THE INDUSIND FOUNDATION

NEW DELHI

INDUSIND MERIT-CUM-MEANS SCHOLARSHIP SCHEME 2008

APPLICATION FORM

(LAST DATE OF SUBMISSION 31 – 08 – 2008)

(Passport size Photograph to be pasted in the right hand corner)

Passport

Size

Photograph

Part 1 – PERSONAL DATA

1. Full Name (Surname first) : ________________________________

2. Sex ________________________________

3. Date of Birth ________________________________

(Proof of age to be attested)

4. Father’s Name : ________________________________

Age: ________________________________

Occupation : ________________________________

Monthly Income : ________________________________

5. Permanent Address: ________________________________

________________________________

________________________________

6. Mailing Address & ________________________________

Telephone No ________________________________

Part II – EDUCATION

7. Name of School where ________________________________

studied 12^th class:

8. Name of Board / University ________________________________

from which 12^th class

Exam. Passed:

9. Month & Year of Passing ________________________________

12^th class Exam

10. Aggregate percentage of marks ________________________________

(for all compulsory & optional

papers) secured in 12^th Class Board / ________________________________

Uni. Exam. (Copy of Mark sheet to be attached)

11. Position in merit list, if any, in Board / ________________________________

Uni. Exam. (Proof to be attached)

12. Name of college / institute to which ________________________________

admitted for degree course:

(Prof of admission to be attached)

13. Is the college Govt. institute ________________________________

or private institute:

14. Name of University to which ________________________________

Institute / College affiliated:

15. Course to which admitted: ________________________________

16. Whether admission is against ________________________________

payment seat or free seat:

17. Total Duration of course: ________________________________

18. The date of commentment of course: ________________________________

19. Whether admission to degree course ________________________________

secured thro’ Entrance Exam.

If so, plz. Give details:

Part III - FINANCIAL STATUS:

20. Father’s / Gaurdian’s / ________________________________

supporter’s monthly income:

21. Details of family : (number of members of family) ____________________________

Name Relationship Age Occupation Monthly income

1.

2.

3.

4.

22. Total family income per month From ________________________________

all sources (as on 1-7-07)

23. a) Details of Fees Paid on admission ________________________________

(copy of receipt to be attached)

b) Details of tuition fees payble every year

24. Whether receiving any other scholarship ________________________________

if yes, indicate monthlyamount and the

period for which scholarship is available

25. Whether living in hostel, if yes, indicate ________________________________

Average monthly hostel expenses

26. Please attach writeup not exceeding 100 words explaining why you should be given scholarship and what you will do for the Society if scholarship is granted to you.

Part IV - VERIFICATION

I hereby certify that the information furnished above by me is true to the best of my knowledge and belief.

I also agree that continuance of scholarship, if granted, will depend on my performance and the decision of the Foundation in this regard, will be final and will not be a subject of adjudication of any kind.

Place:

Date: (Signature of applicant)

Part V - RECOMMENDATION

1. Name & address of association / sabha / panchayat ________________________________

Organisation forwarding the application ________________________________

2. Recommendation of association etc ________________________________

________________________________

Signature and name of office bearer

Forwarding application along with stamp

Of forwarding association.