eSHRIRAM SHRIRAM “Shriram House” No. 4, Burkit Road, T.Nagar, Chennai - 600017 EDUCATION SCHOLARSHIP FORM (FY 2023-2024) Application Number Application Type Region 1 Name of the Student 2. Date of Birth 3. Name of the School 4 Class (Passed) 5 Residence Address 6 City 7 Pin Code 8 Student’s Aadhar Card No. Shriram Seva Sankalp Foundation CIN:U85100TN2015NPL099240 Student's Details Paste Photograph Here Application Date Zone Branch MISS/MASTER, Marks State Mobile No. Email ID Details of the Past Scholarship availed Year Class Passed Percentage / Grade ‘Amount 9 Account Holder’s Name 10 Bank Name 11 Branch Address 12 AICNo. 13 IFSC Code Student's Bank Details MICR No.Parent’s Personal Details 14 Father's Name Age LE Mobile No. occupation [Monthly Income i Mother's Name aeel__] IF Mobile No. Joccupation [Monthly Income ] 16 Driving Licence No. 19 Aadhar Card No, Parent's Consent for Yes No accepting support Parent's Professional Details (For Drivers) 21 Vehicle Details Make Model Year Rex No. 22 Name of the Transport Company (For Owners) 28Name of the Transport Company” 24 How Many Vehicles Owned? 25 Vehicle Details (existing) CMake Model Year Finaneed By ‘Agreement No. 26 Details of relationship with STFC Vehicle Agreement | Finance Date From | DateTo | Total Pay. Finaneed No. Amount made ir = 1 27 Interested in buying a vehicle? Ves No 2W IF Yes which Vehicle? Signature ofthe Parent Name and Situ of ch tT * tn case Application is from Regional Office / Transport Association then instead of Branch Manager, Regional Team Leader / Committee members Name & Signature is required with stamp.