West Bengal Minorities' Development and Finance Corporation

A statutory Corporation under Minority Affairs & Madrasha Education Department,

Government of West Bengal
"Amber", DD/27E,Salt Lake City Sector-I, Kolkata-700064, Toll free No:-18001202130

APPLICATION FOR WB SVMCM SCHOLARSHIP 2019-20

Application ID: SSP2020050602054181 Application Date: 06-11-2020
BASIC INFORMATION
Student's Name: SABANA SULTANA Father's Name: MINARUL HAQUE
Date of Birth: 11-11-2001 Mother's Name: REHENA BIBI
Gender: Female Annual Family Income: 36000
Marital Status: Unmarried Guardian's / Husband's Name: MINARUL HAQUE
E-mail Id: inurul800145@gmail.com Religion: Muslim
Mobile No: 9775205165

ADDRESS INFORMATION
Permanent Address Present Address
Domicile State: WEST BENGAL State: WEST BENGAL
Domicile District: MURSHIDABAD District:MURSHIDABAD
Block/Municipality:Beldanga - I Block/ Municipality:Beldanga - I
Permanent Address: HIJULI Present Address: HIJULI
Post Office: BEGUNBARI Post Office: BEGUNBARI
Police Station: BELDANGA Police Station: BELDANGA
Pin: 742133 Pin: 742133

ACADEMIC INFORMATION
Previous Academic Information Present Academic Information
Previous Institute Name: HAREKNAGAR A.M Institution Name: SEWNARAYAN RAMESWAR FATEPURIA
INSTITUTION COLLEGE
Previous Class / Course Name: XII Current Class / Course Name : BACHELOR OF ARTS (B.A)
Previous Year of Study: XII Current year of Study :1st Year
Name of the Board of Are you a Hosteller: No
last Exam Passed: West Bengal council of Higher Name of the Board / Council / University : KALYANI UNIVERSITY
Secondary Education Course Duration : 3 Year
Year of Passing Last Exam: 2020
% of Marks Obtained
in Last Examination: 75.60
BANK ACCOUNT DETAILS
Name as per Bank Passbook:SABANA SULTANA
Bank:UNION BANK OF INDIA
Branch:BELDANGA
IFSC: UBIN0574261
Savings bank account no.: 742602010000556

Declaration:I hereby declare that the details furnished above are true and correct to the best of my knowledge and belief.

___________________
Signature of Student
DECLARATION OF INCOME
(To be given by the parents/ guardians)

Certified that the gross annual income from all sources in respect of my family is Rs.36000 . I further undertake that in the
event of the particulars given in the declaration being found false, I shall refund the whole amount of the Scholarship paid to
the said Scholarship holder SABANA SULTANA and the Government's decision in this regard shall be final and binding on me.

__________________________
Signature of the parents/ guardian

Instruction
Student is to submit this ***computer-generated filled-in application form (duly signed) to the
educational institution along with following supporting document:
1. Photocopy of the bank-passbook where the details of bank a/c number,IFSC are mentioned
clearly.
1/1

Powered by TCPDF (www.tcpdf.org)