APP-51

Name of the Administrative Unit: Year of Application: DEPARTMENT OF POSTS, INDIA Application for Departmental Scholarship for No. Technical/Technical education (last date for receipt of application by the Secretary, West Bengal Postal Circle Staff Welfare Board is on 30 th September, 2012. A 1. 2. 3. Details of Applicant Name: Shri/Smt. Date of Birth: Designation, Office address and District: Date of receipt: Code No. For office use only in Circle/Directorate

4. 5.

Whether belongs to Class-IV: Address:

Course: Grading:

6. 7(i) ii)

(Whether belongs to SC/ST/OBC): (copy of caste certificate should be attached) Basic pay as on 30th Sept, 2012 Basic pay of wife/Husband as on 30/09/2012 (If wife/Husband is employed) Total Details of Student

Exam. Position

% of marks

iii) B 1. 2. 3. 4.

Selected Waiting list /not selected Rs. Value

Name: Relationship with the applicant: Date of Birth Signature

Secretary

C 1. 2.

Details of Education for which Scholarship is applied Name of the Course: Whether Degree or Diploma:

West Bengal Postal Circle Staff Welfare Board

3(a) Total duration of the course: (b) Stage at which student is studying in 2011-2012 session Prepared & Check by

c)

Name and Address of Institution:

d)

State/University by which recognized/to which affiliated

e)

Scholarship record of the student: Commencing from Minimum qualifying examination before joining the course of study undertaken by the student (should be supported by attested copies of mark sheets). Year of passing Full marks Marks obtained Percentage of marks

Name of Exam

a) b) e)

Secondary Higher Secondary Details of assistance, if any received

1. Is the student exempted from payment of tution fees: 2. If answer to (1) above is yes mentioned the amount exempted: 3. If the student receiving any to (e) above is yes. a) Amount b) Source

I declare that 1. 2. 3. The particulars given above true and complete to the nest of my knowledge and belief. The same child/dependent of mine is to already in receipt of a P&T Scholarship for non-tech. Education/Tech Education. I am the guardian of my brother/sister of whom I have applied for the scholarship and that He/she solely dependent on me.

Station: Date:

Signature of the applicant (Govt. Servant)

Certified that the entries under Column C and E above are correct.

Date:

Signature of Head of the Institution and office seal

1. Certified that the entries under Column A item 1 and 2 above are correct. 2. Forwarded to Secretary, West Bengal Postal Circle Staff Welfare Board and Welfare Officer, O/O the Chief Postmaster General, West Bengal Circle, Kolkata-12.

Date:

Signature of Head of the Institution and office seal

DECLARATION A) I hereby declare that the fact stated in my application for award of scholarship to my son/daughter/brother/sister whose signature is given below are true to the nest of my knowledge and belief. B) That my brother/sister in whose favour a scholarship has been awarded is solely dependent on me. C) That I agree to abide by the rules and regulations regarding the award of scholarship for Technical/non-technical education of Children of P&T Employees issued from time to time and D) That I am not in receipt of any assistance from any other source for the education of my son/daughter/brother/sister who has been awarded to is Scholarship and in the event of getting any such assistance I undertake to intimate the same within 30 days of award thereof. I am in receipt of a sum of Rs. . p.m./lump sum as assistance for my son/daughter/brother/sister from ..(here state source) I understand that in the event of any information furnished in my application for award of Scholarship being found false/incorrect, I am liable to be subjected to disciplinary action as the Chief Postmaster General, West Bengal Circle, may feel an also to refund any amount that is drawn by me as value of the Scholarship. I also understand that the chief Postmaster General, West Bengal Circle reserves the right to cancel/revise the award made to me without assigning any reasons.

(Signature of the student)

(Signature of the Official)

Certified that the student is In receipt of _________________________ Per year/months for through this institution/is not in receipt of any assistance for his/her Education through this Institution.

Signed in my presence Name __________________________ (Head of Unit where the officer/Designation official is employed)

Signature of Head of the Institution and office seal

In-applicable items should be deleted. Note: The declaration should be kept alongwith the application and other papers relating to the grant of Scholarship to the official.