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 (RENEW)
APPLICATION FOR WB TSP SCHOLARSHIP 2022-23
Application ID: SSP2021041501149993 Application Date: 16-09-2022
BASIC INFORMATION
Student's Name: KHUSHBOO BEGUM Father's Name: MD SULEMAN
Date of Birth: 05-07-2001 Mother's Name: DHANMOTI
Gender: Female Annual Family Income: 36000
Marital Status: Unmarried Guardian's / Husband's Name: MD SULEMAN
E-mail Id: abdulrazzak49945@gmail.com Religion: Muslim
Mobile No: 9679421887 Aadhar No : XXXXXXXX8533

ADDRESS INFORMATION
Permanent Address Present Address
Domicile State: WEST BENGAL State: WEST BENGAL
Domicile District: UTTAR DINAJPUR District:UTTAR DINAJPUR
Block/Municipality:Islampur(MUNICIPALITY) Block/ Municipality:Islampur(MUNICIPALITY)
Permanent Address: MUSURALI BASTI CHOPRAJHAR
Present Address: MUSURALI BASTI CHOPRAJHAR
Post Office: ISLAMPUR
Post Office: ISLAMPUR
Police Station: ISLAMPUR
Pin: 733202 Police Station: ISLAMPUR
Pin: 733202

ACADEMIC INFORMATION
Previous Academic Information Present Academic Information
Previous Institute Name: ISLAMPUR COLLEGE UTTAR Institution District :UTTAR DINAJPUR
DINAJPUR Institution Name: ISLAMPUR COLLEGE UTTAR DINAJPUR
Previous Class / Course Name: BACHELOR OF ARTS Current Class / Course Name : BACHELOR OF ARTS (B.A)
(B.A)
Current year of Study :2nd Year
Previous Year of Study: 1st Year
Are you a Hosteller: No
Name of the Board of
last Exam Passed: University of North Bengal Name of the Board / Council / University : University of North
Year of Passing Last Exam: 2022 Bengal
% of Marks Obtained Course Duration : 3 Year
in Last Examination: 51.27
BANK ACCOUNT DETAILS
IFSC: PUNB0049220
Savings bank account no.: XXXXXXXX0371
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.36000 . 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 KHUSHBOO BEGUM 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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