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APPLICATION FORM: ARMY GROUP INSURANCE FUND SCHOLARSHIP SCHEME

NOTE: PLEASE DO NOT LEAVE ANY INFO BLANK

USE BLOCK CAPITAL LETTERS ONLY Parents Details 1. 2. 3. 4. 5. 6. 7. 8. Personal No/Army No Rank Name Arms/Service Regt/Corps and Unit Date of Commission/ Enrolment Date of retirement/Release Death Postal Address (With unit Pin Code No of serving personnel) : : : : : : : :

FOR OFFICIAL USE ONLY

Registration No

(AGIF Use only)

9.

Postal Address (with Pin Code) of retired personnel/ legal guardian (in case of demise of AGIF member)

10.

Particulars of the Students (a) Name (b) Sex (M/F) (c) Date of Birth (d) E-mail (e) Mobile Number

: : : : : : DD MM YY

11. I am studying in _________________ (name of course). My annual Result/Grade for the academic Year __________ is as under:Academic Class Passed Year Marks/ Grade Obtained Total marks Percentage of Marks Overall position in class/ stream

12. For the above Academic Year for which I am applying for AGIF Scholarship, I have been awarded the following scholarship:Type of Scholarship Amount

Place: Date:

Signature of Student (Name of student in full)

CERTIFICATE

1.

Certified that particulars mentioned above and marks sheets have been verified as per records

available with __________ (AWES Institute) in respect of master/Miss _______________________ _________________ Son/Daughter of No _____________________ Rank _________________ Name ______________________________________

2.

CTC of the following are enclosed:(a) (b) (c) Matriculation/10+2 level Certificate (for proof of date of Birth) Marks Sheets Students Identity Card

Station: Dated:

(Head of Institution) (AWES)

CERTIFICATE

1. Students mentioned above have passed in all subjects and merit list for First Year is based on the performance in Class 10+2 level/ equivalent and degree examinations. 2. Merit list has been prepared as per AGIF letter A/56271/R/AG/Ins (Coord) dated 06 June 2012. 3. Particulars of the parents of legal guardian (in case of demise AGIF Member) have been verified as per office records based on which admission has been granted to the students being children of serving / retired Army Personnel.

File reference: Place: Dated:

Signature _________________ Name (Head of the AWES Institution)

DECLARATION-CUM-PRE-RECEIPT 1. Received from the secretary, AGIF, New Delhi, a sum of Rs 40,000/- (Rupees forty thousand

only) being the amount of scholarship awarded to my child from AGIF Scholarship Scheme for the academic year . As below:Name of the child Course of study Academic year Institution

2.

Bank details: Above AGIF scholarship amount may please be remitted to my bank Account

as per detail given below:-

(a) (b) (c) (d) (e) (f) (g)

Name of Bank Branch Bank Code CBS Credit Account No (11 to 16 digits) Account Type IFS Code MICR Number (Please attach cancelled cheque/copy of pass book main page duly attested by Branch manager)

3.

Postal address for Correspondence. My correspondence address is as under:-

4.

I, ____________________ Rank ______________ Name _____________________________

am serving at ____________________________ since ______________ undertake to refund the entire amount of scholarship to secretary, Army Group Insurance Fund if any information pertaining to the documents submitted for AGIF Scholarship is found to be false.

Station: Date:

(Signature of parent/legal guardian In case of demise of the parent) Tele No__________________________ Mobile No ______________________ E-mail __________________________