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: SSP2021011800286634 Application Date: 20-09-2021
BASIC INFORMATION
Student's Name: MD TAJ RAZA Father's Name: GHULAM GHAUS
Date of Birth: 09-07-2008 Mother's Name: SAJDA PARVEEN
Gender: Male Annual Family Income: 48000
Marital Status: Unmarried Guardian's / Husband's Name: GHULAM GHAUS
E-mail Id: gaushgulam798@gmail.com Religion: Muslim
Mobile No: 7003592797
ADDRESS INFORMATION
Permanent Address Present Address
Domicile State: WEST BENGAL State: WEST BENGAL
Domicile District: KOLKATA District:KOLKATA
Block/Municipality:Kolkata MC(MUNICIPALITY) Block/ Municipality:Kolkata MC(MUNICIPALITY)
Permanent Address: Z-3/2/82 BAGDI PARA ROAD Present Address: Z-3/2/82 BAGDI PARA ROAD
Post Office: BADARTALA Post Office: BADARTALA
Police Station: NADIAL Police Station: NADIAL
Pin: 700044 Pin: 700044

ACADEMIC INFORMATION
Previous Academic Information Present Academic Information
Previous Institute Name: MAULANA AZAD Institution District :KOLKATA
PRIMARY SCHOOL Institution Name: MATIABURJ HIGH SCHOOL
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: 2020 Course Duration : 1 Year
% of Marks Obtained
in Last Examination: 81.29
BANK ACCOUNT DETAILS
Name as per Bank Passbook:GHULAM GHAUS
IFSC: SBIN0003142
Savings bank account no.: 20081864116
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.48000 . 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 MD TAJ RAZA 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.

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