DIYA PAKISTAN REGISTERED

1304/474, Hasan Street, Defence Road, New Lalazar, Rawalpindi Tel: 051-5859582, Mobile: 0300-5322592 (Office Telephone Timings: 3:00pm to 5:00pm) Attach a scanned copy of the front side of your CNIC along with this form. 1. APPLICANT'S DETAILS Name: CNIC No: Khadim hussain 44301-8761952-7 Mohammad Rahim muht 44301-2251193-7
Male Female

Age: 21

Father's Name: Mother's Name: Father's CNIC No: Gender: Email:

Mother's CNIC No: Domicile: tharparkar

44301-4135211-0

drkhsamejo@gmail.com room no 33 al razi hostel LUMHS jamshoro

Tel: 0331-3672282

Present Address:

Permanent Address:

village Akliyoon taluka chachro distt tharpakar

Applicant's Status:

Orphan

Disabled

Poor & Deserving

Orphan's Only: Mention year of father's death: Disabled Only: Indicate nature of disability:

2. COURSE DETAILS Name of University / College: Title of Programme / Course: Roll No: 07LM111 26-10-2007 liaquat university of medical and health sciences jamshoro MBBS Registration No: MB-4655 will complete on: Years: 5 12/1/2012 Semesters: 10 8th semester
Reserved Seats Self Finance

Programme started on:

Total Duration of your Programme / Course: Currently Enrolled in Year / Semester: Mode of Admission:
Open Merit

Key person to be contacted in your department: Name: Designation: rasool bux behan director of student affairs Tel:

GUARDIAN DETAILS Name: Relationship: Designation & Grade: mohammad rahim father Occupation: nil CNIC No: farmer Organization / Dept. Do not say Government Servant.00 Position A grade A-1 grade No No 4.77 Yes Yes Year 2005 2007 Roll No. including examinations for which the result has not been declared yet.8 3.79 3.30 80. pensioner.: agriculture field 5000 5000 44301-2251193-7 Total Gross Monthly Income (Salary / Pension / Others): Total Net Monthly Income (Salary / Pension / Others): Note: For occupation. worker etc. Prof or Semester) 1st semester 2nd semester 3ed semester 4th semester 5th semester 6th semester 7th semester Month / Year when exam was conducted Apr-08 Nov-08 May-09 Dec-09 Jun-10 Nov-10 May-11 Results Declaration Date / Status 17-May-08 24-Dec-08 27jun209 10-Feb-10 11-Aug-10 7-Feb-11 30-Jun-11 Average Percentage or GPA obtained 3. 118540 33682 Marks Obtained 597 880 Total Marks 850 1100 % 70. . ACADEMIC RECORD Examination Matriculation Intermediate Bachelors Are you Hafiz-e-Quran? Do you retain Hifz? Current Academic Performance Provide complete details of all examinations that have been administered by your university / college so far.77 3.79 3.76 3.77 3. be exact.3. Examination Level (Mention Year.

. then please provide the details: Total Amount of Scholarship: Name of the Donor / Organization: Type of Scholarship: One-time Yearly Monthly nil If you have stated any amount for 'Income from other sources'.5. for Intermediate you should state the yearly expenses of class XIIth only. then provide complete details of all such sources: Tuition Fee & Other Expenses of Institutes Previously Attended Matriculation Name of the Institute Location Yearly Expenses Amount of any Scholarship / Remission Availed GHS CHELHAR tharparkar 5000 Intermediate GOVT degree college mithi mithi tharparkar 8000 nil nil Note: For matriculation you should state the yearly expenses you had to incur in class Xth only. Similarly. EDUCATIONAL EXPENDITURE Current Expenses on Education Yearly Tuition Fee 12000 Yearly Hostel Fee 4300 Yearly Messing Expenses 48000 Total Expenditure 64300 Sources of Educational Financing other than Guardian's Monthly Income Loan from Relatives / Friends / Organization Scholarship from another organization Remission from College / University Income from other sources nil nil nil nil If you are receiving scholarship from another organization.

HOUSEHOLD DETAILS (Note: Family includes father. brothers and sisters) Family House Type: Status: Rented House Flat Family Owned Quarter Mud House Provided by Govt. mother.: If rented. Yards: 70 Total amount of electricity bills from April to September (6 months): Details of family members currently employed / retired Name nil Age Exact Designation Employer Gross Monthly Income Details of family members currently engaged in business / commercial activity Name nil Age Type of Business Location of Business Gross Monthly Income Details of family members currently studying Name khalid hussain mansoor ahmed Age 18 14 Full Name of Institute primary school umaid ali paro aklyoon primary school umaid ali paro aklyoon Yearly Expenses 1200 1200 7. annual rent: nil 500 200sq ft Total Area in Sq. FAMILY ASSETS . / Organization If own house. give details: Total constructed / covered area in Square Ft.6.

Motorcycle.e.I am position holder in university. tractor etc. pick up. Applicant's Signature Guardian's Signature Verification by Tehsildar or Competent Authority: I attest that the information contained in application form is accurate and the applicant deserves the grant of scholarship award. Details of property owned by the family: Property Type Land / Plots Shop (Commercial) Family House Area nil nil nil Total Worth in Rupees Any other thing that you would like to add or say (related to this application): I belong to a poor family. car. Tehsildar. Signature Stamp / Seal Note: Competent authority includes Area Magistrate.my parents can not afford the expenses of study.thanks Declaration by the Applicant and his/her Guardian: We.Does the family own transport? Yes No If yes. Mukhtiarkar or Area Nazim . give details i. Naib Tehsildar. truck. kindly help me as I can continue my study . the undersigned solemnly affirm that the details/information provided are accurate and that we shall be responsible for any inaccurate or false information. rickshaw.

th this form. .

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For Diya's Office Use Only Decision Reason (if required) History Previous Folio Last Disbursement .

Required Docs Disability Cert Hifz Cert Semester Results Bachelor's Income Certificate Siblings Fee Receipts Flood Attestation .

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