Government of West Bengal

Office of the DWO, HOWRAH District

13.Annual Gross Income (parents / gurdians) from all soureces :Rs.60000/-
14.Whether applied for Merit/National Loan Scholarship or any other Stipend/Scholarship No
15.Whether you in receipant of this scholarship in the previous year NO

Hostel Details
Name & Address of Hostel Charge payable
Date ofjoiningin current Session
RAMAKRISHNA MISSION
VIDYAMANDIRA HOSTEL 2021-09-11 34100

**For academicsession 21-22 only**

(A certificate by Hostel Superintendent and duly countersigned by the Head of the Institution showing exact date of admission to
Hostel & charge payable to be submitted)
17.Identification Proof:Aadhaar Card No. XXXXXXXX1482
I agree to seed my aadhaar details with my bank account.
I undertake that all the statements given above are correct and I shall be liable to penal action if any statement made above is found
false/incorrect.

Place---
Signature of the Applicant
Date

CERTIFICATE OF INSTITUTION

The statements made by the applicant in SI. No. 12,14,15,16 are correct to the best of my knowledge. This Institute is affiliated to
the University Board & is recognized by the Government of India / State
Government of Minimum qualification for admission to the course is a pass in
Examination.
Certifythat,the applicant has not applied for any other scholarship

SEAL
Signature of Head of
Institution
Name (in Block Letter):
Designation:
Address
State
Pin Code
Affiliation/Registration No.