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Attach a scanned copy of the front side of your CNIC aIong with this form.

1. APPLICANT'S DETAILS
Name:
CNC No: Age:
Father's CNC No:
Gender: Domicile:
Email: Tel:
Present Address:
Permanent Address:
Applicant's Status:
Orphan's Only: Mention year of father's death:
Disabled Only: ndicate nature of disability:
2. COURSE DETAILS
Name of University / College:
Title of Programme / Course:
Roll No: Registration No:
Programme started on:
Total Duration of your Programme / Course: Years: Semesters:
Mode of Admission:
Key person to be contacted in your department:
Name:
Designation: Tel:
3. ACADEMIC RECORD
Year Roll No.
Marks
Obtained
Total Marks % Position
Are you Hafiz-e-Quran?
Do you retain Hifz?
Current Academic Performance
ntermediate
DIYA PAKISTAN REGISTERED
1304/474, Hasan Street, Defence Road, New Lalazar, Rawalpindi
Tel: 051-5859582, Mobile: 0300-5322592
(Office TeIephone Timings: 3:00pm to 5:00pm)
Bachelors
Examination Level
(Mention Year, Prof or
Semester)
Month / Year when
exam was conducted
Matriculation
Results Declaration
Date / Status
Provide complete details of all examinations that have been administered by your university / college
so far, including examinations for which the result has not been declared yet.
Average Percentage or
GPA obtained
Examination
Currently Enrolled in Year / Semester:
will complete on:
Father's Name:
Mother's Name:
Mother's CNC No:
Nale Female
Orphan Disabled Poor S Deserving
Open Nerit Reserved Seats Self Finance
Yes No
Yes No
. GUARDIAN DETAILS
Name: CNC No:
Relationship: Occupation:
Note: For occupation, be exact. Do not say Government Servant, pensioner, worker etc.
5. EDUCATIONAL EXPENDITURE
Current Expenses on Education
Sources of Educational Financing other than Guardian's Monthly ncome
Tuition Fee & Other Expenses of nstitutes Previously Attended
Yearly Expenses
Total Amount of Scholarship:
f you are receiving scholarship from another organization, then please provide the details:
Type of Scholarship:
Name of the Donor / Organization:
Designation & Grade: Organization / Dept.:
Name of the nstitute
Amount of any
Scholarship / Remission
Availed
Note: For matricuIation you shouId state the yearIy expenses you had to incur in cIass Xth
onIy. SimiIarIy, for Intermediate you shouId state the yearIy expenses of cIass XIIth onIy.
ntermediate
f you have stated any amount for 'ncome from other sources', then provide complete details of all
such sources:
Matriculation
Location
Yearly Messing
Expenses
Total Expenditure
ncome from other sources
Loan from Relatives / Friends / Organization
Scholarship from another organization
Remission from College / University
Total Gross Monthly ncome (Salary / Pension / Others):
Total Net Monthly ncome (Salary / Pension / Others):
Yearly Tuition Fee Yearly Hostel Fee
Onetime Yearly Nonthly
. HOUSEHOLD DETAILS (Note: Family includes father, mother, brothers and sisters)
Family House Type:
Status:
f own house, give details:
Total constructed / covered area in Square Ft.: Total Area in Sq. Yards:
f rented, annual rent:
Details of family members currently employed / retired
Age
Gross
Monthly
ncome
Details of family members currently engaged in business / commercial activity
Age
Gross
Monthly
ncome
Details of family members currently studying
Age
Yearly
Expenses
7. FAMILY ASSETS
Does the family own transport?
Details of property owned by the family:
NOTE: DIYA'S EDUCATIONAL STIPENDS ARE MOSTLY OUT OF ZAKAT FUNDS
Land / Plots
Shop (Commercial)
Name
Type of Business
Total amount of electricity bills from April to September (6 months):
Any other thing that you wouId Iike to add or say (reIated to this appIication):
Family House
Exact Designation
Property Type Area Total Worth in Rupees
f yes, give details i.e. Motorcycle, car, rickshaw, pick up, truck, tractor etc.
Name Employer
Name Location of Business
Full Name of nstitute
ouse Flat Quarter Nud ouse
Rented Family Owned Provided by Covt. / Organization
Yes No
DecIaration by the AppIicant and his/her Guardian:
Verification by TehsiIdar or Competent Authority:
attest that the information contained in application form is accurate
and the applicant deserves the grant of scholarship award.
We, the undersigned solemnly affirm that the details/information provided are accurate
and that we shall be responsible for any inaccurate or false information.
Applicant's Signature Guardian's Signature
Signature
Note: Competent authority incIudes Area Magistrate, TehsiIdar, Naib TehsiIdar, Mukhtiarkar or
Area Nazim
Stamp / Seal
For Diya's Office Use OnIy
Decision
Reason (if required)
Last Disbursement
History
Previous Folio
Required Docs
Disability Cert
Hifz Cert
Semester Results
!ncome Certificate
Siblings Fee Receipts
Flood Attestation
Bachelor's De