Annexure-2 (Revised 2022-23)

CERTIFICATE AND UNDERTAKING FROM STUDENT

(USE BLUE INK PEN ONLY)

1. Certified that I,_______________________________(Name of Student) am Son/Daughter of Service

No Rank Name (Particulars of ESM / Name of Widow)
was selected for ___________________________ (Name of Course).
2. I was selected for PMSS during Academic Year ______________________.

3. I am presently studying in 2nd / 3rd / 4th / 5th year of (Name of Course).

4. My Selection Number allotted by KSB for PMSS is _________________.

5. I have cleared ALL SUBJECTS IN FIRST ATTEMPT in previous academic year without RA / Fail for award of
scholarship for subsequent year.

Date : (Signature of student)

INSTRUCTIONS CUM CERTIFICATE FOR STUDENT / ESM

1. All documents to be filled in BLUE INK PEN ONLY.

2. The student need to ensure ‘Correct Selection of Instalment’ at Para 5 (a) of renewal of application. Sequence
of instalment to be selected are given below:-

1st Instalment - Paid in Advance on Selection in Merit List

2nd Instalment - Mark sheets of 1st& 2nd semester / 1st year to be uploaded in original
3rd Instalment - Mark sheets of 3rd& 4th semester / 2nd year to be uploaded in original
4th Instalment - Mark sheets of 5th& 6th semester / 3rd year to be uploaded in original

3. Student needs to scan and upload original mark sheets of both semesters / academic year issued by the
university. Uploading photocopies / computer generated mark sheet / incomplete mark sheet will lead to be rejection of
application.

4. Para 5(b) (c) (d) of Application. While calculating aggregate percentage (Grade) of marks, calculation method
of university (converting formula) is to be uploaded alongwith marksheet.

5. Column No 14 of Renewal application to be filled on receipt of payment by logging into KSB account using Log
ID & Password by Saving date of payment and amount received from KSB (this is an acknowledgment from
student side) and mandatory audit requirement to get benefit of PMSS otherwise scholarship will be cancelled and
money paid will be recovered. SAVE BUTTON is provided at bottom of Column 14.

6. Annexure-4 is to be uploaded by those students who receive their mark sheets from the university on completion
of entire course. However, Annexure-4 is not applicable for student where mark sheets are delayed. Annexure-4 is to
be uploaded alongwith marksheets.

7. It will be ensured that Mobile No and mail ID given for PMSS are remain functional till completion of the course
because all alert and SMS about your application are sent on given Mobile No and e-mail. However, in case of any
change, KSB must be informed accordingly for updating your record.

8. Any instalment can be claimed within ONE YEAR OF DECLARATION OF RESULT.

9. Processing of renewal application is done as and when received throughout the year EXCEPT from Jan to
May. During this period (Jan to May) PMSS staff is busy in selection and preparation of merit list for 1stYear students.
It is to be noted while applications status is showing pending to you, but on ground your application is in process at
different levels / functionaries of KSB. Therefore, have PATIENCE and check your e-mail / KSB account for regular
updates.

(Signature of ESM) (Signature of Student)

Name of ESM/Widow ____________________ Name of Student ______________
Date Date ___________________
 Annexure-4

ISSUE OF UNIVERSITY MARK SHEET ON COMPLETION OF COURSE

(CERTIFICATE FOR NON ISSUE OF MARK SHEET TILL COMPLETION
OF COURSE TO BE SIGNED BY UNIVERSITY ONLY)

INSTRUCTIONS FOR STUDENT

1. The student is required to download this certificate available at KSB website under
link PMSS - Renewal Application - Renewal of Scholarships. Scan and upload
computer generated mark sheets of both semesters / academic year issued by the
university. After completing, student is required to upload this certificate at the link ‘Scan
and upload original mark sheets of both semesters / academic year passed’
alongwith mark sheets.
2. Computer generated mark-sheet to be signed by Controller of Examinations/
Registrar (Exam) (whichever is applicable) and upload alongwith this certificate.

(Signature of Student)

1. It is certified that original mark sheets of each semester / academic year is not
issued by this university to following student :-

Name of Student
Name of Course pursuing
Name of Semester / academic year passed
Student presently pursuing the course in 1st year / 2nd year / 3rd year / 4th
which year year / 5th year
Name of College / Institution wherein
the student taken admission in
professional course

2. It is further certified that original mark-sheets of all semesters / full duration of

course will be issued to the student on completion of the course. Computer generated
mark-sheets are the only option available for student to prove that he/she has passed the
particular semester / year.
3. It is also certified that the student has scored 50% aggregate marks, has not failed
in any subject and has not re-appeared for any subject. Deviation (if any) are to be
brought in own handwriting (Controller of Examinations / Registrar (Exam), whichever is
applicable as under :-

Ser Subject Name of subject Semester in Academic Final

No failed Re-appeared / which failed Year Result
Valuation done
1
2

4. Any other relevant information (please mention here) -

Date : Controller of Examinations or

Registrar (Exam)
(Round Stamp of University (Office Stamp of Signing Authority)
 Annexure-3 (Revised 2022-23)

CERTIFICATE TO BE SIGNED BY BRANCH MANAGER OF BANK

(USE BLUE INK PEN ONLY)

1. Name of Student

2. Name of ESM / Widow

3. Bank Account Number of Student

4. Aadhaar Number of Student

5. Name of Bank Branch Name IFS Code

6. It is certified that student’s Aadhaar Number has been linked with above Saving Bank Account Number
& his / her Account number is operational and KYC compliant. ‘Balance Exceeds all Maximum Limit’, if any,
is removed from the Account.

Round Stamp
Date : of Bank Branch (Signature of Branch Manager)
Address & Official Stamp