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

AIKYASHREE (FRESH)
APPLICATION FOR WB PRE MATRIC SCHOLARSHIP 2022-23
Application ID: SSP2022010402500340 Application Date:02-10-2022
BASIC INFORMATION
Student's Name: KAMAL HOSEN MOLLA Father's Name: HOSHEN MOLLA
Date of Birth: 16-10-2013 Mother's Name: MUSLIMA MOLLA
Gender: Male Annual Family Income: 65000
Marital Status: Unmarried Guardian's / Husband's Name: HOSHEN MOLLA
E-mail Id: hoshenmolla786@gmail.com Religion: Muslim
Mobile No: 7699988171 Aadhar No : XXXXXXXX0551
Bangla shiksha ID: 07674219000677

ADDRESS INFORMATION
Permanent Address Present Address
Domicile State: WEST BENGAL State: WEST BENGAL
Domicile District: SOUTH 24 PARGANAS District:SOUTH 24 PARGANAS
Block/Municipality:Basanti(BLOCK) Block/ Municipality:Basanti(BLOCK)
Permanent Address: BHANGANKHALI
Present Address: BHANGANKHALI
Post Office: BHANGANKHALI
Post Office: BHANGANKHALI
Police Station: BASANTI
Pin: 743329 Police Station: BASANTI
Pin: 743329

ACADEMIC INFORMATION
Previous Academic Information Present Academic Information
Previous Institute Name: BHANGANKHALI F P Institution District :SOUTH 24 PARGANAS
Previous Class / Course Name: II Institution Name: BHANGANKHALI F P
Previous Year of Study: II Current Class / Course Name : III
Name of the Board of
Current year of Study :III
last Exam Passed: WEST BENGAL BOARD OF
Are you a Hosteller: No
PRIMARY EDUCATION
Year of Passing Last Exam: 2021 Name of the Board / Council / University : WEST BENGAL
% of Marks Obtained BOARD OF PRIMARY EDUCATION
in Last Examination: 65.02 Course Duration : 3 Year
BANK ACCOUNT DETAILS
IFSC: SBIN0005934
Savings bank account no.: XXXXXXX5918
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.65000 . 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 KAMAL HOSEN MOLLA 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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