FORM

F-1

Registration No.
(To be filled by CBSE

CENTRAL BOARD OF SECONDARY EDUCATION

MERIT SCHOLARSHIP SCHEME
[For single girl children who have passed Class X from CBSE in May 2009
(Please see attached instructions)

Name of applicant (as per X certificate)

Date of Birth (DD/MM/YYYY)

1.

X Roll No.

.././
Mothers name .

Address for correspondence

Year of Passing class X

2.

Marks in first five subjects. Out

of 500 , % age

3.

No. of Brothers-----------(excluding you)

4.

State

Pin code

Sex (Tick)

No. of Sisters ----------------(excluding you)

Male
category:

Nationality __________________________

5.
6.
a)
b)
c)
d)
e)

7.
8.

Female

GEN/OBC/SC/ST/PH (Tick)

(STD code of city). Phone Number ( )

Email Address

Mobile No. (..)

Particulars of Savings Bank Account (Mandatory; Application will be rejected if all the columns are not filled)
Account Number
(of applicant only)
Name of the Bank
& Address (City and State)
Bank Code Number
MICR Code
RTGS:NEFT:IFSC Code
(11 digit Code of the Bank)

Name and Address of School

where you are Studying in Class
XI
Tuition fee charged by
school mentioned above
Enclosure attached

9.
10.

Fathers name .

Signature of Applicant*
WITH date

School Code:

District..State

_________________________.

(affiliated with CBSE/STATE BOARD/ICSCE/PRIVATE) (Tick)

the Class X________________PER MONTH

Class XI_________________________PER MONTH

(even if you have not studied in the present school)

(Affiliated to CBSE/STATE BOARD/ICSCE/PRIVATE etc.)
1. Photocopy of mark sheet
Yes/No
2. Original Affidavit duly sworn in before the First Class Judicial Magistrate/SDM/Executive Magistrate, as per
prescribed format
Yes/No
3. Photocopy of Affidavit will not be accepted.
NOTE: NOTARY ATTESTED AFFIDAVIT WOULD NOT BE ACCEPTED.
---------------------------------------------------

Date ----------------------------------------

The facts stated above including fee by the applicant are hereby certified to be true and correct. The
character and good conduct of the applicant are also certified.

11.

12

Recent Color
Photograph of the
Applicant attested
and stamped by
Principal of
School/Institution
where student is
presently studying
CBSES REF. NO.

Signature of Principal ----------------------------Name/Designation---------------------------------Tel & Mobile No.---------------------------------Email ID-------------------------------------------Affiliation No.of CBSE--------------------------School Code
Seal-------------------------------------------------_________________

Instructions for filling F-1 form

Eligibility
The applicant should fulfill all the following criteria for her consideration for award of scholarship:(i) The applicant should be an Indian national.
and
(ii) The applicant should be a single Girl child.
and
(iii) The applicant should be the only child of her parent.
and
(iv) Should be a student of CBSE in class X.(i.e passed class X from a CBSE affiliated school)
and
(v) Scored 60% or more marks in Class X examinations 2009 conducted by the CBSE.
and
(vi) Currently studying in CBSE affiliated schools where the tuition fee for X standard was not more than Rs.1500/per month during the Academic year 2008-09. In the next 02 years the total enhancement of tuition fee in such
schools shall not be more than 10% of the tuition fee charged in the year 2008-09.
Value of scholarship Rs. 500/- per month and duration: 2 years only.
Bank Account Details:
Applicants should write their Bank Account number with detailed address of the Bank along with the Bank Code, MICR
Code and RTGS/NEFT code of the Bank. Applicant should open Bank Account in their name only. Scholarships will be sent
by ECS mode directly to Bank Account of the selected candidates. In case the Bank details as mentioned above are not
complete and in prescribed format, the application will be rejected.
Signature:
All the applications must be signed by the applicant. Unsigned applications or signed by the parents will be rejected.
Attestation:
All the applications must be certified along with signature / stamp of the Principal / Dean of the Institute where the student
has taken admission. In case applications are not attested the same will be rejected.
Documents to be sent with the Application:
1. Annexure-I: Form F-1
2. Annexure-II: attested copy of Mark sheet of class X-2009.
3. Annexure-III: An affidavit from the parent that the candidate is the only child of her parents on a non-judicial stamp
paper of Rs.10/- duly sworn in before First class Judicial Magistrate/SDM/Executive Magistrate should be submitted
along with the application. Applications with Affidavit attested by Notary will be rejected summarily and no
correspondence will be entertained in this regard. Photocopy of affidavit will not be accepted.
4. Annexure-IV: An additional photograph mentioning the name of student and name of father/mother on its back should
be sent with Application form. It should be stapled on a Plain paper and attached with the application form.
Where to send Duly filled up Application Forms
The duly filled in proforma be sent in an envelope super scribing Merit Scholarship for SGC X (F-1) Form -2009
should be sent to the Deputy Secretary (A&V), CBSE, Shiksha Kendra, 2 Community Centre, Preet Vihar, Delhi110092.
Note:
For renewal of scholarship to those who have passed class X in 2008 and have received the scholarship, there
is separate form (F-2) for renewal and applicants are advised to apply in prescribed form only.
Last Date of Receipt of Application for the year 2009 :

30st Sept, 2009

FORMAT OF AFFIDAVIT TO BE ATTACHED WITH THE APPLICATION

(ON NON-JUDICIAL STAMP PAPER OF RS.10/- SWORN BEFORE
FIRST CLASS JUDICIAL MAGISTRATE/SDM/EXECUTIVE MAGISTRATE )

I ___________________ s/o,d/o _____________ r/o __________________ do hereby solemnly affirm and declare
as under:1)
2)
3)

That _____________________ is my only one daughter and her date of birth is ______________________.
That I am the father/mother and Ms. ____________________ is my only daughter.
That I have no other child except my above named daughter.