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MINISTRY OF DEFENCE Department of Ex-Servicemen Welfare


PMS SCHOLARSHIP SCHEME
FOR DEPENDENT WARDS / WIDOWS OF EX-SERVICEMEN AND EX-INDIAN COAST GUARD

Brochure-Cum-Application Form
For Academic Year 2011-12

Application Form consists of Col No 1 to 18, Payment Form and list of RSB / Coast Guard Headquarter at state and UT level attached. (Brochure-Cum-Application form consists of 31 pages)

KENDRIYA SAINIK BOARD


West Block-IV, Wing-VII, 2nd Floor R K Puram, New Delhi-110066 Website: www.mod.nic.in E-Mail: jdpmscholarshipksb@gmail.com
Note: This application form (page number 13 to 18 alongwith required documents only) is to be
deposited by individual to respective RSB / Directorate General of Coast Guard. Applications duly recommended by RSBs / Directorate General of Coast Guard shall only be considered by KSB. Therefore, candidates are advised not to forward applications directly to KSB as the same shall not be considered and will be returned unactioned to individual.

PRIME MINISTERS SCHOLARSHIP SCHEME ACKNOWLEDGEMENT SLIP


OFFICE COPY Your Application Form dated_________ has been received on__________. The

application will be examined for eligibility. The dak receipt number ____________ is to be mentioned for further correspondence with this office.

Office Seal:

(Signature of RSB / Coast Guard Headquarter)

Tear off

Tear off

ACKNOWLEDGEMENT SLIP
STUDENT COPY Your Application Form dated_________ has been received on__________. The

application will be examined for eligibility. The dak receipt number ____________ is to be mentioned for further correspondence with this office.

Office Seal:

(Signature of RSB / Coast Guard Headquarter)

Note:

Student copy duly stamped and signed by RSB / Coast Guard Headquarter is to be given to the student by hand or by post. (Envelope enclosed alongwith the application may be used.) Office copy duly filled by the RSB/Coast Guard Hqs to be attached with the application.

PRIME MINISTERS SCHOLARSHIP SCHEME (PMSS) 1. Introduction. Prime Ministers Scholarship Scheme has been introduced from the Academic year 2006-07. To encourage higher technical and professional education for the dependent wards of Ex-Servicemen / Ex-Coast Guard and their widows (below officer rank only) and dependent wards / widows of Ex-Servicemen / Ex-Coast Guard who died in harness due to causes attributable to military service / Coast Guard Service, irrespective of the rank. 2. Scholarships Available. A total number of 4000 scholarships will be allotted. 3. Students eligible for the scholarship. (a) (b) Dependent wards of ex-servicemen / Ex-Coast Guard and their widows (below officer rank only) Dependent Wards / widows of Ex-servicemen & Ex-Coast Guard who died in harness due to causes attributable to military service / coast guard service, irrespective of the rank. The candidate irrespective of his marital status is eligible for PMSS. However, an earning / serving candidate is not eligible. (ii) For dependent wards of widows and widows of personnel died in harness due to causes attributable as mentioned in para 3 (b) above, there will be no rank restriction. 4. How to Apply For Scholarship. One candidate to submit only one application form for one course, if any candidate submit two application for more than one course, both the applications will be rejected. Forms are to be downloaded from the website www.mod.nic.in. Application forwarded in any other format will not be considered. Application to be forwarded on plain A4 size paper (typed or handwritten) in the prescribed format duly completed in all respects with superscription on the envelope Prime Ministers Scholarship Scheme for the Academic Year 2011-12. Documents to be attached alongwith PMSS application form are as follows:(a) (b) Extract of Ex-servicemen / Ex-Coast Guard discharge book as per specimen. (Refer page number 21) Matriculation certificate duly attested.

Note: (i)

(c)

Minimum Entry Qualification certificate duly attested. (10+2 Marksheet or full Graduation Marksheet which ever is applicable) Bonafide studentship certificate from Collage in original as per specimen. (Refer page number 20)

(d)

Note: Failure to attach above mentioned documents / certificate will lead to rejection. 5. Selection Procedure. Applications will be short listed based on Ex-servicemen / Ex-Coast Guard category (as given below in para 6) and percentage of marks obtained in minimum entry qualification (MEQ). 6. PRIORITY for Grant of Scholarship. Order of preference for allotment of scholarships will be as under:Category 1 Category 2 Wards/ widows of defence / Coast Guard personnel killed in action. Wards of Ex-servicemen / Ex-Coast Guard disabled in action and boarded out of service with disability attributable to Military / Coast Guard service. Wards / widows of defence / Coast Guard personnel who died while in service for causes attributable to Military / Coast Guard service. Wards / widows of ESM / Ex-Coast Guard personnel disabled in service with disability attributable to Military / Coast Guard service. Wards of ex-servicemen / Ex-Coast Guard in receipt of gallantry awards. Wards of ex-servicemen / Ex-Coast Guard (PBOR Only).

Category 3

Category 4

Category 5 Category 6 7. Eligible Courses.

First year professional degree programme in BE, B Tech, BDS, MBBS, B Ed, BBA, BCA, B Pharma, etc. duly recognized by the respective government regulatory bodies, such as All India Council for Technical Education, Medical Council of India, UGC etc (master degree course are not eligible to apply for Prime Ministers Scholarship except MBA, MCA). The scheme is open for courses mentioned above in recognized institutions (in India only). Students studying abroad are not eligible for this scheme. Students getting stipend for the professional degree course are also not entitled. The candidates may avail only scholarship for first degree course (Professional) i.e. graduate level only under PMSS.

8.

Scholarship for Integrated Courses. The facility under PMSS is restricted for professional courses only, such as B Ed but not for BA+B Ed, also for LLB not for BA+LLB duly recognized by the respective Government regulatory bodies such as All India Council for Technical Education, Medical Council of India etc.

9.

Minimum Eligible Marks in 10+2 or Graduation. (Minimum Educational Qualification for Entry) should be 60%. Minimum educational qualification (MEQ) for entry to different professional course is different e.g. for MBBS and B E it is 10+2 where as it is graduation for B Ed and MBA. A candidate must have minimum 60% marks in MEQ to be considered for scholarship.

10.

Duration of Scholarship. Two to five years as approved by the concerned regulatory body (Except one year for B Ed).

11.

Amount of Scholarship. a) The amount of scholarship would be as follows: (i) (ii) Rs. 1250/- per month for boys Rs. 1500/- per month for girls
Paid after successful completion of each academic year, till completion of course.

12.

Payment of Scholarship. On completion of 1st year the candidate shall submit the Payment Form alongwith two acknowledgement slips, Bonafide Certificate (as per Specimen) duly signed by the Principal / Dean / Registrar of the institution / college and Photocopy of Passbook to KSB either in person or by post for Payment of scholarship and same procedure shall continues for the subsequent academic years till completion of course. For easy comprehension an illustration has been given below:Student admitted in B Tech. Marks in 10+2. Apply for PMSS. Finds his name in Payment of Scholarship by candidates Apply for second the list of 4000 successful submitting selected for grant& 4PMSS. second year / 3rd of th two semester results. Apply forsecond installment. Granted first Payment of Scholarship by submitting first year / first two semester results. Apply for third Payment of Scholarship by submitting third Granted first th installment. year / 5th & 6 two semester results. Granted third installment. Apply for fourth Payment of Scholarship by submitting fourth year / 7th & 8th two semester results. Granted fourth installment. September 2011 61% Before 31 December 2011 June 2012 October 2013 October 2012 December 2013 October 2014 December 2012 December 2014 October 2015 December 2015

6 * Dates given above are to illustrate an example for easy comprehension and the same may not be quoted as authority.

13.

IMPORTANT INSTRUCTIONS FOR PMS SCHOLARSHIP SCHEME


Incomplete form / pages / column / documents will lead to rejection or returned to RSB / Coast Guard Headquarter unactioned.

(a) Checklist duly signed by student & parent is to be attached on the top of the application form.

7 (b) Applications alongwith relevant documents & certificates are to be deposited to respective Rajya Sainik Board / Coast Guard Headquarter latest by 15TH Feb 2012. Incomplete application form and non submission of required document is liable to be rejected and will be returned unactioned. The application will be received by the RSBs / Coast Guard Headquarter and will be acknowledged with a seal and date of receipt. (c) The concerned RSBs / Coast Guard Headquarter to scrutinize / check the application forms with regard to their eligibility criteria prior to forwarding the same to KSB. (d) Candidates and RSBs / Coast Guard Headquarter to note that all applications received after the due date will not be considered and returned unactioned. (e) List of selected candidates will be forwarded to RSBs / Coast Guard Headquarter after the merit list is finalized by the BOO at KSB. (f) Two stamped (Rs. 5 each) blank window envelopes of 27x12 cms are to be attached with each application so as to facilitate correspondence with the candidate by KSB / RSB / Coast Guard Headquater. (g) The scholarship is admissible for only two children of ESM / Ex-Coast Guard. Particulars of all children should be indicated in column 16 of application form. This should be in uniformity with the Discharge Book / Certificate of the Ex-servicemen / Ex-Coast Guard. (h) The amount of scholarship, including any other scholarship or financial assistance from any other source will not exceed the total grant of assistance available under this scheme. (i) The payment of scholarship will be granted after the successful completion of each academic year and on the submission of the Payment form, as per the percentages mentioned in Criteria for eligibility. In case, KSB ask a student to submit the mark sheet for the full year, a student is liable to produce the same, failing which the scholarship will be held up. On receipt of Payment form at KSB it may take approximately two months for processing the form and completing the payment procedure. (j) Candidature of a student shall stand automatically rejected if, at any stage, it is discovered that he / she has secured scholarship fraudulently by making false statement or misrepresentation of facts. Candidate shall have to refund the amount already given, if any. (k) The attached photocopies of the supporting documents should be duly attested by gazetted officer (unattested documents will not be considered). In case of legally adopted son / daughter or child born after retirement, the certificates are to be attached with the application form duly attested by Secretary, RSB / ZSB / Coast Guard Headquarter. (l) In case of change of any address, course, college, it is to be intimated immediately to Kendriya Sainik Board & Rajya Sainik Board / Coast Guard Headquarter in writing. Always mention selection serial number, name of applicant

8 and ESM / Ex-Coast Guard particular for any correspondence with KSB & RSB / Coast Guard Headquarter after getting selected for the scholarship. (m) The Ministry of Defence, Government of India can suitably modify these instructions to remove anomalies, if any, for successful implementation of the scheme, as may be necessary from time to time and will be applicable to all students under the scheme. (n) Ex-servicemen entitlement will be governed as per the existing definition of ex-servicemen, as amended from time to time. The definition is available in the guide book available with the RSB / ZSB, also applicable to Ex-Indian Coast Guard personnel as per the rules of DGCG. (o) The application form should be downloaded from the official website of MOD, i.e. www.mod.nic.in. The application form should be submitted to the respective Rajya Sainik Board / Coast Guard Headquarter, (List of RSBs / COAST GUARD HEADQUARTER is attached along with the brochure) duly completed. (p) While filling the application form, leave 1 (one) box blank between 2 (Two) words. Column wise guidelines are explained further for filling up the application form.

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IMPORTANT INSTRUCTIONS FOR PAYMENT FORM


(a) Payment Form (Specimen given at page 24) to be filled carefully and the following documents should be attached with it:(i) A Bonafide certificate from the College/Institute indicating that the candidate continues to study in the subject course and showing his / her percentage of marks for which the Prime Ministers Scholarship has been sought (As per the specimen attach).

9 (ii) Photocopy of passbook showing name, account number with photograph of individual and cancelled leaflet cheque. (Scholarship will not be sent in absence of photocopy of passbook) (iii) Candidate to attach a self addressed envelope, duly stamped to receive the acknowledgement of Payment form by post.

15. COLUMN WISE GUIDE LINES FOR FILLING UP OF APPLICATION FORM (a) Column -1. Fill your name as in matriculation certificate only:(Not to be filled in any other format.) A S R J I A A N N Y G A H

1st Name Middle Name Surname

10 (b) Male (c) D 1 Column -2. Put a tick () mark as shown.

Female

Column 3. Date of Birth as shown in matriculation certificate only. For Example:- (10 June 1982) D 0 M 0 M 6 Y 1 Y 9 Y Y 8 2

(d) Column 4. Mention your Rajya Sainik Board and Zila Sainik Board name, from where your father / mother have registered and have obtained ex-servicemen / widow identity card (Not for Ex-Coast Guard). (e) Column 5. Write your permanent address and correspondence address in block letters. (f) Column 6. Write phone number along with STD code and email ID for any query (email ID is must). (g) Column 7. Category as per para 6 to be written (attach the required document, if any). Category 1 (One). Category 1 O N E

(h) Column 8. Full Particulars of Father/ Ex-Serviceman / Ex-Coast Guard is to be mentioned as per the discharge book. A blank space to be provided between names. (Example: - KAMLESH CHANDRA CHOUDHURY) K A M L E S H 1 4 5 2 3 6 K C H A N D R A C H O U D H U R Y

S E R G E A N T A I R F O R C E

(i) Column 9. Details of 10+2 or MEQ. Leave blank space between words. Marks to be shown in words and figures.
a. Total Marks (in words) (in figure) b. Marks obtained (in words) (in figure) c. % of marks scored (in words) (in figure) O T 1 N F 9 S P T 7 N W 2 I O 4 E O H 8 E O 0 N R 0 V I R . E N E 3 N T E 3 T Y T E I I R G T H Y T T H 0 E T Y H U N D R E D H U O N U D S R A E N D D

11 (j) Column 10. Tick as applicale. Yes

No

(k) Column 11. The student is to specify the course which he / she is presently studying. (Example:- B TECH)
B T E C H

(l) Column 12. Duration of the course both in numbers and figures to be mentioned (without Internship). For example 4 years 6 months. (In figure) Y 0 (In word)
F O U M O N R T H Y S E A R S A N D S I X

Y 4

M 0

M 6

(m) Column 13. Write date of commencement & completion of course as shown below: (Course Commencement / Date of Admission) D D M M Y Y 0 1 0 7 2 0 (Course completion) D D M M Y Y 3 1 1 2 2 0 Y Y 0 7 Y Y 1 2

(n) Column - 14 Write the full name and address of the college with email ID and phone number of principal.
Name of Student A J A Y S I N G H R A N A

Roll No.

E A T

3 I N S T I T U T E

Name of College A J M E R O F T E C H N O L O G Y

Full Address of college

P U S H K A J M E R

State Pin Code

R 3

A 0

J 5

A 0 0

S 0 1

T 4

Tel No. (with STD Code)

12 E-Mail ID College Website (o)


A

a l

i .

t _ a j c o M a i

m e t a

r j

@ r m e

e d r .

m a

w w w .

c o m

Column - 15 Write the regulatory body of your college.


I C T E

(p) Column 16. Furnish the particulars of your all children as per specimen given:Sl. No. 1 2. 3. 4. Name of Child Prakash Singh Rana Satish Singh Rana Ajay Singh Rana Komal Rana Gender M M M F Date of Birth 10/10/1982 12/05/1984 03/07/1987 14/02/1989 Age 28 Years 26 Years 23 Years 21 Years

(q) Column 17. Given details of the scholarship availed by your brother / sister in the past, if not availed write Not Applicable.
Sl. No. 1. Selection Serial No. given by KSB 6359 Name of the brother/sister Satish Singh Rana Course of Study B Tech Academic year in which applied 2007-08 Amount received so far 15000

Note: Application form from page number 13 to 18 alongwith required documents only to be forwarded.

CHECK LIST OF DOCUMENTS TO BE ATTACHED WITH THE APPLICATION FORM 1. Candidates / ESM / Ex-Coast Guard are to ensure that the following documents are attached (as applicable) along with the Application Form (non submission of these certificate will lead to rejection and application will be returned unactioned). (a) Extract of ESM / Ex-Coast Guard discharge book as per specimen.

13 (b) If child born after discharge then affidavit is to be submitted by ESM / Ex-Coast Guard, that child is dependent on him and he / she is a ward of ESM / Ex-Coast Guard. (c) (i) (ii) (iii) (iv) (v) Additional Certificates Attested copy of following documents. Category 1: Category 2: Category 3: Category 4: Category 5: Part II Order Part II Order Part II Order Part II Order Award Certificate alongwith gazette notification Equivalent of other services i.e. Army / Navy / Air Force / Coast Guard

(d) Attested photocopy of matriculation or equivalent examination certificate for verification of date of birth. (e) Attested photocopy of mark sheet of MEQ as applicable (e.g. 10 plus 2, graduation / diploma etc). In case the MEQ is graduation / diploma, then complete mark sheet is required to be submitted. (f) In case of MBA / MCA applicants, attested copy of minimum entry qualification certificate. i.e Graduation (g) Bonafide studentship certificate to be issued by Registrar / Dean / Principal of College / Institution pertaining to course for which scholarship is claimed (As per specimen attach).

Date: _____________________ _______________________________ Full Name & Signature of Candidate

Place: ____________________

_______________________________________ Checked / counter singed by ESM / Ex-Coast Guard / Widow

FOR OFFICIAL (KSB) USE ONLY Signature of Supervisor/ IC PMSS ___________________________ Remarks of Supervisor _______________________________ _______________________________

14 _______________________________ RECOMMENDED / NOT RECOMMENDED Remarks of JD PMSS _______________________________ Signature of JD PMSS ____________________ _______________________________ ______________________________

__________________________________________________________________________
(To be allotted by KSB)

Selection Serial Number ......................

APPLICATION FOR PRIME MINISTERS SCHOLARSHIP FOR THE YEAR 2011-12 ___. Recent Photograph Of Student
(Write your name & ESM/Ex-Coast Guard/widow particular on reverse)

Note:

1.) 2.) 3.) 4.)

Please read column wise guide lines carefully before filing the application Application Form to be filled in Capital letters except email ID. Checklist must be attached on the top of application duly tick marked. One candidate to submit only one application form for one course.

1.

NAME:First Name Middle Name Surname

2.

Put a tick mark ()

Male

Female

LEAVE BLANK SPACE BETWEEN WORDS


3. Date of Birth (please attach proof of age) (i.e : Matriculation certificate) DD MM Y Y Y Y

4. Your Rajya Sainik Board or Zila Sainik Board (Where ESM is registered and obtained Exservicemen Identity card) (Only for ESM)

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RSB

ZSB

5. Full Address: a) Present Correspondence Address: - (Where you want your letter to be sent in case of selection / rejection) House No. Street No. & Name

Tehsil District State

Pin Code b) Permanent Address:House No. Street No. & Name

LEAVE BLANK SPACE BETWEEN WORDS

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Tehsil District State

Pin Code

6.

Telephone Number. STD Code Land Line No. Mobile No.

E-Mail (mandatory)

7. Ex-servicemen / Ex-Coast Guard Category - (Mention category as per Para 6 of the brochure and attach supporting documents duly attested).

8.

Ex-servicemans / Ex-Coast Guards Particulars:a) Name of ex-serviceman / Ex-Coast Guard b) Service No. c) Rank d) Type of Service (Tick one) Army Air Force Navy Coast Guard

9. Details of MEQ / course for qualifying examination for scholarship (10+2/equivalent

or minimum entry qualification)


a. Name of Course/MEQ b. Year in which exam passed c. Total Marks (in words) (in figure)

LEAVE BLANK SPACE BETWEEN WORDS

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d. Marks obtained (in words)

(in figure) e. % of marks scored (in words) (in figure) 10. Whether the applicant is in receipt of any other financial assistance/scholarship/ fellowship from any govt. / Private source for the course to which the scholarship applied for. If yes, then state the amount and source Yes No Rs (per month / year)

11. Name of the Course


(as per specimen)

12. Duration of Course in Years


and months

in figure in words

13. Date of Commencement and Approximate Date of Completion.


D a) Course commenced on D b) Course completion date approximately D M M Y Y Y Y D M M Y Y Y Y

14. Details of College / Institute.


Name of Student Roll No. Name of College

Full Address of college

LEAVE BLANK SPACE BETWEEN WORDS

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State Pin Code Tel No. (with STD Code) E-Mail ID (if any) College Website

15. Regulatory bodies/ Council. (For example all engineering degrees and management degree courses are recognized by AICTE & UGC and all medical degree are recognized by Medical Council of India or Dental Council of India, specify as per case).

16. Furnish particulars of all children in order of age, as reflected in the discharge book or attached a certificate in case child born after discharge, by the RSB / ZSB / Record Office / Coast Guard Headquarter, as applicable.
Sl. No. Name of Child Gender Date of Birth

17. Details of brother/sister availing the PMs Scholarship, if any. (Including yourself if granted earlier) Sl. No. Selection Serial No. given by KSB Name of the brother/sister Course of Study Academic year in which applied Amount received so far

18.

Declaration: Certified that the particulars given by me in the application are correct and any false statement made by us will disqualify me / my ward for award of PMs Scholarship Scheme, besides recovery of scholarship already paid. I also undertake to abide by the conditions mentioned in the general instructions of the scheme. (Signature of ward) _____________________________ (Full Name of Ward) _____________________________

Place: Date:

Place: Date:

(Signature of Parent) ____________________________ (Full Name of Parent) ___________________________

19 CERTIFICATE FROM RSB / ZSB / DIRECTORATE GENERAL OF COAST GUARD

It is certified that PM Scholarship application form for academic year 2011-12 in respect of Mr. / Ms. __________________________________________________________ S/o / D/o Ex -____________________________________________________ has been checked, found correct as per check list provided by KSB and the applicant is eligible to apply as per rules of the scheme.

Office seal:

Secretary / Director RSB / ZSB / Coast Guard Headquarter

Place: ________________ Date : ________________

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CERTIFICATE FOR PM SCHOLARSHIP


1.

It is certified that Ms. / Mr._____________________ is Bonafide student of __________________________________ college. His / Her roll number is __________ and he / she is studying in the I / II / III / IV / V year or ______ semester of the One / Two / Three / Four / five years _______________ course in ____________________ branch (if any). He / she has joined this college in the academic year 20___ - ___ and the course will be completed in the month of ____________ 20___ -___. This is also certified that _____________ course is a professional degree course and this college is approved by ________________________________________________.

2.

3.

This is also certified that student is getting Rs._____________ per

month / year (If not getting write N/A) scholarship / stipend from this Institute / College or any other sources. Office Seal: Signature of Principal / Dean / Registrar

Date:- ______________ Place:-_____________

21 SPECIMEN COPY OF EX-SERVICEMEN / EX-COAST GUARD CERTIFICATE (This is important document, fill it carefully) (In lieu of Discharge Book) 1. Type of _______________________________________
Service (Army, Navy, Air Force or Coast Guard)

: : : : : : : : : :

2. Service No. _______________________________________ 3. Rank _______________________________________ 4. Name & Initials _______________________________________ 5. Trade _______________________________________ 6. Date of enrolment _______________________________________ 7. Date of Discharge _______________________________________ 8. Reason for Discharge _______________________________________ 9. Duration/Length of Service _______________________________________ 10. Regular / Reserve _______________________________________

11. ESM ID Card issued vide sl no RSB/ZSB/ dated... 12. ESM / Ex-coast Guard died on (if applicable) : _______________________________________ 13. Cause of death & : _______________________________________ Whether Attributable to military / coast guard service 14. Sl. No. 1. 2. 3. 4. Particulars of dependent children:Name Gender Date of Birth

22 5. 6. It is certified that the above information is duly checked from the discharge book of Exservicemen / Ex-Coast Guard and found to be correct. Office Seal: Dir RSB/ZSB/OI/C Record Office / Coast Guard Headquarter Date: ________________________ Place: ______________________

IMPORTANT INSTRUCTION FOR PAYMENT FORM

1.

Minimum Marks for Payment of Scholarship.

The candidates should have secured a minimum of 50% marks, uninterrupted for continuation of scholarship in every year for the duration of course up to a maximum period of 5 years as prescribed for that programme of study. A person granted scholarship for one programme would not be entitled for scholarship for another programme. * Note:If the marks in the qualifying examination are expressed in grades only, then equivalent percentage (100 point scale) duly certified by the concerned college / Board must be furnished (KSB will not be calculating the percentage of marks).

2.

Account Details.

All candidates to open individual bank accounts in the nearest State Bank of India branch or Punjab National Bank which has electronic clearance system / Core Banking, to facilitate transfer of the scholarship amount. Account number of the sister concern bank will not be accepted. i.e State Bank of Travancore, State Bank of Bikaner & Jaipur, etc. Candidate to attach a attested photocopy of passbook, showing name and account number of the individual. A cancelled leaflet of a blank crossed cheque will duly authenticate the account number. A joint account with parent will also fulfill the requirement. DOCUMENTS TO BE ATTACHED WITH PAYMENT FORM: (a) A Bonafide certificate from the College/Institute indicating that the candidate continues to study in the subject course and showing his / her percentage of marks for which the Prime Ministers Scholarship has been sought (As per the specimen attach). Photocopy of passbook showing name, account number with photograph of individual and cancelled leaflet cheque. (Scholarship will not be sent in absence of photocopy of passbook)

(b)

(c)

23 Candidate to attach a self addressed envelope, duly stamped to receive the acknowledgement of Payment form by post.

PRIME MINISTERS SCHOLARSHIP SCHEME ACKNOWLEDGEMENT SLIP


OFFICE COPY Your Payment form dated_________ has been received on__________. The

application will be examined for eligibility. The dak receipt number ____________ is to be mentioned for further correspondence with this office.

Office Seal:
Tear off

(Signature of RSB / Coast Guard Headquarter)


Tear off

ACKNOWLEDGEMENT SLIP
STUDENT COPY Your Payment form dated_________ has been received on__________. The

application will be examined for eligibility. The dak receipt number ____________ is to be mentioned for further correspondence with this office.

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Office Seal:

(Signature of RSB / Coast Guard Headquarter)

Note:

This copy duly stamped and signed by RSB / Coast Guard Headquarter is to be given to the student by hand or by post. Selection Serial Number......................

PAYMENT FORM FOR 1st, 2nd, 3rd and 4th YEAR SCHOLARSHIP UNDER PRIME MINISTERS SCHOLARSHIP SCHEME (To be send only if selected for scholarship) 1. Name of the applicant (Ward/widow):

2. Put a tick mark ()

Male

Female

3. Selection serial No. given by KSB:

4.

Particular of ESM / Ex-Coast Guard: Name of ESM /


Ex-Coast Guard

Rank
Service Number

5. Present address (where you want your letter is to be sent) (To be filled up only in case of change from previous address or write N / A)
House No. Street No. & Name Tehsil & Post Distt State Pin Code

6. Details of Bank account of SBI or PNB for Electronic Clearing Services ( (PLEASE ATTACH A
PHOTOCOPY OF PASS BOOK, CROSSED BLANK CHEQUE SHOWING YOUR ACCOUNT NUMBER TO BE FORWARDED, EVEN IT IS SUBMITTED EARLIER).

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Name of account holder

Bank Name

LEAVE BLANK SPACE BETWEEN WORDS


Branch Name Branch Address

State Bank Tel. No. Branch Code

MICR (9 digit) No.


(PLEASE ATTACH A PHOTOCOPY OF CHEQUE & PASS BOOK)

Account No. REPEAT Account No.

Place:_____________________ Date:______________________

________________________________ Full Name & Signature of the ward / widow

It is certify that the information submitted by my child / self is correct.

Place :_____________________

_____________________________

26 Date :_____________________ Parent Full Name & Signature of the

LEAVE BLANK SPACE BETWEEN WORDS

Please Fill Properly Your Full Year (Both Semesters) Marks

1.

It is certified that Ms. / Mr._____________________ is a Bonafide student

of __________________________________ college. He / she is studying in the I / II / III / IV / V year of the two / three / four / five years _______________ course. He / she had joined this college in the academic year 20___ - ___ and the course will be completed in the month of ____________ 20___ - ___. 2. This is also certified that Ms. / Mr. ___________________________

__________ has successfully completed his / her 1st / 2nd / 3rd / 4th / 5th year and scored Year Marks Obtained Out of ______ ______ ______ ______ Percentage

1st Year (1st & 2nd sem) ____________ 2nd Year (3rd & 4th sem) ____________ 3rd Year (5th & 6th sem) ____________ 4th Year (7th & 8th sem) ____________ 5th Year (9th and 10th sem) ____________

_________ _________ _________ _________ _________

______

3. He / she is continuing the course in 2nd / 3rd / 4th / 5th year.


4. This is also certified that student is getting Rs _____ per month / year (If not

27

getting write N/A) scholarship / stipend from this Institute / College or any other sources. 5. His / Her renewal of scholarship is hereby recommended. His / her account no. is ___________________________________ Office Seal: Signature of Principal / Dean / Registrar Date: ________________ Place: _______________ ADDRESS OF DEPTT OF SAINIK WALFARE / RAJYA SAINIK BOARDS & DIRECTORATE GENERAL OF COAST GUARD
Sl No ANDAMAN & NICOBAR ISLANDS (UT) Address of RSB Secretary Rajya Sainik Board A & N Administration, Secretariat Port Blair - 744 101 Director Deptt of Sainik Welfare Block IV, II Floor, Gruhakalpa Premises, MJ Road, Nampally, Hyderabad - 500 001 For Detail, Pl contact RSB Port Blair03192-235621 (O) 03192-235621(F) secretaryrsbandnic@gmail.com Hyderabad 040-24736890 (F) 040-24747991 (O) apsainik@gmail.com Itanagar0360-2212282 (O) 0360-2212282 (F) 0360-2213615 (F) rsbaruna@gmail.com Guwahati4 ASSAM Director Dte of Sainik Welfare, Sainik Bhavan, House No-74, Lachit Nagar, Guwahati - 781 007 0361-2522229 (O) 0361-2522229 (F) rsbassam@gmail.com Patna Director Sainik Kalyan Nideshalaya 0612-2217301 (O) 0612-2217301 (F)

ANDHRA PRADESH

ARUNACHAL PRADESH

Director Dte of Relief, Rehabilitation & Settlement, Govt of Arunachal Pradesh, New Itanagar-791110

BIHAR

28 Home Deptt, Old Secretariat Barrack No.10, Patna 800015 directorsknbihar@gmail.com Chandigarh Zila Sainik Welfare Officer 6 CHANDIGARH (UT) 0172-2701947 (O) Zila Sainik Welfare Office (UT) 0172-2700317 (O) Opposite Aroma Hotel, Sector-21- 0172-2726325 (F) D, Chandigarh - 160 022 zsw_chd@yahoo.com Raipur Director Deptt of Sainik Welfare, CG 0771-2445165 (O) Near Collectorate Parisar, Behind 0771-2427449 (O) Home Guard Office 0771-2420084 (F) Raipur - 492 001 dirsw.cg@gmail.com DelhiSecretary Rajya Sainik Board 011-23991876 (F) Opp Tis Hazari Court 011-23969260 (O) No.1, Rajpur Road, Delhi-110 054 rsbdelhi@nic.in Panaji Secretary Deptt of Sainik Welfare Collectorate Building Panaji - 403 001 0832-2227138 (O) 0832-2227138 (F) secyrsbgoa@gmail.com Gandhinagar Director Directorate Sainik Welfare & Resettlement, Gujrat State Gaurav Senani Bhavan, Shahibaug-Airport Road, Shahibag, Ahmedabad-380001 Secretary Rajya Sainik Board Sainik Bhawan, Sector 12, Shaheed Capt Rohit Kaushal Marg, Panchkula - 134 109 Director Deptt of Sainik Welfare Govt of Himachal Pradesh Hamirpur - 177 001 079-22868347 (O) 079-22868348 (O) 079-22868346 (F) dir_sw@gujarat.gov.in rsb_guj@rediffmail.com Panchkula 0172-2560462 (O) 0172-2560462 (F)) sainikparivar@yahoo.com Hamirpur01972-221854 (O) 01972-224659 (O) 01972-225643 (F) dir_sw_hp@nic.in

CHHATTISGARH

DELHI

GOA

10

GUJARAT

11

HARYANA

12

HIMACHAL PRADESH

29 Jammu 13 JAMMU AND KASHMIR Director Deptt of Sainik Welfare Ambphalla, Jammu - 180005 0191-2561547 (O) 0191-2575362 (F) jkrsbsecy@yahoo.in Ranchi14 JHARKHAND Director Sainik Kalyan Nideshalaya Ranchi (Jharkhand) Director Deptt of Sainik Welfare & Resettlement, Fd Mshl KM Cariappa, Bhavan, No 58, Fd Mshl KM Cariappa Road, Bangalore - 560 025 Director Deptt of Sainik Welfare Vikas Bhavan, Thiruvananthapuram - 695 033 Director Deptt of Sainik Welfare Southern Shopping Centre Guru Teg Bahadur Complex, TT Nagar, New Market, P.B.NO 364, Bhopal - 462 003 Director Deptt of Sainik Welfare Maharashtra State Raigad, Opp National War Memorial, Solapur Road, Ghorpadi, Pune-411 001 0651-2330178 (O) 0651-2331434 (F) jharkhand_skn@yahoo.in Bangalore080-25589459 (O) 080-25589459 (F) dirdswrblr@gmail.com Thiruvananthapuram 0471-2304980 (O) 0471-2304980 (F) directordswkerala@yahoo.com Bhopal0755-2553992 (O) 0755-2577209 (F)

15

KARNATAKA

16

KERALA

17

MADHYA PRADESH

dswoffice@mp.gov.in Pune020-26332763 (O) 020-26332764 (O) 020-26334427 (O) mahasainik@dataone.in dsw@mahasainik.com

18

MAHARASHTRA

19

MANIPUR

Secretary Rajya Sainik Board ImphalSainik Rest House Opp. Lamphel Police Station, PO- 0385-2416228 (O) Lamphel, Imphal-795004 Director Dte of Sainik Welfare Public Service Commission Building Beyond DC Building Shillong - 793 001 Shillong0364-2225613 (O) 0364-2225613 (F) rsbmegha@rediff.com

20

MEGHALAYA

30 Aizawl21 MIZORAM Director Deptt of Sainik Welfare & Res, Tuikual A, PB No. 119 Aizawl - 796 001 0389-2322732 (O) 0389-2322732 (F) rsbmizoram@yahoo.in Kohima22 NAGALAND Secretary Rajya Sainik Board, Home Deptt, Home Br, Nagaland Civil Sectt., Kohima - 797 001 0370-2270029 (O) 0370-2270029 (F) secyrsb-ngl@nic.in Bhubaneshwar 23 ORISSA Secretary Rajya Sainik Board, Nageswar Tangi, Lewis Road, Bhubaneshwar-751002 0674-2432268 (O) 0674-2435998 (F) secyrsbors@rediffmail.com secyrsbbbsr@gmail.com Puducherry

24

PUDUCHERRY (UT)

Director Deptt of Sainik Welfare 0413-2253107 (O) Jawan Bhavan Complex, Lawspet 0413-2250575 (F) Main Road, Pakkamudayanpet, Puducherry - 605 008 dswpuducherry@gmail.com Chandigarh Director Dte of Sainik Welfare, Punjab Punjab Sainik Bhawan, Sector 21-D, Chandigarh - 160 022 0172-2701845 (O) 0172-2707345 (F) 0172-2706014 (F) dswpb@rediffmail.com ddhq@rediffmail.com ddmpb@rediffmail.com Jaipur0141-2227897 (O) 0141-2227650 (F) rajasthansainik@yahoo.com Gangtok-

25

PUNJAB

26

RAJASTHAN

Nideshak Sainik Kalyan Vibhag Secretariat Building, North Block, Jaipur - 302 005

27

SIKKIM

Secretary Rajya Sainik Board, Sikkim Paljor Stadium Road, Gangtok-737 101

03592-202534 (O) 03592-221456 (O) 03592-221456 (F) rsbsikkim@ymail.com

31 Chennai28 TAMIL NADU Joint Director Dte of Ex-Servicemens Welfare 22, Raja Muthiah Salai, Choolai Chennai - 600 003 044-26691747 (O) 044-26691886 (O) 044-26691886 (F) exweldte@tn.gov.in Agartala 29 TRIPURA Secretary Rajya Sainik Board, Nehru Office Complex, Gorkhabasti, P.O. Kunjaban, Agartala - 799 006 West Tripura 0381-2326507 (O) 0381-2326507 (F) rsb_sainikboard@rediffmail.com rsb.tripura@gmail.com Lucknow0522-2625354 (O) 0522-2625354 (F) 0522-2305107 (F) directorsainikkalyan@yahoo.com Dehradun31 UTTARAKHAND Director 0135-2744208 (O) Sainik Kalyan Evam Punarvas 0135-2743773 (F) Uttarakhand, 15C, Kalidaas Marg, 0135-2741481 (O) PO-Haathibadkala, Dehradun - 248121 dskddn@gmail.com KolkataSecretary Rajya Sainik Board, Block 'I' (First Floor), Writers Building Kolkata - 700 001 033-22141347 (O) 033-22144643 (F) 033-22143220 (O) rsbkolkata@yahoo.com rajyasainikboardwestbengal@gmail.c om

30

UTTAR PRADESH

Director Dte of Sainik Kalyan Evam Punarvas, Kariappa Bhawan, Kaiserbagh, Lucknow - 226 001

32

WEST BENGAL

FOR EX-INDIAN COAST GUARDS ONLY

01

COAST GUARD

Directorate General of Coast Guard Headquarter National Stadium Complex New Delhi-110001

011-23074132 (O) 011-23386766 (F)

Note:

32 Dadar Nagar Haveli: Daman & Div Lakshadweep: ESM of this state can submit their Prime Minister Application form to Kerala RSB. ESM of these states can submit their Prime Minister Application form to Gujrat RSB.