8/6/2019 Pre Matric Scholarship Form

1/2

PRE MATRIC SCHOLARSHIP FORMCentral Govt. Stipend for Bihar State Minorities Student

NEW For the Year RENEWAL

FOR OFFICE USE ONLY

DISTRICTDISTRICTDISTRICTDISTRICT SL. NO.SL. NO.SL. NO.SL. NO. CLASSCLASSCLASSCLASS PERCENTAGEPERCENTAGEPERCENTAGEPERCENTAGE APPROVEDAPPROVEDAPPROVEDAPPROVED

YESYESYESYES NONONONO

(PLEASE FILL THE FORM IN BLOCK LETTERS)

Students Name

Fathers/ Mothers Name

Residential Address Vill. / Mohalla

Block / P. S.

DISTRICT PIN

Contact No. Religion

Male / Female Age Date of Birth - -

Present Class Roll No.

Annual Incomeof the parent

Note :- Certificate issued by local Mukhiya / Ward Commissioner / C.O. / Affidavit

of Parents or Guardian / Certificate of employers (in case of serviceman)

Details of Last Passed Examination (enclosed attested copy of Marksheet)

Name of the Examination Name of the Board/Class Year of PassingMarks

Obtained% of Marks

Hosteller / Day Scholar

Name & Address of theHostel / RentedAccommodation

PIN Contact No.Name & Address of the Present Institute / School

DISTRICT STATE

Contact No. PIN

Institute / School Recognized by

Status of the Institution PRIVATE GOVT.

Annual Fee Payable to Institute / School Rs.

Student Bank Name & A/c No. -

School Bank Name & A/c No. -

I hereby declare that the information given above is correct.

Signature of the Parent Signature of the Student

Certified that the information given above is correct. The applicant is a bonafied student of this

School/Institute and is a day Scholar / Hosteller as per above. Student is not availing any other scholarship for

this purpose from any other source.

Date :- .. Signature of the Head of the School / Institution

With Office Seal

8/6/2019 Pre Matric Scholarship Form

2/2

FORMAT OF RESIDENCEFORMAT OF RESIDENCEFORMAT OF RESIDENCEFORMAT OF RESIDENCE----CUMCUMCUMCUM----INCOMEINCOMEINCOMEINCOME CERTIFICATECERTIFICATECERTIFICATECERTIFICATE

(Instead of affidavit, certificate issued by 1. Local Mukhiya 2. Ward Commissioner 3. Circle Officer of the

block can be given.)

This is to certify that Shri / Smt. .......

. Father / Guardian of Shri / Smt.

........................ is a Permanent resident of ... He

/ She is known to me. His / Her annual family income is Rs . (Rupees

.

only).

Signature of the Parent / Guardian

Document enclosed with the applicationDocument enclosed with the applicationDocument enclosed with the applicationDocument enclosed with the application

Attested copies of Mark Sheet of last passed examination.

Permanent Residential Certificate issued by Mukhiya / Ward Commissioner / BDO / CO. Income Certificate issued by Mukhiya / Ward Commissioner / BDO / CO.

Religion Certificate (Except Muslim).

To be submittedTo be submittedTo be submittedTo be submitted through Registerthrough Registerthrough Registerthrough Registered / Speed Posted / Speed Posted / Speed Posted / Speed Post / in the BOX kept in BSSWB/ in the BOX kept in BSSWB/ in the BOX kept in BSSWB/ in the BOX kept in BSSWB ::::----

Address :Address :Address :Address :----

Bihar State Shia Wakf Board

2nd

Floor, Haj Bhawan, 34, Harding Road (Ali Imam Path),

Patna - 800001