Indiabulls foundation scholarship (2015-2016) application form for new students



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INDIABULLS FOUNDATION SCHOLARSHIP (2015-2016)

APPLICATION FORM FOR NEW STUDENTS


*Recent passport size photo of the candidate




Name of student:- _______________________ __________________________ _______________________

(First Name) (Middle Name) (Last name)
Course:-_____________________________________________________________________________________
Name of Institute/ University:- __________________________________________________________
Whether approved?_____________________Sign_________________(for IBF office use only)



Note:

Institute/Indiabulls Foundation.

  • Incomplete applications will not be accepted.

  • All the documents should be attested & self attested by the candidate

  • The following supporting documents must be submitted along with the application form:




  1. Photo identity proof of applicant (Aadhar card/ Voter I – card/PAN card/Driving license etc.)

and College Identity Card

  1. Photo identity proof of applicant Parent’s/legal guardian(Aadhar card/ Voter I – card/PAN card/

Driving license etc.)

  1. Residential proof of applicant’s Parent’s/legal guardian(Ration card, Telephone bill, Electricity

bill etc.)

  1. Proof of gross family income per month (Income certificate/latest IT returns/Form 16/latest

Salary Slip/Letter from employer)

  1. Attested copies of all mark sheets and certificates in support of your educational qualifications

  2. Attested copies of MT-CET/AIEEE/IIT-JEE or other score cards as per the students course

preference

  1. College prospectus as a proof of course fees/college fees structure for current academic year

  2. Proof/ receipt of admission-Post Admission Process

  3. Post admission process: Duly sealed & signed Declaration by the Head of Institute/University

(Pg 5)

Details of Fees (For IBF office use only)
Complete fees except for the refundable fees for the current semester / year

Rupees in Figures___________________________________________________________________________________________________

Rupees in Words___________________________________________________________________________________________________

Name of the institute/student (whichever is applicable) on which the demand draft is to be issued:

________________________________________________________________________________________________________________________

________________________________________________________________________________________________________________________


Personal Information
Full Name: ­­­­­­­­­­___________________________________ ___________________________________ ____________________________________

(First Name) (Middle Name) (Last Name)

Date of Birth: _______________________________________________ Sex: __________________________ (Male/Female)

Marital Status :___________________________________________________________( Married / Unmarried/ Divorce)

Father’s Name: _______________________Occupation _______________________ Mobile No_____________________________

Mother’s Name: ______________________Occupation ________________________ Mobile No____________________________

Husband’s Name: ______________________Occupation _______________________ Mobile No____________________________

BPL Card No ________________ Date of Issue__________________ Issuing Authority__________________ [If Applicable]

Correspondence Address___________________________________________________________________________________________

________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Permanent Address (if different from Correspondence Address) ________________________________________________________________________________________________________________________

_______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Tel No (with STD Code) ____________________________________________________________________________________________

Mobile No: ___________________________________________________________________________________________________________

E-mail Address ______________________________________________________________________________________________________

References: College Professor: Name ____________________________________ Contact no___________________________

Father’s Employer: Name__________________________________________________ Contact no___________________________

Mother’s Employer: Name__________________________________________________ Contact no___________________________

Employer of Self: Name_____________________________________________________ Contact no___________________________




Academic Details (CURRENT)
Name of Course______________________________________________________________________________________________________

Specialization / Discipline /Branch_______________________________________________________________________________

Duration of the Course _________________ (Semester –wise / year wise) _________________________________________

Currently which semester/year ___________________________________________________________________________________

Name of Institute ___________________________________________________________________________________________________

Address of Institute _________________________________________________________________________________________________

Contact Person / College Authority __________________________________ Contact No._______________________________

Admission details: Date of admission ___________________ current semester/ year of study ____________________

Student I Card No / Roll No. _______________________________________________________________________________________

Received any subsidy or concession on tuition fees: YES ( ) NO( ) which one___________________________



Academic Details (Previous):

Please provide the academic qualification in reverse chronological order, starting from latest:



Certification/

Degree

Subjects/ Specialization


Board/ University

Year of passing


Overall %(convert CGPA into % as per AICTE norms)

Rank/ Grade


































































* For students who appeared for MT-CET/AIEEE/IIT-JEE

Please provide the rank in the qualifying entrance examination for course in which you are enrolled

Examination Name ___________________Conducted by __________________ Rank __________Marks (in %)____________


DECLARATION BY THE STUDENT
I _________________________________ hereby declare that the information provided above and in the enclosed documents are true and correct to the best of my knowledge. If any of the information furnished above is found to be incorrect at any stage, my application for the scholarship is liable to be cancelled. I agree that to be able to continuously receive IBF scholarship till the completion of my course I need to score minimum 50% in all exams of the said course. I also understand that Indiabulls Foundation or any company or subsidiary of Indiabulls Group is not liable to provide me any kind of employment anywhere after the completion of this course. I cannot receive any other scholarship from any other source. If known, the scholarship will be immediately revoked and cancelled. Indiabulls Foundation will not be liable if the Demand Draft that is issued is misplaced or lost by me. Indiabulls Foundation holds the right for Legal Action against me if found the scholarship is misused. I take the entire responsibility to refund the money to Indiabulls Foundation in case I withdraw from the course during the academic session or change the institute/college.

Signature: ____________________________(Student)

Date: _________________ Place: ____________________
Signature of Father/Mother/Husband/Guardian___________________

Date: ________________Place: _______________________








For University/Institute use Only (Post Admission Process)


DECLARATION BY THE HEAD OF INSTITUTE
I solemnly declare that the Institute / College __________________________________________ is a deemed

University/under _______________________________________________University duly recognized by Central

Govt. /State Govt. or fully owned by Central/State Govt._________________________________Departments.

I also declare that the above information furnished by the candidate Mr./Ms. _____________________________

who is studying in (course and Discipline) ____________________________________________________________________

(semester / year) __________ is true and correct in all respect to the best of my knowledge and available

office records. I therefore, recommend his/her candidature for the Indiabulls Foundation Scholarship

as the student belongs to an economically challenged category.


Signature: _____________________________________________


Name: _________________________________________________
Designation:___________________________________________
Date: ______________________ Place: ____________________

Seal of Institute ______________________________________








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