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

FRESH
APPLICATION FOR WB PRE MATRIC SCHOLARSHIP 2021-22
Application ID: SSP2021010200314460 Application Date: 07-09-2021
BASIC INFORMATION
Student's Name: SK SAHID AKTAR Father's Name: SK ASMAT
Date of Birth: 31-01-2008 Mother's Name: NOBINA BIBI
Gender: Male Annual Family Income: 40000
Marital Status: Unmarried Guardian's / Husband's Name: SK ASMAT
E-mail Id: Religion: Muslim
Mobile No: 7719279412
ADDRESS INFORMATION
Permanent Address Present Address
Domicile State: WEST BENGAL State: WEST BENGAL
Domicile District: PURBA MEDINIPUR District:PURBA MEDINIPUR
Block/Municipality:Nandigram - I(BLOCK) Block/ Municipality:Nandigram - I(BLOCK)
Permanent Address: HOSEN PUR Present Address: HOSEN PUR
Post Office: RAJARAM CHAK Post Office: RAJARAM CHAK
Police Station: NANDIGRAN Police Station: NANDIGRAN
Pin: 721631 Pin: 721631

ACADEMIC INFORMATION
Previous Academic Information Present Academic Information
Previous Institute Name: Rajaramchak Institution District :PURBA MEDINIPUR
Sikshaniketan Institution Name: Rajaramchak Sikshaniketan
Previous Class / Course Name: V Current Class / Course Name : VI
Previous Year of Study: V Current year of Study :VI
Name of the Board of Are you a Hosteller: No
last Exam Passed: West Bengal Board of Name of the Board / Council / University : West Bengal Board of
Secondary Education Secondary Education
Year of Passing Last Exam: 2021 Course Duration : 1 Year
% of Marks Obtained
in Last Examination: 65.32
BANK ACCOUNT DETAILS
Name as per Bank Passbook:SK SAHID AKTAR
IFSC: SBIN0001555
Savings bank account no.: 38759571027
Declaration:I hereby declare that the details furnished above are true and correct to the best of my knowledge and belief and I
have not applied for any other scholarship/stipend, etc. from any other government sources.

___________________
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.40000 . 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 SK SAHID AKTAR 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)