SATNAM SARAB KALYAN TRUST (Regd.)

Last date to apply : 10.08.2017 SATNAM SARAB KALYAN TRUST (Regd.) 1078/2, Sector 39-B, Chandigarh. PH. +91 172 269 1922. Email: [email protected] www.satnamsarabkalyantrust.org PASTE YOUR LATEST APPLICATION FOR BHAI SAHIB BHAI JIWAN SINGH JI COLOURED PASSPORT SIZE EDUCATIONAL SCHOLARSHIP FOR THE YEAR 2017-18 PHOTOGRAPH (TO BE FILLED IN BLOCK LETTERS)

1. NAME OF THE STUDENT :

………………………………………………………………………………………………………

2. DATE OF BIRTH : ……………………………………………………………………………………………

3. RELIGION : ………………………………………… SABAT SURAT : YES/NO

4. PRESENT / PROPOSED CLASS / COURSE …………………………………… YEAR ………… SEMESTER……………… DURATION OF THE COURSE……………………………………………………………. 5. NAME OF THE INSTITUTION:

…………………………………………………………………………………………………………

WITH ADDRESS :

………………………………………………………………………………………………………………….

6. FATHER'S NAME & QUALIFICATION : ………………………………………………………………………………………………..

PROFESSION & ANNUAL INCOME : …………………………………………………………………………………………..

7. MOTHER'S NAME & QUALIFICATION: ……………………………………………………………………………………………… PROFESSION & ANNUAL INCOME: …………………………………………………………………………………………..

8. NAME & QUALIFICATION OF BROTHERS / SISTERS: ………………………………………………………………………………….

…………………………………………………………………………………………………….

9. P ERMANENT ADDRESS : ……………………………………………………………………………………………………

……………………………………………………………………………………………………… 10. CORRESPONDENCE ADDRESS : ……………………………………………………………………………………………………… ………………………………………………………………………………………………………………… CONTACT NO. : (L) ……………………………… (M) ………………………………………..

EMAIL (Compulsory) : ………………………………………………….

11. LAST EXAMINATION PASSED : ……………………… Year ……………..Marks obtained……………… out of …………… Percentage...... 12. DETAIL OF EXAMINATION PASSED : Class Year Of Marks Total %age Name of Board/ Marks obtained Passing Obtaine Marks University in Gurmat d 10th 12th

(Note : Attach photocopies of the certificates)

13. Any other extra curricular activities/information whi ch you may like to mention here :

…………………………………. ……………………

……………………………………………………………………………………………………………………………………

……………

14. Name the classes & last school in which you have studied gurmat :

…………………………………………………………

……………………………………………………………………………………………………………………………

…………..

15. Are you getting/expecting scholarship from any other source? If so, give details.: ………………

……………… ………

……………………………………………………………………………………………………………………………

…………

16. Have you availed any financial assistance from this trust last year? :

……………………………………………………..

17. Detail of annual/semester expenses on studies :

Particulars Annual Semester Admission Fee Tuition fee

Other expenses (Books, transport, uniform etc.) Total

18. Detail of Bank Account

a) Name of the payee as in bank passbook : b) Bank a/c no. : c) Name of the bank & address : d) IFSC code no. (Compulsory) :

19. Exceptional/compassionate ground if any :

______

Signature of father/guardian Signature of Student

Name : Address:

PLACE : DATE :

List of enclosures: 1. Photocopies of all educational certificates 2. 2 passport size coloured photograph. 3. Fee deposit receipts if any. 4. Income proof (Affidavit etc.)