PARA WISE GUIDE LINES FOR FILLING UP OF APPLICATION FORM Para 1.

1st Name Middle Name Surname

Fill your name as in matriculation certificate only:(Not to be filled in any other format) A S R J I A A N N Y G A H

Para 2. Male Para 3.

Put a tick () mark as shown.

Female Date of Birth as shown in matriculation certificate only. For Example:- (10 June 1982) M 0 M 6 Y 1 Y 9 Y Y 8 2

D 1

D 0

Para 4. Mention your Rajya Sainik Board (See details at LIST OF RSBs) and Zila Sainik Board name, from where your father / mother have registered and have obtained ex-servicemen / widow identity card (Not for Ex-Coast Guard). Para 5. Write your permanent address and correspondence address in block letters. Para 6. Write phone number along with STD code and email ID for any query (email ID is must). Para 7. Category as per Para 7 of brochure to be written (attach the required document, for cat 1-5). Category 1 (One). Category 1 O N E

Para 8. Full Particulars of Father / Ex-Serviceman / Ex-Coast Guard is to be mentioned as per the Discharge Book. A blank space to be provided between names. (Example: - KAMLESH CHANDRA CHOUDHURY) K A M L E S H 1 4 5 2 3 6 K C H A N D R A C H O U D H U R Y

S E R G E A N T A I R F O R C E

Para 9. Details of 10+2 or Diploma / Graduation. Marks to be shown in words and figures.
(a) Name of Course/MEQ 1 0 + 2

(b) Year in which exam passed (c) Total Marks (in words) (in figure) (d) Marks obtained (in words) (in figure) (e) % of marks scored (in words) (in figure) O T 1 N F 9 S P T 7

2 N W 2 I O 4 E O H 8

0 E O 0 N R 0 V I R .

3 T H H U O N U D S R A E N D D

0 E T Y H U N D R E D

E N E 3

N T E 3

Y T

E I

I R

G T

H Y

Para 10.

Whether the applicant is in receipt of any other financial assistance/scholarship/ fellowship from any Govt. / Private source for the course to which the scholarship applied for. If yes, then state the amount and source. Tick as applicable.

Yes
Source

No
S T A

Rs (per month / year) T E G

45000/-

O V T

Para 11. The student is to specify the course which he / she is presently studying. (Example:- MBBS)
M B B S

Para 12. Duration of the course both in numbers and figures to be mentioned (without Internship). For example 4 years 6 months. (In figure) Y Y 0 4 (In word)
F O U M O N R T H Y S E A R S A N D S I X

M 0

M 6

Para 13.

Write date of commencement & completion of course as shown below:

(Course Commencement / Date of Admission) D 0 D 1 M 0 M 7 Y 2 Y 0 Y Y 1 3

(Course completion) D 3 D 1 M 1 M 2 Y 2 Y 0 Y Y 1 7

Para 14 Write the full name and address of the College with email ID and phone number of Principal.
Name of Student. A J A Y S I N G H R A N A

Roll No.

E A T I

3 I N S T I T U T E

Name of College. O F T E C H N O L

A J M E R O G Y

Full Address of College

P U S H K A J M E R

State Pin Code

R 3

A 0

J 5

A 0 0

S 0 1

T 4

Tele No. (with STD Code)

E-Mail ID

a l

i .

t _ a j c o M a i

m e

@ r

e d

m a

College Website

w w w .

m e

c o m

Para 15.
A I

Write the Regulatory Body of your course.

C T E

Para 16. Details of Bank Account of SBI or PNB for Electronic Clearing Services (PLEASE ATTACH A PHOTOCOPY OF PASS BOOK, ONE CROSSED BLANK CHEQUE LEEF SHOWING YOUR ACCOUNT NUMBER AND NAME).
Name of Account Holder: A J A Y S I N G H R A N A

Name of Bank (Put a tick mark () Branch Name: R A M A K R I S H N

SBI

PNB

(PLEASE ATTACH A PHOTOCOPY OF CHEQUE & PASS BOOK)

Account No.

3 0 8 3 0 0 0 6 0 8 0 6 5 8 8 5

REPEAT Account No. 3 0 8 3 0 0 0 6 0 8 0 6 5 8 8 5

Para 17.
Sl. No. 1 2. 3. 4.

Furnish the particulars of your all children as per specimen given:Name of Child Prakash Singh Rana Satish Singh Rana Ajay Singh Rana Komal Rana Gender M M M F Date of Birth 10/10/1982 12/05/1984 03/07/1987 14/02/1989 Age 28 Years 26 Years 23 Years 21 Years

Para 18. Give details of the scholarship availed by your brother / sister in the past, if not availed write Not Applicable.
Sl. No. 1. Selection Serial No. given by KSB 6359 Name of the brother/sister Satish Singh Rana Course of Study B Tech Academic year in which applied 2007-08 Amount received so far 45000

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