- SITARAM JINDAL FOUNDATION

Application Review & Final Submission

1. Aadhar No:

2. Name:

3. Gender:

4. Email Id:

5. Mobile No:

6. Date of Birth:

7. Country:

8. Nationality:

9. Permanent Address:

10. Permanent Pin Code:

11. Permanent City:

12. Permanent Post Office:

13. Permanent State:

14. Present Address:

Same as Permanent Address

15. Present Pin Code:

16. Present City:

17. Present Post Office:

18. Present State:

19. Physically Handicapped:

20. Ward of Ex-Serviceman:

21. Belong to BPL Family:

a) BPL Reference Number:

22. Single Parent:

23. Orphan:

1. Country:

2. Pin Code:

3. City:

4. College Post Office:

5. State:

6. Present Institute/College/School name:

7. College Email:

8. College Phone No. (With STD Code):

9. Previous Exam:

a) Previous Semester:

b) Previous Year:

10. Obtained Marks in Previous Exam:

11. Total Marks in Previous Exam:

12. Percentage (%) in Previous Exam:

13. Current Course:

a) Current Semester:

b) Current Year:

c). Select Quota:

14. Course Duration (In Years):

15. Choose your Preference:

Regular

Part-time

Correspondence

Evening College

16. Annual Fee:

17. Course Started From: (Enter the month and year when your current course began (e.g.,01-07-20XX))

18. Final Exam:

19. Required Scholarship Amount (Per month):

20. Have You Applied Before S.R.Jindal Scholarship Scheme:

a) Scholarship Reference No:

21. Are you getting any stipend/Fee reimbursement/scholarship from any other source?

a) Mention Source: If yes, please Enter amount received per month:

22. Have you applied / or getting any scholarship from Minorities Welfare dept / SC / ST / OBC in your state

a) Scholarship Status: b) If sanctioned, please enter the amount received per month.

23. Current Stay:

a) PG/Hostel Address:

b) PG/Hostel/Mess Fee (Per month):

1. Name:

2. Relation:

3. Mobile Number:

4. Alternate Number:

5. Email Id:

6. Occupation:

7. Family Income:

1. Bank Name:

2. Account Number:

3. IFSC Code:

4. Beneficiary Name:

5. Branch Address: