Bazm-e-Niswan Charitable Trust (R)

No.37, Muniswamy Road, Tasker Town, Bangalore - 560051

www.bazmeniswan.org | 080-22860023 | 80505 75504 ( Scan QR code for
Google Map Location)

BAZM-E-NISWAN SCHOLARSHIP 2021

Dear IQRA FATHIMA

The hardcopy of this filled Application (BZPU20212164) with student photo, student signature,
parent signature, Seal & Signature of College Principal and hard copy of documents uploaded Kindly paste the same
must be submitted by the Student in person to the office address given below on or photo which you have
before 11-10-2021.
uploaded in the online
application
Bazm-e-Niswan Charitable Trust (R)
No 37, Muniswamy Road, Tasker Town, Shivajinagar, Bangalore - 560051
Timings : 10am-4pm (Mon-Fri) & 10am-1pm (Sat). Sunday Holiday.

This Scholarship is only for Zakat Eligible Students. Poor & deserving Students who
belong to SYED CATEGORY will be given scholarship from NON Zakat Funds.

For Office use by Bazm-e-Niswan Charitable Trust :

Received by Verified by Approved by Status

Scholarship ID: BZPU20212164 (Fresh) Submitted on 2021-10-04 16:48:02

Student Name IQRA FATHIMA
Gender FEMALE Date of Birth 28-Nov-2005
Aadhaar Number 900524750262 Mobile 9035123905
Email Id MDZAIDNH@GMAIL.COM
Permanent Address NO. 119, THANISANDRA
Landmark: BEHIND GOVT SCHOOL
BANGALORE - 560077
Current Address NO. 119, THANISANDRA
Landmark: BEHIND GOVT SCHOOL
BANGALORE - 560077
EDUCATION DETAILS
College studying KARNATAKA COMP PU COLLEGE , THIRUMANAHALLY JAKKUR PO
Course Commerce Class 1st PUC
Previous Exam / Year SSLC/10th - 2021 Marks Secured 372/625 - 59.52 %
Total College Fee 40000 Fee Paid 12000
Fee Due 28000
School studied SONIYA PRIMARY AND HIGH SCHOOL, SARAIAPALYA BANGALORE 560077
Year / Board 2021 - State Marks 372/625 - 59.52 %
FAMILY DETAILS
Father's Name SYED IRSHAD Mother's Name YASMEEN TAJ
Father's Qualification Did not complete School Mother's Qualification Did not complete School
Father's Occupation AUTO DRIVER Mother's Occupation HOME MAKER
Siblings Elder Brothers - 0, Elder Sisters - 0, Younger Brothers - 0, Younger Sisters - 1

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 ADDITIONAL DETAILS
Does your family have BPL Yes Eligible to receive Zakath Yes
Card? amount?
Are you physically disabled? No Own house or Rented house? Rented
Are you an Orphan? No Annual Income 110000
Did your father or mother lose No Did your father or mother die No
their job due to COVID-19 ? due to COVID-19 in 2021 ?
Your Achievements in Sports Organizing a successful charity event. Help to others
& Extra Curricular Activities
What is your Ambition in life ? Organizing a successful charity event. Help to others

NOTE : Incomplete application with false information will be rejected

DOCUMENTS SUBMISSION LIST

Document Name Kindly tick the documents attached

SSLC (X) Marks Sheet Yes ( ) No ( )
Previous Semesters / Previous year Marks Sheet Yes ( ) No ( )
Aadhaar Card Yes ( ) No ( )
First Page of Bank Passbook/Cancelled Cheque Yes ( ) No ( )
Fee receipt Yes ( ) No ( )
Income and Caste Certificate Yes ( ) No ( )

DECLARATION BY THE PARENT / GUARDIAN

We hereby solemnly declare that the statement made and the information furnished in this application are
true. Should it however, be found that any information furnished herein is either false or not true in any material
particulars we shall be liable to criminal prosecution. We also agree that the education concessions awarded on
the basis of this declaration shall be liable to be cancelled and that any amount received by the applicant together
with an additional equal amount as penalty, shall be liable to be returned to the Secretary, Bazm-e-Niswan
Charitable Trust, Bangalore - 560 051.

Signature of Father Signature of Mother Signature of Guardian

(Not Applicable if expired) (Not Applicable if expired) (If both parents are not alive)

Date:

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 Bazm-e-Niswan Charitable Trust (R)
No.37, Muniswamy Road, Tasker Town, Bangalore - 560051

BAZM-E-NISWAN SCHOLARSHIP 2021

INSTITUTE VERIFICATION FORM
(To be signed by the College Principal where the student is currently
studying academic year 2021-22)

This is to certify that IQRA FATHIMA , daughter of SYED IRSHAD is a bonafide

student of KARNATAKA COMP PU COLLEGE , THIRUMANAHALLY JAKKUR
PO studying Commerce - 1st PUC for the year 2021-2022

It is further certified that the Student Name, Address, Aadhaar No., Previous Exam
Marks provided by the student in Bazm-e-Niswan scholarship application form are
true and correct to best of my knowledge and belief.

The total fees of IQRA FATHIMA studying Commerce - 1st PUC for the academic
year 2021-2022 is _____________.

Name of the College Principal: _______________________

Office Contact: _______________________

Seal & Signature of College Principal

Date:

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 Bazm-e-Niswan Charitable Trust (R)
No.37, Muniswamy Road, Tasker Town, Bangalore - 560051

BAZM-E-NISWAN SCHOLARSHIP 2021

DECLARATION BY THE STUDENT

I IQRA FATHIMA , Scholarship Application ID : BZPU20212164 daughter of SYED

IRSHAD residing at NO. 119, THANISANDRA BANGALORE - 560077 studying in
Commerce - 1st PUC at KARNATAKA COMP PU COLLEGE , THIRUMANAHALLY
JAKKUR PO , do hereby declare that, I have applied for Bazm-e-Niswan Educational
Scholarship for the year 2021-2022

1. My family circumstances are such that we cannot afford to pay for the expenses of PUC &
Degree course I intend to undertake. I assure that I shall pursue my studies very seriously and
become an asset for the community and nation.

2. In case the details furnished by me are found to be incorrect, the organization can initate suitable
action against me.

3. My Bank Details given below are correct and I have submitted them after verifying with my Bank
Documents.

Account Holder Name IQRA FATHIMA Account Number 3247108001658

Bank Name CANARA BANK Bank IFSC Code CNRB0003247

Signature of the Student

For Office use by Bazm-e-Niswan Charitable Trust

Bazm-e-Niswan Scholarship 2021 amount of Rs ____________________
(in words ____________________________________________________________) transferred
through
NEFT / Cheque No. ____________________________ on _______________ date from Bazm-e-Niswan
Charitable Trust Bank Account, Banglore.

Above details filled by: ________________

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