ACCEPTANCE OF OFFER OF CBSE MERIT SCHOLARSHIP SCHEME

I accept the offer of award of scholarship of Central Board of Secondary Education,

Delhi. I certify that I fulfill the conditions of the CBSE scholarship scheme. The required
details as desired are stated below:

PROFORMA Paste here

recent
Scholarship No. : photograph
attested by Head
1. Name of the candidate: ………………………………………………………….
of Institution
2 Mother’s Name: …………………………………………………………………. joined by you.
3. Father’s Name: …………………………………………………………………..
4 Date of Birth: dd/mm/yy: …../…../……..
5 Sex: ……….
6 Category: ……….
7 Details of Appearance in Professional Examinations conducted by CBSE ,2006 (Write
NA if not Applicable)
(i) Roll No of the Candidate: (a) AIPMT (Final): …………….
(b) AIEEE Exam: ……………….
(ii) All India Rank in: (a) AIPMT (Final) ………….….
(b) AIEEE (Engg): …………….
8 Details of Appearance in Board Examination, 2006
(a) Class (X/XII) :……………
(b) Roll No.: ………………..
(c) Board of Examination: ………………………………………
(d) Total Aggregate Marks (first five subjects) obtained: ………. out of …………
(total marks)
(e) Year of examination passed: ………..
(f) Name and address of the school:
…………………………………………………………………………………………
………………………………………………………………………………..………
…………………………………………………………………………………………
Address for Correspondence:
………………………………………………………….……

……………………………………………………………….

……………………………………………………………….

State: ………………………………………………. Pincode: ………………

Telephone No. with STD Code: …………………….

Email Address:
…………………………………………………………………………………….

10 (a) Are you the Only child of your Parents : Yes / No

(b) Details of your Brothers/sisters:

Sl.No. Names of sibling Relationship with Name of the School/ Remarks,
the applicant- college he/ she studying/ if any.
Brother/sister have studied.

11 Details of receipt of any other scholarship:

………………………………………………………………………………………….
12 Details of Medical/Engineering/Undergraduate/+2 course joined:
10 Name of Course : Medical …………
Engg………….
Under Graduate ………….
+2 course ………………..
11 Duration of Course: …………………………………
(Note – write 2 years if you are joining class XI)
(c) Name of Institution joined with full address:
…………………………………………………………………………………………
………………………………………………………………………………………..
…………………………………………………………………………………………
13 Particulars of Savings Bank Account of the applicant:
a) Account No. …………………….
b) Name of Bank…………………………………………………………………………..
c) Branch Code: ………………………..
d) Branch address: …………….
……………………………………………………………………………
……………………….
……………………………………………………………………………………
……………………………………………………….

Place: …………………… Signature of the candidate

Date:……………………..
 TO BE FILLED BY THE UNIVERSITY/COLLEGE/INSTITUTION
CONCERNED

I/we certify that the facts stated above by Mr. /Miss

…………………………………………………..
S/o / D/o
…………………………………………………………………………………………
…….
R/o…………………………………………………….....................................................
...........……… for the purpose of award of scholarship by Central Board of Secondary
Education, Delhi, are true and correct as per the records submitted to the
…………………………………………………….… (College/University/School).
The Board may consider award of the scholarship.

Place: ………..…… Signature: ………………..

Date: ……………... Name & Designation:

Telephone No.:

………………………

SEAL:...
…………………

NOTE:

1. The duly filled in proforma be sent in an envelope super scribing “CBSE MERIT
SCHOLARSHIP SCHEME” to the Secretary, CBSE, Shiksha Kendra, 2
Community Centre, Preet Vihar, Delhi-110092 so as to reach latest by 15th July
2006.
2. An affidavit from the parent that the candidate is the only child of her parents on
a non-judicial stamp paper of Rs.10/- sworn before I class Judicial
Magistrate/SDM/Executive Magistrate.
3. An additional photograph mentioning the name of student and name of
father/mother on its back.