APPLICATION FOR ALLOTMENT OF LAPTOP (NET BOOKS)

TO VISUALLY HANDICAPPED STUDENTS

To
The Joint Managing Director,
Telangana Vikalangula Cooperative Corporation,
Telangana State,
Hyderabad-500036.

(Through AD (DW)/DM, TVCC, Concerned District)

Eligibility: Visually Handicapped Students studying Professional/PG Courses are eligible

to apply for sanction of laptop from the Corporation.

PARTICULARS OF VISUALLY HANDICAPPED STUDENT

1 Name of the Applicant :
2 Father's /Guardian Name :
3 Home Address :

4 Disability Percentage :
5 Mobility Percentage :
6 Age :
7 Sex :
8 E-mail :
9 Occupation of father :
10 Occupation of Mather :
11 Family income per month Rs. :
12 Ration Card Xerox copy to be attached :
Particulars of Student
13 Name of current course :
14 Duration of course : From to
15 University ID Number :
16 Medium of Instruction :
17 University/Institution Name and Address :
18 Name of Head of Department and :
Mobile No.

19 Education Qualification (Xerox copies of certificates with marks sheets to be attached)

a) Intermediate year of passing :
b) Degree year of passing :
c) Post Graduate year of passing :
d) Any other courses year of passing :
 Certificate by visually handicapped student

I ……………………………….declare that the information given above is true to

best of my knowledge. I understand that I am getting this Netbook for my personal use only.

I agreed not to sell or rent or gift this Netbook to any other person or agency. I agree that if I

receive the Netbook from the Corporation, I will send a report on utilization of Netbook after

every three months for next two years. I hereby, declare that I have not received the Netbook

before under any scheme implemented by the Corporation.

Name:

Signature or

Thumb impression of applicant………………………..

Date:

Enclosed:

1. Copy of Disability Certificate.

2. Copy of College/ Institution ID Card (as applicable).

3. Copy of Education Certificates with marks sheets.

a)

b)

c)