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 SHARMIN BANU

The hardcopy of this filled Application (BZPU20212159) 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: BZPU20212159 (Fresh) Submitted on 2021-10-04 16:21:19

Student Name SHARMIN BANU
Gender FEMALE Date of Birth 02-Jul-2005
Aadhaar Number 218010256251 Mobile 8123366148
Email Id NOORJAANHUMAZ786@GMAIL.COM
Permanent Address NO 32 THANISANDRA
Landmark: NEAR ALI MASJID
BANGALORE - 560077
Current Address NO 32 THANISANDRA
Landmark: NEAR ALI MASJID
BANGALORE - 560077
EDUCATION DETAILS
College studying PRESIDENCY PU COLLEGE , #98/3 KOGILU CR YELAHANKA
Course Science Class 1st PUC
Previous Exam / Year SSLC/10th - 2021 Marks Secured 397/625 - 63.52 %
Total College Fee 75000 Fee Paid 10000
Fee Due 65000
School studied SONIYA PRIMARY AND HIGH SCHOOL, SARAIPALYA 560077
Year / Board 2021 - State Marks 397/625 - 63.52 %
FAMILY DETAILS
Father's Name LATE TANVEER Mother's Name SALMA KOUSER
Father's Qualification Did not complete School Mother's Qualification Did not complete School
Father's Occupation NA Mother's Occupation HOMEMAKER
Siblings Elder Brothers - 0, Elder Sisters - 0, Younger Brothers - 1, Younger Sisters - 0

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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? Father Expired Annual Income 98000
Did your father or mother lose Father Lost Job Did your father or mother die No
their job due to COVID-19 ? due to COVID-19 in 2021 ?
Your Achievements in Sports While the goal is common: “I want to become a doctor,” reasons to become a ... to go for the
& Extra Curricular Activities private practice of medicine, the opportunities are endless.
What is your Ambition in life ? While the goal is common: “I want to become a doctor,” reasons to become a ...

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 ( )
Disability 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 SHARMIN BANU , daughter of LATE TANVEER is a bonafide

student of PRESIDENCY PU COLLEGE , #98/3 KOGILU CR YELAHANKA
studying Science - 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 SHARMIN BANU studying Science - 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 SHARMIN BANU , Scholarship Application ID : BZPU20212159 daughter of LATE

TANVEER residing at NO 32 THANISANDRA BANGALORE - 560077 studying in
Science - 1st PUC at PRESIDENCY PU COLLEGE , #98/3 KOGILU CR YELAHANKA ,
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 SHARMIN BANU Account Number 0419108011754

Bank Name CANARA BANK Bank IFSC Code CNRB0000419

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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