APPLICATION FORM FOR SCHOLARSHIP FROM Rehabilitation & Welfare Section Adjutant General's Branch Army HQ, DHQ Post New Delhi - 110011. PASS PORT SIZE PHOTOGRAPH OF THE CHILD (Attested by ZSB/School/College Principal/Maj & Above) APPLICATION FORM FOR EDUCATION SCHOLARSHIP SCHEME FOR THE ACADEMIC YEAR Note: PLEASEDO NOT LEAVE ANY INFORMATION BLANK, Under Secretary BLOCK LETERS. PART-I Personal Particulars of father (a) Army Number (b) Rank (Retired/Serving) (d) Arm / Service (f) Date of Casualty (g) Date of Invalidment (h) Name and Address of Present Guardian:-Name of NOK (e) Name of Operation in which killed / disabled (Attach supporting documents Percentage disability % (Date) (Month) (Year) (Date) (Month) (Year) Vill Post Office Tehsil District State PIN Telephone Number (i) Pension Payment Order No. (Attach copy duly attested) dt (k) Discharge Book (Attach copy duly attested) PART - II 2. Particulars of the Child (b) Sex -Male / Female (c) Relationship (Attach supporting documents) (d) Date of Birth - (g) In case of undergraduate and above specify stream: BA/BSc/B Com/ BE/B Tech/MBBS/MBA/MCA/Any Other PLEASE STRIKE OUT WHICHEVER IS NOT APPLICABLE (h) Has the application of brother/sister has also been forwarded? - Yes/No (i) If 'YES' specify Name (b) Name of Bank (c) Place (d) Pin (e) Class Passed Mark (Attach copy of marks s (%) sheet) (f) Date of completion of the academic session (j) Is the child in receipt of financial assistance for education from any source? If Yes give details. (k) School studying in - KV/Govt/Private/Other/Not applicable. 4. Bankers Details (a) Type of Account Number Certified that I have not applied/received any other education scholarship from Central/State Govt, Kendriya Sainik Board,/RSB, Army or any other source for the said applicant. Date (Name and Signature of the soldier/NOK) (To be filled by the ZSB/Kendriya Sainik Board/Record Office) Certified that Miss/Master ------------------------------------------- Son / daughter of --------------------------------------------------is recorded in his Record of Service and that his / her date of birth is ----------------------. Station: Date : (Signature of Secretary ZSB/OIC Records/OC Unit) CERTIFICATE FROM SCHOOL Certified that Miss/Master ----------------------------------- Son/daughter of----------------is a bonafied student of -------------------- Class/course in this institute. Aggregate percentage of marks obtained by the student in Class ---------------- are --------------The total fees including hostel charges (if any) for the current sessions is Rs.------(Rupees ------------------------------------------------------------------------------------ only). Station: Date: (Signature of Principal)
