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 POST MATRIC SCHOLARSHIP 2022-23
Application ID: SSP2021020300655131 Application Date:23-12-2022
BASIC INFORMATION
Student's Name: JASMINA KHATUN Father's Name: SK KUTUBUDDIN
Date of Birth: 01-05-2001 Mother's Name: MARUFA BEGUM
Gender: Female Annual Family Income: 72000
Marital Status: Unmarried Guardian's / Husband's Name: SK KUTUBUDDIN
E-mail Id: jasminakhatun786@gmail.com Religion: Muslim
Mobile No: 9051279719 Aadhar No : XXXXXXXX9858

ADDRESS INFORMATION
Permanent Address Present Address
Domicile State: WEST BENGAL State: WEST BENGAL
Domicile District: HOWRAH District:HOWRAH
Block/Municipality:Panchla(BLOCK) Block/ Municipality:Panchla(BLOCK)
Permanent Address: PANCHLA
Present Address: PANCHLA
Post Office: PANCHLA
Post Office: PANCHLA
Police Station: PANCHLA
Pin: 711322 Police Station: PANCHLA
Pin: 711322

ACADEMIC INFORMATION
Previous Academic Information Present Academic Information
Previous Institute Name: ULUBERIA COLLEGE Institution District :HOWRAH
Previous Class / Course Name: BACHELOR OF Institution Name: ULUBERIA COLLEGE
COMMERCE (B.COM) Current Class / Course Name : BACHELOR OF COMMERCE
Previous Year of Study: 2nd Year
(B.COM)
Name of the Board of
Current year of Study :3rd Year
last Exam Passed: CALCUTTA UNIVERSITY
Year of Passing Last Exam: 2022 Are you a Hosteller: No
% of Marks Obtained Name of the Board / Council / University : CALCUTTA
in Last Examination: 52.50 UNIVERSITY
Course Duration : 3 Year
BANK ACCOUNT DETAILS
IFSC: IDIB000D597
Savings bank account no.: XXXXXXX4386
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.72000 . 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 JASMINA KHATUN 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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