Anjuman Wazifa-e-Sadat wa Momineen (Regd.

)
Ahmad Nagar, P.O. Box 94, Aligarh-202002
Affix

Application for Wazifa

Passport
Size

st

Due Date : 31 August, Applications received after the due date will
not be entertained.

Photograph

1. Name of the Student (CAPITAL letters) _________________________________________

2. Date of Birth_______________________3. Class/ Course of Study____________________
4. Duration of Course__________________________________________________________
5. Name of the Institution_______________________________________________________
6. Fathers Name (CAPITAL letters)_______________________________________________
7. Total monthly income________________________________________________________
8. Guardians Name(CAPITAL letters)_____________________________________________
9. Relationship_______________________________________________________________
10. Permanent address of 6 or 8 (CAPITAL letters) with proof of residence (Photo copy of ration
card, Electricity bill etc.) ______________________________________________________
_________________________________________________________________________
11. Present address of 6 or 8 with proof as above_____________________________________
_________________________________________________________________________
12.
Examination
Passed

Board

University

13. Details of brothers and sisters of the applicant:

S. No.
Name
Class

Year

Division

Name of the Institution

Percentage

Age

14.
Has the applicant received scholarship from the Anjuman in the past_______ when
____________Scholarship No.___________ Why discontinued?_________________________
15. The names & scholarship numbers of the family members receiving scholarship from the
Anjuman:
1._________________________________ 2._______________________________________
3._________________________________ 4._______________________________________
5._________________________________ 6._______________________________________

16. Family members who have received scholarship from the Anjuman:
Name
Wazifa No.
Present
Is he/she paying back His/Her Present
Occupation
Anjumans Money? If Address
not. Why?

17.
18.
19.
20.
21.

Details of Scholarships/Grants received by the applicant from other sources___________

_______________________________________________________________________
Recommendation by the Local Secretary of the Anjuman: _________________________
Recommendation by any other member of the Anjuman:__________________________
Recommendation by Aalim e Din or any prominent person of the locality:____________
_______________________________________________________________________
Bonafide Certificate of the Head of the Institution to be attached.____________________

I hereby declare that all the information given above is true and correct. If any
information is found by Anjuman to be false or incorrect at any stage, Anjuman is authorized to
cancel or discontinue the Wazifa (loan).
I also declare that it is my legal, moral & social obligation that I will repay the total
amount of Wazifa (loan) immediately on getting any employment.

Signature of Father/Guardian
Full Name
______________________
Place
______________________
Phone/Mobile No.___________________

Signature of Applicant
Full Name_____________________
Date__________________________

_________________________________________________________________________________

INSTRUCTIONS
The following documents should be sent with the application. The forms along with the
documents should reach the office by due date. If any document is not attached for any valid
reason, it should be submitted at the earliest.
1. Authentic Birth Certificate.
2. Attested mark sheet of last examination passed.
3. Head of institutions bonafide certificate.
4. Two attested photo of the student.
5. Member (19) recommending the application, through a separate letter should
confidentially inform the office of the Anjuman regarding the applicants genuine need for
monetary help. He shall be personally responsible for the return of the scholarship
amount.