J&K STATE WOMEN'S DEVELOPMENT CORPORATION LTD. 615-A, Gandi Nagar, Jammu/Old Secretariat Srinagar APPLICATION FORM FOR EDUCATIONAL LOAN FOR Female Candidate belonging to the families with yearly income upto Rs. 1.00 Lakh Regd. NO. ________________ PART-A 1. Particulars of Student a. Full Name (in Capital Letters) ___________________________________________________ b. Date of Birth ________________________________________________________________ c. Place of Birth ________________________________________________________________ d. Full Address i) Present _____________________________________________ ___________________________________________________ ___________________________________________________ ii) Permanent __________________________________________ ___________________________________________________ ___________________________________________________ JKWDC.CO M e. Present Educational Qualification ________________________________________________ f. Name of the Institution/University _______________________________________________ g. Last attended 2. Particulars of Parent/Guardian: a. Full Name (In Capital Letters) ___________________________________________________ b. Full Address i) Present _____________________________________________ ___________________________________________________ ___________________________________________________ ii) Permanent __________________________________________ ___________________________________________________ ___________________________________________________ c. Phone No ___________________________________________________ d. Age ___________________________________________________ 3. If in Service a. Designation ___________________________________________________ b. Office Address ___________________________________________________ c. Total emoluments (yearly) ___________________________________________________ with date of superannuation ___________________________________________________ d. Certified by Employer ___________________________________________________ In case of any other Profession/ Independent private service. a. Total monthly income ___________________________________________________ b. Total yearly income/wages ___________________________________________________ c. Certified by affidavit from Parent/Guardian JKWDC.CO M 4. Particulars of Course Admitted to: a. Name of Course _________________________________________________________ b. Duration of Course _________________________________________________________ c. Name of the Institution_________________________________________________________ (Only Govt. or Govt. Recognised) d. Date of commencement of Course ________________________________________________ e. Date of Completion of Course ___________________________________________________ f. Total expenses of the Course ____________________________________________________ 5. Any other useful information Sig. of Applicant PART - B Certificate from Parent/Guardian Please sanction the aforesaid amount of Loan in favour of my daughter Ms. _______________________________________. I certify that to the best of my knowledge and belief, the information furnished here in above is true and correct. I undertake to abide by the terms and conditions governing the Loan facility. Signatures of Witness. Signature of Parent/Guardian Name ________________________ Address _______________________ ______________________________ ______________________________ Signature of Applicant JKWDC.CO M PART - C Certificate from Principal/H.O. Institute I __________________________________________________________________________ Principal/H.O. _____________________________________________________ Institute certify that M/s _____________________________________ D/o, W/o ________________________________ R/o _______________________________________________________________________ has been selected for __________________________________________________________ Course in our Institute/Organisation which is a Govt./Govt. Recognized Institute. Signature of Principal/H.O. Institute with Seal JKWDC.CO M (Affidavit on Rs. 5/- Stamp Paper with Rs. 10/- Adhesive Stamp Paper duly notarized) SPECIMEN OF THE AFFIDAVIT TO BE SWORN/AFFIRMMED BY THE APPLICANT BEFORE THE COMPETENT AUTHORITY AFFIDAVIT I ___________________________________ D/o, W/o ________________________________ R/o _ ____________________________________________________________________________ hereby solemnly affirms and declares as under:- 1. That I am a permanent resident of Jammu and Kashmir State residing __________________ from the last _____________________________ years. 2. That I belong to ___________________ Muslim/Sikh/Buddhist/Christian/Zoroastrian Community. 3. That my family income per annum is Rs _________________________________ from all Sources. 4. That I have not drawn loan/financial assistance under any scheme of the state Govt. or Bank, Corporation of Financial Institution or Central Government and I am also not indebted to any Bank or Financial Institute for Education Loan. 5. Neither me nor any member of my family is in the Govt. Service and am also not indebted to any Bank of Financial Institute. 6. That I shall utilize the loan only for the purpose to which it will be given to me by J&K State Women's Development Corporation. In case of any deviation/default, I shall be liable to immediately repay to the corporation the full amount of loan granted to me with the amount of interested penalty as applicable. 7. I undertake to abide by all terms and conditions as or will be laid down by J&K State Women's Development Corporation from time to time. Deponent Verified this day of ________________________________________________ that the above averments made in the affidavit are correct ant true to my knowledge and belief and nothing has been concealed thereon. Deponent Date: ______________________ Place: _____________________ JKWDC.CO M
