RECEIPT

Dated:

Received a sum of Rs. (Rupees ) only from the

(Name of Funding
Agency/Department) on Account of _________________________ (Name of Scholarship)

Scholarship for the session 2022-23 of the Period from July to May Kindly transfer the same in my S.B. A/c No.

_______________by RTGS. Bank details are as under.

Name of the Account Holder:

Bank A/c No:
Name of Bank:
IFSC Code:
REVENUE
Bank Address: STAMP

AADHAR NO. Signature of the Student

(On Revenue Stamp)

Name of the Student:

Category: _

Subcategory - HINDU/MUSLIM/MINORITY/OTHER/PWD

Student institute’s ID:

Mobile No:.
E-mail Address: _
Hostler with Room No./ Day Scholar

Name of Class with branch:

Father Name:

Mobile No:
E-mail Address of father
Student Permanent Address:

UNDERTAKING
(A) I undertake that I am not in receipt of any other regular scholarship/stipend from institute and other sources
till today. In future if found any wrong fact regarding my eligibility/payment and double scholarship
payment I shall refund whole amount or any penal-action may be taken against me as per rules.
(B) There are No-Dues against me till today on account of Fee etc. Therefore, I request you kindly release my
scholarship payment

(SIGNATURE OF STUDENT WITH NAME)