<p> SAI VILAYATRAI SAI JIWATSINGH SAI VISHINDAS CHARITABLE TRUST</p><p>KAMBAR DARBAR, SHANTILAL MODI RD, KANDIVLI (WEST)</p><p>MUMBAI 400067. TEL: 022- 28072734 / 65881672</p><p>SAI VILAYATRAI SCHOLARSHIP SCHEME FOR PROFESSIONAL COURSES</p><p>Sai Vilayatrai Charitable Trust, Mumbai a non profit & charitable organization grants educational scholarships every year of an amount ranging upto Rs 20,000/- per year to meritorious & needy students for studying higher professional courses. </p><p>Following students are eligible for scholarship:</p><p>1. Studying Engineering, C A, IPCC, CPT, CFA, C S, Pharma, B Arch, MBA (reputed institute with above 70% marks in graduate program), Medicine, BDS.</p><p>2. Also eligible high school students who have scored more than 80% marks in SSC in English medium and are preparing for higher professional courses.</p><p>Application for grant of scholarship is to be made in the prescribed form a copy of which can be downloaded from our website www.kambardarbar.org. Applications must be always accompanied with attested copies of ALL the enclosures asked in the application form.</p><p>For any clarification please contact: [email protected].</p><p>No phone calls will be accepted.</p><p>TRUSTEE</p><p>1 SAI VILAYATRAI SAI JIWATSINGH SAI VISHINDAS CHARITABLE TRUST</p><p>KAMBAR DARBAR, SHANTILAL MODI RD, KANDIVLI (WEST)</p><p>MUMBAI 400067. TEL: 022- 28072734 / 65881672</p><p>SAI VILAYATRAI SCHOLARSHIP SCHEME FOR PROFESSIONAL COURSES APPLICATION FORM</p><p>- Applying for first time: Yes / No Paste recent If No: passport size - Give past record of scholarships received: photograph </p><p>Date received: ______</p><p>Amount received: Rs. ______</p><p>PART 1- PERSONAL DATA 1. Full Name (Surname First): : ______2. Sex : ______3. Date of Birth : ______</p><p>4. Father’s Name : ______Occupation : ______[If Service: Designation & Name : of organization (Signed copy of recent salary certificate/pay ship) If Business: provide full detail, type, size, sales/year, no of employees, name of firm, no of partners, Net Income/Month, etc. (Provide details on the firms letterhead)]</p><p>2 SAI VILAYATRAI SAI JIWATSINGH SAI VISHINDAS CHARITABLE TRUST</p><p>KAMBAR DARBAR, SHANTILAL MODI RD, KANDIVLI (WEST)</p><p>MUMBAI 400067. TEL: 022- 28072734 / 65881672</p><p>5. Postal Address : ______6. Last (most recent) exam : passed, date of passing and marks obtained. (Enclosed mark sheet)</p><p>7. The higher-level : ______professional course in ______which the candidate has received admission & when? - Presently in which : year/semester.</p><p>8. Current Landline No : ______9. Current Mobile No :</p><p>10. Email id : </p><p>3 SAI VILAYATRAI SAI JIWATSINGH SAI VISHINDAS CHARITABLE TRUST</p><p>KAMBAR DARBAR, SHANTILAL MODI RD, KANDIVLI (WEST)</p><p>MUMBAI 400067. TEL: 022- 28072734 / 65881672</p><p>PART II – EDUCATION DETAILS Sr. Examination Name of School / Major Aggregate Position in Year Of Any No College/Universit Subjects Percentag Merit List Passing Awards/ y and Place e Marks (If any) Others 1. XIIth Std / Higher Secondary 2. Degree Course (Final Year) 3. Higher Exams Passed semester wise.</p><p>If grades – Give equivalent percent marks and method of grading (Copy of university cicular)</p><p>PART III – FINANCIAL STATUS 1. Fathers / Guardians Monthly income : ______2. Details of family: (Number of members of family) :</p><p>Sr. Relationship Name Age Occupation Monthly Income 1. Mother 2. Brother 3. Brother 4. Sister 5. Sister 6. Others</p><p>Any false information about income will blacklist the candidate.</p><p>4 SAI VILAYATRAI SAI JIWATSINGH SAI VISHINDAS CHARITABLE TRUST</p><p>KAMBAR DARBAR, SHANTILAL MODI RD, KANDIVLI (WEST)</p><p>MUMBAI 400067. TEL: 022- 28072734 / 65881672</p><p>3. If total family income is less then Rs. : 10,000/- per/month what are the other sources for supporting the education of children and monthly expenses of family</p><p>4. Any other sources of income/help : (From property)</p><p>5. Total family income per month from all : sources ______6. a) Details of total fees paid : (Attach proof) ______b) Any fees payable during year : (Attach proof) ______7. Whether receiving any other : scholarship (please provide details) (Any false information about income ______will blacklist the candidate. ) 8. Whether living in hostel /with family : and if in hostel average monthly hostel expenses (Give proof of payment) ______9. List two References (non relations One : must be professor of college/institute where studying)</p><p>Sr. Name Phone No Occupation Designation No 1. 2.</p><p>5 SAI VILAYATRAI SAI JIWATSINGH SAI VISHINDAS CHARITABLE TRUST</p><p>KAMBAR DARBAR, SHANTILAL MODI RD, KANDIVLI (WEST)</p><p>MUMBAI 400067. TEL: 022- 28072734 / 65881672</p><p>PART IV – VERIFICATION / DECLARATION</p><p>I hereby certify that the information furnished above by me is true to the best of my knowledge and belief. Any information found untrue will automatically make me ineligible for the scholarship, forever.</p><p>I also agree that grant/continuance of scholarship will depend on my performance and the decision of the Trust in this regard will be Final and not a subject of discussion /adjudication of any kind.</p><p>I further declare that I shall treat the scholarship, if granted to me, as interest-free loan, and shall repay the amount to the trust as soon as I start earning.</p><p>Place: ______</p><p>Date: ______(Signature of the applicant)</p><p>6 SAI VILAYATRAI SAI JIWATSINGH SAI VISHINDAS CHARITABLE TRUST</p><p>KAMBAR DARBAR, SHANTILAL MODI RD, KANDIVLI (WEST)</p><p>MUMBAI 400067. TEL: 022- 28072734 / 65881672</p><p>PART V-- LIST OF DOCUMENTS TO BE ATTACHED </p><p>Sr. Document Type No 1. Proof of passing 12th class or equivalent Mark sheet. examination 2. Proof of admission in higher professional Certificate from head of College/Institute where course studied/mark sheet of professional course. 3. Proof of payment of fees & Hostel charges Fee receipt issued by college/institute on (if any) admission 4. Children of salaried persons (both I Tax Form 16 government and private) should enclose latest Form-16, or Income Tax return. 5. Children of self-employed persons should Income Tax Returns and Sales Tax Returns enclose latest Tax return. 6. Please enclose mark sheet for each semester exam. 7. Incomplete forms will not be considered and no correspondence will be made in this respect. 8. All documents to be certified True Copies attested by SEO or similar authority.</p><p>7</p>