FOR ACADEMIC SESSION : ______________________ APPLICATION WHERE THE CHILD IS A BORDER: Certified that ___________________________________________ (Name of student) S/o, D/o Shri _________________________________ is a bonafied regular student of Class _____________ of this college during the year (current academic session) from_____________ and finishes on_____________ (next year). 2. Shri/Miss______________________________________S/o, D/o Shri ________________________________ joined Class ___________ on _________ During the academic session_______________________. 3. Certified that he/she is a Boarder student. 4. Certified that the Boarding House / Hostel ___________________ _____________________________________ in which the child i.e. Shri/Miss _____________________________ S/o, D/o Shri __________________ student of Class ____________during session ________________ which starts from ______________ and finishes on _______staying/residing is being run by _____________________ _________________________________________________________. 5. Certified that the Hostel in which the child is residing is run by the same Institution in which he/she is studying as bonafide student of Class ________________________________________(Name of class). 6. The following charges are being paid by the child (student):- a) Boarding charges of Rs.________________________ is being paid from _______________ to ______________. b) Lodging charges of Rs. ______________ is being paid from____________to __________________. c) Tuition fees of Rs.___________________ is being paid from_________________ to _________________. d) Book & Stationery, Sports & Science fee Medical cover. Rs._______________________________. 7. Is the student getting scholarship/stipend/subsidy/hostel subsidy? If yes then how much Rs.____________________________________ 8. Certified that the Institution/College in which the child studying is recognised by Govt./ State Govt.____________________________. 9. Certified that above information is correct. Dated___________ Signature of the Head of Place___________ Institutions with office stamp. 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 _____________ reimbursable. 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________________________
