OFFICE OF THE DEAN STUDENTS’ WELFARE

UNIVERSITY OF DELHI
Photo
Application Form for the Financial Support Scheme (FSS)
(Ref. DU Notification. Acad-I/Fee Waiver /SSSV/753, dated 11.11.2022)

Name of the Applicant: ___________________________________________

University Enrolment Number: _____________Category Applied for (1) upto 50% (2) upto 100%
Course and Semester: _____________________________________________
Centre/Institute/Department: _______________________________________
Academic Record of Last Examination Passed:
S.No. Course/ Month Institute/ Department CGPA
Semester &Year obtained

Email Address: _________________________Mobile Number: _______________

I declare that there is no pending ER/ Arrear paper of previous examination.

Signature of the applicant:

Date:
To be certified by Head of Departments/ Institution/ Centres
This is to certify that_________________________ is a bonafide student of
institution_________________________ pursuing course_____________ Semester_________.
The facts stated by him/her are correct as per office record.

Signature of the Head (with stamp)

Enclosure Checklist
1. (a) Annual family income certificate for the Last Financial Year in the standard format issued
by Tehsildar or equivalent Competent Authority and as per the committee’s assessment
(b) Copy of ITR of parents, wherever applicable
2. Copies of mark sheet of the last exam passed.
3. Copy of bonafide student certificate in Degree/Postgraduate degree course
4. Copy of Fee Receipt mentioning the amount under different heads separately.
5. Copy of Bank Pass Book showing the student’s name, Account number, IFSC code and Photograph pasted at the appropriate place.