office 0381-2326507 (O)
29 TRIPURA Complex, Gorkhabasti, P.O. 0381-2326507 (F)
Kunjaban, Agartala - 799 006
West Tripura rsb_sainikboard@rediffmail.com
rsb.tripura@gmail.com
Lucknow-
Director
0522-2625354 (O)
UTTAR Dte of Sainik Kalyan Evam
30 0522-2625354 (F)
PRADESH Punarvas, Kariappa Bhawan,
0522-2305107 (F)
Kaiserbagh, Lucknow - 226 001
directorsainikkalyan@yahoo.com
Dehradun-
Director
0135-2744208 (O)
Sainik Kalyan Evam Punarvas
31 UTTARAKHAND 0135-2743773 (F)
Uttarakhand, 15C, Kalidaas Marg,
0135-2741481 (O)
PO-Haathibadkala,
Dehradun - 248121
dskddn@gmail.com
32 WEST BENGAL Secretary Kolkata-
Rajya Sainik Board, Block 'I'
(First Floor), Writers’ Building 033-22141347 (O)
Kolkata - 700 001 033-22144643 (F)
033-22143220 (O)
 33

rsbkolkata@yahoo.com
rajyasainikboardwestbengal@gmail.c
om

FOR EX-INDIAN COAST GUARDS ONLY

Directorate General of Coast

Guard Headquarter 011-23074132 (O)
01 COAST GUARD
National Stadium Complex 011-23386766 (F)
New Delhi-110001

Note:

Dadar Nagar Haveli: ESM of these states can submit their Prime Minister Application form to
Gujrat RSB.
Daman & Div

Lakshadweep: ESM of this state can submit their Prime Minister Application form to
Kerala RSB.