FOR ACADEMIC SESSION : ______________________ APPLICATION WHERE THE CHILD IS A DAY SCHOLAR: Certified that _______________________________________________ (Name of student) S/o, D/o Shri __________________________________ is a bonafied regular student of Class ____________________________________ (Class to be indicated in figures as well as in words) of this School/College ________________________________________________________________ (Name of the Institutions with complete postal address) during the year i.e. Academic Session ________________________________________(Academic Session to be indicated in words and figure) which starts from _________(date) and finishes on _____________(date). 2. Shri/Miss ______________________________________S/O, D/O Shri ________________________________ joined Class ___________ (Name of class) on ______________ (exact date on which student joined in class) during _______________(Session). 3. The following charges being paid by the student:- a) Tuition fee Rs.___________ per year from ________________(date) to _______________(date). b) Any other charges Rs._____________ per year from ____________(date) to_____________(date). 4. Is the student getting any scholarship/stipend? Is the student is getting MERIT scholarship the same may please be indicated separately. a) Scholarship as a help Rs. ________________________________ _____________________________________________________ (State the amount in figures and in words). b) Scholarship on the basis of merit Rs.________________ (Rupees_________________________________________). 5. Certified that the School/Institution is recognised by the State/Central Govt. 6. Certified that the above information is correct and as per records of this School/Institution. Date : Signature of the Place : Head of the School/Institution. NOTE: Certificate must be signed by Head of Institution Headmaster / Headmistress / Principal. ANNEXURE - 'B' UNIT________________________________________________ S.No. Name in block letter and age of student Father's name in block letters, Basic Pay, Name of Unit and place of posting in SSB. Name & place of Institution in which the student is studying Standard of class in which the child is receiving education. Total fees required to be paid during academic session Tuition fee Boarding Mess charges Lodging (room rent charges) 1 2 3 4 5 6 7 8 Total amount of scholarship to be received from Govt./Private agencies during the academic session. Total amount of children Edn. All /subsidy received during academic session. Percentage of marks obtained during 3 years Class Whether fail or passed Indicate name of unit from which transferred in present unit. Year Name of Board Percentage of marks obtained 9 10 11 12 13 14 15 16 Signature of the applicant Countersigned (With name in block letters) Signature of the controlling officer. APPENDIX - 'C' 1. Certified that the child for whom I have applied for financial assistance for the academic session_________________ is neither married, not an earning hand and is below 24 years of age. 2. Certified that I have _________ children and that through this application I have claimed for the grant of financial assistance for the education of my first/second/third/fourth in order of age. 3. Certified that I am not eligible to draw the children education allowance/subsidy/hostel subsidy for the child for whom I have applied for grant of financial assistance for session_____________________ for the following reasons:- 4. In case the applicant is eligible to get children education allowance/subsidy/hostel subsidy/scholarship in respect of the child for whom he has applied for grant of financial assistance the amount of children education allowance subsidy/hostel subsidy to which he is entitled from Govt. fund should be indicated as below:- S.No. Description Rate per month admissible 1. Children Education 2. Allowance 3. Subsidy 4. Hostel subsidy 5. Scholarship (Other then merit Scholarship) from State/Central Govt. In case the incumbent is not eligible to receive the children education allowance but is eligible to claim re-imbursement of tuition fee from the Govt. fund in respect of the child for whom he has applied for scholarship, then the following information must be furnished. a) Amount of tuition fee reimbursable per month. b) Date from_______________ to _____________re-imburseable. c) Certified that my child is not paying tuition fee. Reasons for not paying the tuition fee may also be indicated i.e. whether because of being scheduled caste/scheduled tribe or due to some other reasons. In case the child has been granted freeship. What he would have paid as tuition fee had be not been granted freeship (indicate the amount per month). Certified that I am claiming for one child. Certified that I ________________________________ undertake to inform the Unit/Education Committee in case my ward leaves the studies/hostel in the middle of the session. Certified that the above information is correct to the best of my knowledge and belief. Signature______________________ Name in block letters_________________ Designation_____________________ Unit/Directorate________________________
