Specimen Application Form

The Manager

Peoples Bank

………………. Branch

Special Loan Scheme to Purchase Laptops for University entrants of State

Universities/Higher Educational Institutions (HEIs) under the purview of University
Grants Commission (UGC) for the academic year 2019/2020

1). Name of the Student :

2). Student Registration No. :

3). Name of the University/HEI :

4). NIC No. :

5). Contact No. : Mobile - Fixed –

6). Selected Option/Brand/Model :

7). Name of the Vendor :

8). Price of the Laptop :

9). Invoice attached : Yes / No

10). The letter/email received from the UGC/University/HEI for the registration as an internal
student is attached herewith.

I hereby confirmed that the information given above is true and correct.

…………………………… …………………………

Signature Date