ANNEXURE E

APPLICATION PROFORMA FOR SCHOLARSHIP (MERITORIOUS STUDENT)

APPLICANT DETAILS
S.No Particulars Remarks
1 Name of the applicant
2 Father’s Name
3 Mother’s Name
4 Address of the Applicant (Including PIN Code)
5 Date of Birth
5 Mobile Number Alternate Number
6 e-mail ID
7 Domicile (Punjab or outside Punjab)
ACADEMIC DETAILS
S.No Class Subjects/Course Name of Board/Uni. Marks Percentage
1 10th
2 12th
3 Graduation
4 Name of school from which class 10th Board
Examination Passed & marks %age
5 Name of school from which class 12th Board
examination passed and marks %age
SCHOLARSHIP COURSE DETAILS
1 Name of course for which scholarship sought
2 Name of the Institute
3 Type of Institute (Govt./Private)
DETAILS OF THE STUDENT’S BANK ACCOUNT
Name of account Holder
Account Number (Full)
Bank Name Branch Name
IFSC MICR

I solemnly affirm that the information provided above is true to the best of my knowledge and belief
and nothing has been concealed therein. I further submit that in case information provided is proven to
be false, Board may take appropriate legal action and shall also be entitled to seek refund thrice the
amount paid as scholarship.

Sign. Of Student Signature of Parent/Guardian

Name: Name:

Documents to be attached:
th th
1. Mark sheets of 10 /12 .
2. Photocopy of the bank passbook.
3. Copy of Adhaar Card
 ANNEXURE E

CERTIFICATE BY PRINCIPAL/HEAD OF THE SCHOOL

Certified that _____________________________ passed his examination of class ___________ as a

student of this institute namely ______________________________ (Name of school) under roll no.
______________and obtained __________% marks in the Board examination. He bears good moral
character.

Place: Sign and Stamp of Principal/Head

Date: Name of the Principal/Head:
Name of school:

Report of Rent Collector:

The case of applicant for meritorious scholarship is

Recommended Not-Recommended

Signature of Rent Collector:

Name of Rent Collector:

Report of Estate Officer:

Based on the application and the report of the Rent Collector, the application along with the requisite documents
is forwarded to the CEO Punjab Waqf Board, Chandigarh as
RECOMMENDED NOT-RECOMMENDED

Signature & Stamp of Estate Officer

Name of Estate Officer:

Note: Report of Rent collector and EO is not required for students studying and passing from Waqf or
Waqf Aided schools and their applications along with requisite documents may be forwarded by the
concerned principal directly to the EDO (Education development officer), Punjab Waqf Board.
 ANNEXURE E

DECLRATION/UNDERTAKING BY STUDENT FOR SCHOLARSHIP

I, Mr. /Ms. ................................................................................................................................ ,

Son/Daughter of …………………………………… permanent resident of
.....…………….........................................................................................................................
...................................................................................................................................................
Phone No:.................................................................(Give permanent home address with
telephone no.), do hereby undertake on this the……… (Day), of.................. (Month)..............
(Year), the following:-

1. I, hereby, declare that, the entries made by me in the Application Form are complete and
true to the best of my knowledge and based on records.
2. I, hereby, undertake to present the original documents immediately upon demand by the
concerned authorities.
3. I, hereby declare that, I have gone through the provisions of the policy of the Punjab
Waqf Board for scholarship and am willing to abide by the same.
4. I declare that my total family income is ______________(Rupees, in numerals & words)
5. I further declare that our total family land ownership is ______________Acre.
6. I, further declare that my Scholarship may be cancelled, at any stage if I am found
ineligible and/or the information provided by me is found to be incorrect. Further Board
may take such legal action as may be applicable.
7. I hereby further declare that I have not applied for or availed any other scholarship
(Except PM Scholarship for Minority students).
8. I, hereby undertake to inform the Punjab Waqf Board, about any changes in information
submitted by me, in the Application Form and any other documents, including change in
addresses and phone nos., from time to time.

Date: Signature of Student

DECLARATION BY PARENT/ GUARDIAN

I …………………………………………………, (Mother / Father / Guardian) OF ………………………………………

hereby fully endorse the above undertaking/declaration given by my child/ward. And I will
endeavour to induce my child/ward to do his/her best to observe the above stated undertaking
in words and spirit and further take responsibility as a surety to ensure the repayment of
amount paid with penalty in case the information provided is incorrect.
 ANNEXURE E

Place .................................................. Signature of Mother / Father / Local Guardian

Date: ……………………………