APPLICATION FORM FOR COMBINED MERIT SCHOLARSHIPS FOR THE YEAR 2023-2024

UNDER DIRECTORATE OF HIGHER EDUCATION, ASSAM

Application No. CD20236871

1. Name of candidate (In block letters): Prerona Saikia

2. Father/Mother/Husband's Name with Ratul Saikia

Permanent Address Namdhali kush ,PO Tamulbari ,Titabar

3. Present Address for Communication Namdhali kush ,PO Tamulbari ,Titabar

4. Name of the Institution with address with Nanda Nath Saikia College
PIN code No. (In full) Titabar PIN-785630
5. Contact No. of the Student (Mobile) 8822339700
6. a) Name of the Course BSc
b) Duration of the course 4 Years
c) Class in which at present studying 1st Semester
d) Date of admission in the course 2023-08-01
7. Date of Birth 01-10-2005
8. Religion Hinduism
9. Gender Female
10. Are you a permanent resident of the state of Assam.

11 . Education Qualification
(Enclose all examination passed commencing from HSLC/HSSLC equivalent Examination with attested copeis of mark-
sheets)

Name of Exam Name of the Year of Class/Division Marks Total

Passed University/Board Passing secured obtained marks Percentage
HSLC SEBA 2021 1st 504 600 84
HSSLC AHSEC 2023 1st 300 500 60

12 . The required records are mandatory with Photostat copy of 1st page of Bank Passbook: (Preferably in SBI)

Name of the A/c Holder Name of the Bank Bank Account No. Branch Name IFSC Code No.
Prerona Saikia STATE BANK OF INDIA. 40432611625 Garhali Jorhat SBIN0004460

I hereby apply for the State Government COMBINED MERIT SCHOLARSHIPS FOR THE YEAR 2023-2024 and declare that the

information given in the application is true and correct to the best of knowledge and belief. In case any information given in this
proves to be false or incorrect, I shall be responsible for the consequences and my candidature may be rejected at any point of
time.

Date: 20-11-2023 
Signature of the applicant

N.B. Hard Copies of online form alongwith all relevant certificate/testimonies are to be submitted to the

registrar/Principal/Head of Institution where the student is presently studying.

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