Pocket Money
CENTRAL SECTOR SCHEME OF SCHOLARSHIP FOR COLLEGE AND UNIVERSITY STUDENTS DATA SHEET 1. Name of the Candidate (in Block letters, as per XII Certificate)
2. Date of Birth (DD/MM/YY)
(as per X certificate)
3. Sex: Male OBC General
Female
4. Category: SC
ST
5. Physically Handicapped: Yes
No
5. Details of Father/Guardian/Husband (as the case may be) a. Name
b. Permanent Address Pin: c. Profession/ Designation with address Pin: 6. Details for Communication: a. Address for Correspondence Pin: b. Telephone with STD code c. Mobile No.
d. Email ID:
7. Whether father / guardian is a citizen of India: Yes No 8. Total annual income of both parents/guardian or husband’s income in case of married unemployed girl student (in Rupees). An income affidavit as per Annexure – III should be attached in support.
9. Particulars of School/Institution last attended Class XII (as per the school Transfer Certificate) a. Name of school / Institution
b. Date of entry (DD/MM/YY)
c. Date of leaving (DD/MM/YY)
d. Remarks, if any (if this space is not sufficient separate sheet may be attached.)
10. Details of Class XII Examination passed by the candidate: a. Name of the Examination passed: Higher Secondary Course Certificate Examination b. Register Number: c: Year of Passing: March 2012 State Board of School Examinations, Tamil Nadu, Chennai – 600 006
d. Name of the Board which conducted the examination passed by the candidate together with its headquarters. e. Total aggregate marks obtained in the examination: f. Percentage of marks obtained in aggregate 11. Is the candidate in receipt of any other scholarship from State Government or other institution or person (If yes, particulars should be given including the monthly rate and date from which the scholarship is drawn) 12. Particulars of Savings Bank Account of the Candidate: a. Account Number b. Name and Address of the Bank:
C A N A R A B A N K
/
. Yes % No
1
2
0
0
PIN
c.
2. Date of Birth (DD/MM/YY)
(as per X certificate)
3. Sex: Male OBC General
Female
4. Category: SC
ST
5. Physically Handicapped: Yes
No
5. Details of Father/Guardian/Husband (as the case may be) a. Name
b. Permanent Address Pin: c. Profession/ Designation with address Pin: 6. Details for Communication: a. Address for Correspondence Pin: b. Telephone with STD code c. Mobile No.
d. Email ID:
7. Whether father / guardian is a citizen of India: Yes No 8. Total annual income of both parents/guardian or husband’s income in case of married unemployed girl student (in Rupees). An income affidavit as per Annexure – III should be attached in support.
9. Particulars of School/Institution last attended Class XII (as per the school Transfer Certificate) a. Name of school / Institution
b. Date of entry (DD/MM/YY)
c. Date of leaving (DD/MM/YY)
d. Remarks, if any (if this space is not sufficient separate sheet may be attached.)
10. Details of Class XII Examination passed by the candidate: a. Name of the Examination passed: Higher Secondary Course Certificate Examination b. Register Number: c: Year of Passing: March 2012 State Board of School Examinations, Tamil Nadu, Chennai – 600 006
d. Name of the Board which conducted the examination passed by the candidate together with its headquarters. e. Total aggregate marks obtained in the examination: f. Percentage of marks obtained in aggregate 11. Is the candidate in receipt of any other scholarship from State Government or other institution or person (If yes, particulars should be given including the monthly rate and date from which the scholarship is drawn) 12. Particulars of Savings Bank Account of the Candidate: a. Account Number b. Name and Address of the Bank:
C A N A R A B A N K
/
. Yes % No
1
2
0
0
PIN
c.