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 PRE MATRIC SCHOLARSHIP 2023-24
Application ID: SSP2019011800023783 Application Date: 31-08-2023
BASIC INFORMATION
Student's Name: MD SUHAAN ALAM Father's Name: MD ALAM CHAND
Date of Birth: 21-09-2011 Mother's Name: SAIRA KHATOON
Gender: Male Annual Family Income: 96000
Marital Status: Unmarried Guardian's / Husband's Name: MD ALAM CHAND
E-mail Id: Religion: Muslim
Mobile No: 7003994039 Aadhar No XXXXXXXX0444

Bangla shiksha ID: 04884019003410

ADDRESS INFORMATION
Permanent Address Present Address
Domicile State: WEST BENGAL State: WEST BENGAL
Domicile District: KOLKATA District:
Block/Municipality:Kolkata MC(MUNICIPALITY) Block/ Municipality:
Permanent Address: 2, A.K. MD SIDDIQUE LANE Present Address: 2, A.K. MD SIDDIQUE LANE
Post Office: PARK STREET Post Office: PARK STREET
Police Station: PARK STREET Police Station: PARK STREET
Pin: 700016 Pin: 700016
ACADEMIC INFORMATION
Previous Academic Information Present Academic Information
Previous Institute Name: GOVT.SPON Institution District :KOLKATA
MULTIPURPOSE(B)TAKI Institution Name: GOVT.SPON MULTIPURPOSE(B)TAKI
Previous Class / Course Name: V Institution UDISE/AISHE/NCVT Code : 19170103914
Previous Year of Study: V Current Class / Course Name : VI
Name of the Board of Current year of Study :VI
last Exam Passed: West Bengal Board of Secondary Education Are you a Hosteller: No
Year of Passing Last Exam: 2022 Name of the Board / Council / University : West Bengal Board of Secondary
% of Marks Obtained Education
in Last Examination: 81.00 Course Duration : 1 Year
BANK ACCOUNT DETAILS
IFSC: SBIN0001723
Savings bank account no.: XXXXXXX2810

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(one-student-one-
scholarship).NB:The application of student applying for more than one scholarship application/scheme is liable to be rejected.

___________________
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.96000 . 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 MD SUHAAN ALAM 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 within 7 days:

1. Photocopy of the bank-passbook where the details of bank a/c number,IFSC are mentioned clearly.

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