1

MINISTRY OF DEFENCE Department of Ex-Servicemen Welfare

PM’S SCHOLARSHIP SCHEME FOR

DEPENDENT WARDS / WIDOWS OF EX-SERVICEMEN AND EX-INDIAN COAST GUARD

Brochure-Cum-Application Form

For Academic Year 2011-12

Application Form consists of Col No 1 to 18, Payment Form and list of RSB / Coast Guard Headquarter at state and UT level attached. (Brochure-Cum-Application form consists of 31 pages)

KENDRIYA SAINIK BOARD West Block-IV, Wing-VII, 2nd

E-Mail:

Floor R K Puram, New Delhi-110066

Website: www.mod.nic.in jdpmscholarshipksb@gmail.com

Note: This application form (page number 13 to 18 alongwith required documents only) is to be

deposited by individual to respective RSB / Directorate General of Coast Guard. Applications duly recommended by RSB’s / Directorate General of Coast Guard shall only be considered by KSB. Therefore, candidates are advised not to forward applications directly to KSB as the same shall not be considered and will be returned unactioned to individual.

2

PRIME MINISTER’S SCHOLARSHIP SCHEME

ACKNOWLEDGEMENT SLIP

OFFICE COPY

Your Application Form dated_________ has been received on__________. The

application will be examined for eligibility. The dak receipt number ____________ is to be

mentioned for further correspondence with this office.

Office Seal: (Signature of RSB / Coast Guard Headquarter)

Tear off Tear off

ACKNOWLEDGEMENT SLIP

STUDENT COPY

Your Application Form dated_________ has been received on__________. The

application will be examined for eligibility. The dak receipt number ____________ is to be

mentioned for further correspondence with this office.

Office Seal: (Signature of RSB / Coast Guard Headquarter)

Note: Student copy duly stamped and signed by RSB / Coast Guard Headquarter is to be given to the student by hand or by post. (Envelope enclosed alongwith the application may be used.) Office copy duly filled by the RSB/Coast Guard Hqs to be attached with the application.

3

PRIME MINISTER’S SCHOLARSHIP SCHEME (PMSS)

1. Introduction.

Prime Minister’s Scholarship Scheme has been introduced from the Academic year 2006-07. To encourage higher technical and professional education for the dependent wards of Ex-Servicemen / Ex-Coast Guard and their widows (below officer rank only) and dependent wards / widows of Ex-Servicemen / Ex-Coast Guard who died in harness due to causes attributable to military service / Coast Guard Service, irrespective of the rank.

2. Scholarships Available. A total number of 4000 scholarships will be allotted. 3. Students eligible for the scholarship.

(a) Dependent wards of ex-servicemen / Ex-Coast Guard and their widows (below officer rank only)

(b) Dependent Wards / widows of Ex-servicemen & Ex-Coast Guard who died in

harness due to causes attributable to military service / coast guard service, irrespective of the rank.

Note: (i) The candidate irrespective of his marital status is eligible for PMSS. However, an earning / serving candidate is not eligible.

(ii) For dependent wards of widows and widows of personnel died in

harness due to causes attributable as mentioned in para 3 (b) above, there will be no rank restriction.

4. How to Apply For Scholarship.

One candidate to submit only one application form for one course, if any candidate submit two application for more than one course, both the applications will be rejected. Forms are to be downloaded from the website www.mod.nic.in. Application forwarded in any other format will not be considered. Application to be forwarded on plain A4 size paper (typed or handwritten) in the prescribed format duly completed in all respects with superscription on the envelope “Prime Minister’s Scholarship Scheme for the Academic Year 2011-12.” Documents to be attached along with PMSS application form are as follows:- (a) Extract of Ex-servicemen / Ex-Coast Guard discharge book as per specimen.

(Refer page number 21) (b) Matriculation certificate duly attested.

4

(c) Minimum Entry Qualification certificate duly attested. (10+2 Mark sheet or full Graduation Mark sheet which ever is applicable)

(d) Bonafide studentship certificate from Collage in original as per specimen. (Refer

page number 20) Note: Failure to attach above mentioned documents / certificate will lead to rejection. 5. Selection Procedure.

Applications will be short listed based on Ex-servicemen / Ex-Coast Guard category (as given below in para 6) and percentage of marks obtained in minimum entry qualification (MEQ).

6. PRIORITY for Grant of Scholarship.

Order of preference for allotment of scholarships will be as under:- Category 1 Wards/ widows of defence / Coast Guard personnel killed in

action. Category 2 Wards of Ex-servicemen / Ex-Coast Guard disabled in action

and boarded out of service with disability attributable to Military / Coast Guard service.

Category 3 Wards / widows of defence / Coast Guard personnel who died

while in service for causes attributable to Military / Coast Guard service.

Category 4 Wards / widows of ESM / Ex-Coast Guard personnel disabled in

service with disability attributable to Military / Coast Guard service.

Category 5 Wards of ex-servicemen / Ex-Coast Guard in receipt of gallantry

awards. Category 6 Wards of ex-servicemen / Ex-Coast Guard (PBOR Only).

7. Eligible Courses.

First year professional degree programme in BE, B Tech, BDS, MBBS, B Ed, BBA, BCA, B Pharma, etc. duly recognized by the respective government regulatory bodies, such as All India Council for Technical Education, Medical Council of India, UGC etc (master degree course are not eligible to apply for Prime Minister’s Scholarship except MBA, MCA). The scheme is open for courses mentioned above in recognized institutions (in India only). Students studying abroad are not eligible for this scheme. Students getting stipend for the professional degree course are also not entitled. The candidates may avail only scholarship for first degree course (Professional) i.e. graduate level only under PMSS.

5 8. Scholarship for Integrated Courses.

The facility under PMSS is restricted for professional courses only, such as B Ed but not for BA+B Ed, also for LLB not for BA+LLB duly recognized by the respective Government regulatory bodies such as All India Council for Technical Education, Medical Council of India etc.

9. Minimum Eligible Marks in 10+2 or Graduation.

(Minimum Educational Qualification for Entry) should be 60%. Minimum educational qualification (MEQ) for entry to different professional course is different e.g. for MBBS and B E it is 10+2 where as it is graduation for B Ed and MBA. A candidate must have minimum 60% marks in MEQ to be considered for scholarship.

10. Duration of Scholarship.

Two to five years as approved by the concerned regulatory body (Except one year for B Ed).

11. Amount of Scholarship.

a) The amount of scholarship would be as follows: (i) Rs. 1250/- per month for boys Paid after successful completion of each academic year, till completion of course.

(ii) Rs. 1500/- per month for girls

12. Payment of Scholarship. On completion of 1st

year the candidate shall submit the Payment Form along with two acknowledgement slips, Bonafide Certificate (as per Specimen) duly signed by the Principal / Dean / Registrar of the institution / college and Photocopy of Passbook to KSB either in person or by post for Payment of scholarship and same procedure shall continues for the subsequent academic years till completion of course. For easy comprehension an illustration has been given below:-

Student admitted in B Tech. September 2011 Marks in 10+2. 61% Apply for PMSS. Before 31 December 2011 Finds his name in the list of 4000 successful candidates selected for grant of PMSS.

June 2012

Apply for first Payment of Scholarship by submitting first year / first two semester results.

October 2012

Granted first installment. December 2012

6

* Dates given above are to illustrate an example for easy comprehension and the same may not be quoted as authority.

Apply for second Payment of Scholarship by submitting second year / 3rd & 4th

October 2013 two semester results.

Granted second installment. December 2013 Apply for third Payment of Scholarship by submitting third year / 5th & 6th

October 2014 two semester results.

Granted third installment. December 2014 Apply for fourth Payment of Scholarship by submitting fourth year / 7th & 8th

October 2015 two semester results.

Granted fourth installment. December 2015

7

Incomplete form / pages / column / documents will lead to rejection or returned to RSB / Coast Guard Headquarter unactioned.

13. IMPORTANT INSTRUCTIONS FOR PM’S SCHOLARSHIP SCHEME

(a) Checklist duly signed by student & parent is to be attached on the top of the application form.

(b) Applications along with relevant documents & certificates are to be deposited to respective Rajya Sainik Board / Coast Guard Headquarter “latest by 15TH Feb 2012. Incomplete application form and non submission of required document is liable to be rejected and will be returned unactioned. The application will be received by the RSBs / Coast Guard Headquarter and will be acknowledged with a seal and date of receipt. (c) The concerned RSBs / Coast Guard Headquarter to scrutinize / check the application forms with regard to their eligibility criteria prior to forwarding the same to KSB. (d) Candidates and RSB’s / Coast Guard Headquarter to note that all applications received after the due date will not be considered and returned unactioned. (e) List of selected candidates will be forwarded to RSBs / Coast Guard Headquarter after the merit list is finalized by the BOO at KSB. (f) Two stamped (Rs. 5 each) blank window envelopes of 27x12 cms are to be attached with each application so as to facilitate correspondence with the candidate by KSB / RSB / Coast Guard Headquater. (g) The scholarship is admissible for only two children of ESM / Ex-Coast Guard. Particulars of all children should be indicated in column 16 of application form. This should be in uniformity with the Discharge Book / Certificate of the Ex-servicemen / Ex-Coast Guard. (h) The amount of scholarship, including any other scholarship or financial assistance from any other source will not exceed the total grant of assistance available under this scheme. (i) The payment of scholarship will be granted after the successful completion of each academic year and on the submission of the Payment form, as per the percentages mentioned in ‘Criteria for eligibility’. In case, KSB ask a student to submit the mark sheet for the full year, a student is liable to produce the same, failing which the scholarship will be held up. On receipt of Payment form at KSB it may take approximately two months for processing the form and completing the payment procedure.

8 (j) Candidature of a student shall stand automatically rejected if, at any stage, it is discovered that he / she has secured scholarship fraudulently by making false statement or misrepresentation of facts. Candidate shall have to refund the amount already given, if any. (k) The attached photocopies of the supporting documents should be duly attested by gazetted officer (unattested documents will not be considered). In case of legally adopted son / daughter or child born after retirement, the certificates are to be attached with the application form duly attested by Secretary, RSB / ZSB / Coast Guard Headquarter.

(l) In case of change of any address, course, college, it is to be intimated immediately to Kendriya Sainik Board & Rajya Sainik Board / Coast Guard Headquarter in writing. Always mention selection serial number, name of applicant and ESM / Ex-Coast Guard particular for any correspondence with KSB & RSB / Coast Guard Headquarter after getting selected for the scholarship.

(m) The Ministry of Defence, Government of India can suitably modify these instructions to remove anomalies, if any, for successful implementation of the scheme, as may be necessary from time to time and will be applicable to all students under the scheme.

(n) Ex-servicemen entitlement will be governed as per the existing definition of ex-servicemen, as amended from time to time. The definition is available in the guide book available with the RSB / ZSB, also applicable to Ex-Indian Coast Guard personnel as per the rules of DGCG. (o) The application form should be downloaded from the official website of MOD, i.e. www.mod.nic.in. The application form should be submitted to the respective Rajya Sainik Board / Coast Guard Headquarter, (List of RSBs / COAST GUARD HEADQUARTER is attached along with the brochure) duly completed. (p) While filling the application form, leave 1 (one) box blank between 2 (Two) words. Column wise guidelines are explained further for filling up the application form.

9 14. IMPORTANT INSTRUCTIONS FOR PAYMENT FORM

(a) Payment Form (Specimen given at page 24) to be filled carefully and the following documents should be attached with it:-

(i) A Bonafide certificate from the College/Institute indicating that the candidate continues to study in the subject course and showing his / her percentage of marks for which the Prime Minister’s Scholarship has been sought (As per the specimen attach).

(ii) Photocopy of passbook showing name, account number with photograph of individual and cancelled leaflet cheque. (Scholarship will not be sent in absence of photocopy of passbook)

(iii) Candidate to attach a self addressed envelope, duly stamped to receive the acknowledgement of Payment form by post.

10

15. COLUMN WISE GUIDE LINES FOR FILLING UP OF APPLICATION FORM

(a) Column -1. Fill your name as in matriculation certificate only:- (Not to be filled in any other format.)

1st A Name J A Y Middle Name S I N G H Surname R A N A

(b) Column -2. Put a tick (√) mark as shown.

Male √ Female (c) Column – 3. Date of Birth as shown in matriculation certificate only. For Example:- (10 June 1982)

D D M M Y Y Y Y 1 0 0 6 1 9 8 2

(d) Column – 4. Mention your Rajya Sainik Board 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). (e) Column – 5. Write your permanent address and correspondence address in block letters.

(f) Column – 6. Write phone number along with STD code and email ID for any query (email ID is must).

(g) Column – 7. Category as per para 6 to be written (attach the required document, if any). Category 1 (One).

Category - 1 O N E

(h) Column – 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 C H A N D R A C H O U D H U R Y 1 4 5 2 3 6 K S E R G E A N T A I R F O R C E

11 (i) Column – 9. Details of 10+2 or MEQ. Leave blank space between words. Marks to be shown in words and figures. a. Total Marks O N E T H O U S A N D (in words) T W O H U N D R E D (in figure) 1 2 0 0

b. Marks obtained N I N E H U N D R E D

(in words) F O R T Y

(in figure) 9 4 0

c. % of marks scored S E V E N T Y E I G H T (in words) P O I N T T H I R T Y T H R E E (in figure) 7 8 . 3 3

(j) Column – 10. Tick as applicale.

Yes √ No (k) Column – 11. The student is to specify the course which he / she is presently studying. (Example:- B TECH)

B T E C H (l) Column – 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 M M

0 4 0 6 (In word)

F O U R Y E A R S A N D S I X M O N T H S

(m) Column – 13. Write date of commencement & completion of course as shown below: (Course Commencement / Date of Admission)

D D M M Y Y Y Y 0 1 0 7 2 0 0 7

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

12 (n) Column - 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. 0 8 E A T I T 0 4 3

Name of College A J M E R I N S T I T U T E O F T E C H N O L O G Y

Full Address P U S H K A R B Y P A S S A of college J M E R

State R A J A S T H A N

Pin Code 3 0 5 0 0 4

Tel No. (with STD Code) 0 1 4 5 - 2 3 0 0 6 2 8

E-Mail ID a i t _ a j m e r @ r e d i f f m a i l . c o M College Website w w w . a i t a j m e r . c o m

(o) Column - 15 Write the regulatory body of your college.

A I C T E (p) Column – 16. Furnish the particulars of your all children as per specimen given:-

Sl. No. Name of Child Gender Date of Birth Age 1 Prakash Singh Rana M 10/10/1982 28 Years 2. Satish Singh Rana M 12/05/1984 26 Years 3. Ajay Singh Rana M 03/07/1987 23 Years 4. Komal Rana F 14/02/1989 21 Years

(q) Column – 17. Given details of the scholarship availed by your brother / sister in the past, if not availed write Not Applicable. Sl. No.

Selection Serial No.

given by KSB

Name of the brother/sister

Course of Study

Academic year in which applied

Amount received so far

1. 6359 Satish Singh Rana B Tech 2007-08 15000

Note: Application form from page number 13 to 18 alongwith required documents only to be forwarded.

13

CHECK LIST OF DOCUMENTS TO BE ATTACHED WITH THE APPLICATION FORM

1. Candidates / ESM / Ex-Coast Guard are to ensure that the following documents are attached (as applicable) along with the Application Form (non submission of these certificate will lead to rejection and application will be returned unactioned). (a) Extract of ESM / Ex-Coast Guard discharge book as per specimen. (b) If child born after discharge then affidavit is to be submitted by ESM / Ex-Coast Guard, that child is dependent on him and he / she is a ward of ESM / Ex-Coast Guard. (c) Additional Certificates – Attested copy of following documents. (i) Category 1: Part II Order Equivalent of other (ii) Category 2: Part II Order services i.e. Army / (iii) Category 3: Part II Order Navy / Air Force / Coast (iv) Category 4: Part II Order Guard (v) Category 5: Award Certificate alongwith gazette

notification

(d) Attested photocopy of matriculation or equivalent examination certificate for verification of date of birth. (e) Attested photocopy of mark sheet of MEQ as applicable (e.g. 10 plus 2, graduation / diploma etc). In case the MEQ is graduation / diploma, then complete mark sheet is required to be submitted. (f) In case of MBA / MCA applicants, attested copy of minimum entry qualification certificate. i.e Graduation (g) Bonafide studentship certificate to be issued by Registrar / Dean / Principal of College / Institution pertaining to course for which scholarship is claimed (As per specimen attach).

Date: _____________________ _______________________________ Place: ____________________ Full Name & Signature of Candidate

_______________________________________

Checked / counter singed by ESM / Ex-Coast Guard / Widow

14

Recent Photograph Of Student

(Write your name & ESM/Ex-Coast Guard/widow particular on

reverse)

FOR OFFICIAL (KSB) USE ONLY

Signature of Supervisor/ IC PMSS Remarks of Supervisor ___________________________ _______________________________

_______________________________

_______________________________

RECOMMENDED / NOT RECOMMENDED Remarks of JD PMSS _______________________________

Signature of JD PMSS _______________________________

____________________ ______________________________ __________________________________________________________________________

Selection Serial Number

(To be allotted by KSB) ......................

APPLICATION FOR PRIME MINISTER’S SCHOLARSHIP FOR THE YEAR 2011-12 ___.

Note: 1.) Please read column wise guide lines carefully before filing the application 2.) Application Form to be filled in Capital letters except email ID.

3.) Checklist must be attached on the top of application duly tick marked. 4.) One candidate to submit only one application form for one course.

1. NAME:- First Name

Middle Name

Surname

2. Put a tick mark (√)

Male Female

15 LEAVE BLANK SPACE BETWEEN WORDS

3. Date of Birth (please attach proof of age) (i.e : Matriculation certificate)

DD MM Y Y Y Y

4. Your Rajya Sainik Board or Zila Sainik Board (Where ESM is registered and obtained Ex-servicemen Identity card) (Only for ESM) RSB

ZSB

5. Full Address:

a) Present Correspondence Address: - (Where you want your letter to be sent in case of selection / rejection)

b) Permanent Address:-

House No. Street No. & Name

Tehsil District State Pin Code

House No. Street No. & Name

16 LEAVE BLANK SPACE BETWEEN WORDS

6. Telephone Number.

STD Code Land Line No. Mobile No.

E-Mail (mandatory)

7. Ex-servicemen / Ex-Coast Guard Category - (Mention category as per Para 6 of the brochure and attach supporting documents duly attested).

8. Ex-serviceman’s / Ex-Coast Guard’s Particulars:-

a) Name of ex-serviceman / Ex-Coast Guard

b) Service No.

c) Rank d) Type of Service (Tick one) Army Air Force Navy Coast Guard

9. Details of MEQ / course for qualifying examination for scholarship (10+2/equivalent or minimum entry qualification)

a. Name of Course/MEQ

b. Year in which exam passed

c. Total Marks (in words) (in figure)

Tehsil District State Pin Code

17 LEAVE BLANK SPACE BETWEEN WORDS

d. Marks obtained (in words) (in figure)

e. % of marks scored (in words) (in figure)

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

Yes No Rs (per month / year)

11. Name of the Course (as per specimen)

12. Duration of Course in Years in figure and months in words 13. Date of Commencement and Approximate Date of Completion. D D M M Y Y Y Y a) Course commenced on D D M M Y Y Y Y b) Course completion date approximately 14. Details of College / Institute. Name of Student Roll No. Name of College Full Address of college

18 LEAVE BLANK SPACE BETWEEN WORDS State Pin Code Tel No. (with STD Code)

E-Mail ID (if any) College Website

15. Regulatory bodies/ Council. (For example all engineering degrees and management degree courses are recognized by AICTE & UGC and all medical degree are recognized by Medical Council of India or Dental Council of India, specify as per case).

16. Furnish particulars of all children in order of age, as reflected in the discharge book or attached a certificate in case child born after discharge, by the RSB / ZSB / Record Office / Coast Guard Headquarter, as applicable.

Sl. No. Name of Child Gender Date of Birth

17. Details of brother/sister availing the PM’s Scholarship, if any. (Including yourself if granted earlier)

Sl. No.

Selection Serial No.

given by KSB

Name of the brother/sister

Course of Study

Academic year in which applied

Amount received so far

18. Declaration: “Certified that the particulars given by me in the application are correct

and any false statement made by us will disqualify me / my ward for award of PM’s Scholarship Scheme, besides recovery of scholarship already paid. I also undertake to abide by the conditions mentioned in the general instructions of the scheme.”

Place: (Signature of ward) _____________________________ Date: (Full Name of Ward) _____________________________ Place: (Signature of Parent) ____________________________ Date: (Full Name of Parent) ___________________________

19

CERTIFICATE FROM RSB / ZSB /

DIRECTORATE GENERAL OF COAST GUARD “It is certified that PM Scholarship application form for academic year 2011-12 in

respect of Mr. / Ms. __________________________________________________________

S/o / D/o Ex -____________________________________________________ has been

checked, found correct as per check list provided by KSB and the applicant is eligible to apply

as per rules of the scheme”.

Office seal: Secretary / Director

RSB / ZSB / Coast Guard Headquarter

Place: ________________ Date : ________________

20

CERTIFICATE FOR PM SCHOLARSHIP 1. It is certified that Ms. / Mr._____________________ is Bonafide

student of __________________________________ college. His / Her roll

number is __________ and he / she is studying in the I / II / III / IV / V year

or ______ semester of the One / Two / Three / Four / five years

_______________ course in ____________________ branch (if any). He

/ she has joined this college in the academic year 20___ - ___ and the

course will be completed in the month of ____________ 20___ -___.

2. This is also certified that _____________ course is a professional

degree course and this college is approved by

________________________________________________.

3. This is also certified that student is getting Rs._____________ per

month / year (If not getting write N/A) scholarship / stipend from this

Institute / College or any other sources.

Office Seal: Signature of Principal / Dean / Registrar

Date:- ______________

Place:-_____________

21

SPECIMEN COPY OF EX-SERVICEMEN / EX-COAST GUARD CERTIFICATE

(This is important document, fill it carefully) (In lieu of Discharge Book)

1. Type of : _______________________________________ Service (Army, Navy, Air Force or Coast Guard)

2. Service No. : _______________________________________

3. Rank : _______________________________________

4. Name & Initials : _______________________________________ 5. Trade : _______________________________________ 6. Date of enrolment : _______________________________________ 7. Date of Discharge : _______________________________________ 8. Reason for Discharge : _______________________________________ 9. Duration/Length of Service : _______________________________________ 10. Regular / Reserve : _______________________________________ 11. ESM ID Card issued vide sl no RSB/ZSB/………………………………………dated……………... 12. ESM / Ex-coast Guard died on (if applicable) : _______________________________________ 13. Cause of death & : _______________________________________

Whether Attributable to military / coast guard service 14. Particulars of dependent children:-

Sl. No.

Name Gender Date of Birth

1. 2. 3. 4. 5. 6.

It is certified that the above information is duly checked from the discharge book of Ex-servicemen / Ex-Coast Guard and found to be correct.

Office Seal:

Dir RSB/ZSB/OI/C Record Office / Coast Guard Headquarter

Date: ________________________ Place: ______________________

22

IMPORTANT INSTRUCTION FOR PAYMENT FORM 1. Minimum Marks for Payment of Scholarship. The candidates should have secured a minimum of 50% marks, uninterrupted for continuation of scholarship in every year for the duration of course up to a maximum period of 5 years as prescribed for that programme of study. A person granted scholarship for one programme would not be entitled for scholarship for another programme. * Note:- If the marks in the qualifying examination are expressed in grades only, then equivalent percentage (100 point scale) duly certified by the concerned college / Board must be furnished (KSB will not be calculating the percentage of marks).

2. Account Details. All candidates to open individual bank accounts in the nearest State Bank of India branch or Punjab National Bank which has “electronic clearance system” / Core Banking, to facilitate transfer of the scholarship amount. Account number of the sister concern bank will not be accepted. i.e State Bank of Travancore, State Bank of Bikaner & Jaipur, etc. Candidate to attach a attested photocopy of passbook, showing name and account number of the individual. A cancelled leaflet of a blank crossed cheque will duly authenticate the account number. A joint account with parent will also fulfill the requirement. DOCUMENTS TO BE ATTACHED WITH PAYMENT FORM: (a) A Bonafide certificate from the College/Institute indicating that the candidate continues

to study in the subject course and showing his / her percentage of marks for which the Prime Minister’s Scholarship has been sought (As per the specimen attach).

(b) Photocopy of passbook showing name, account number with photograph of

individual and cancelled leaflet cheque. (Scholarship will not be sent in absence of photocopy of passbook)

(c) Candidate to attach a self addressed envelope, duly stamped to receive the

acknowledgement of Payment form by post.

23 PRIME MINISTER’S SCHOLARSHIP SCHEME

ACKNOWLEDGEMENT SLIP

OFFICE COPY

Your Payment form dated_________ has been received on__________. The

application will be examined for eligibility. The dak receipt number ____________ is to be

mentioned for further correspondence with this office.

Office Seal: (Signature of RSB / Coast Guard Headquarter)

Tear off Tear off

ACKNOWLEDGEMENT SLIP

STUDENT COPY

Your Payment form dated_________ has been received on__________. The

application will be examined for eligibility. The dak receipt number ____________ is to be

mentioned for further correspondence with this office.

Office Seal: (Signature of RSB / Coast Guard Headquarter)

Note: This copy duly stamped and signed by RSB / Coast Guard Headquarter is to be

given to the student by hand or by post.

Selection Serial Number......................

24

PAYMENT FORM FOR 1st, 2nd, 3rd and 4th

YEAR SCHOLARSHIP UNDER PRIME MINISTER’S SCHOLARSHIP SCHEME

(To be send only if selected for scholarship)

1. Name of the applicant (Ward/widow):

2. Put a tick mark (√) 3. Selection serial No. given by KSB:

4. Particular of ESM / Ex-Coast Guard:

5. Present address (where you want your letter is to be sent)

(To be filled up only in case of change from previous address or write N / A)

6. Details of Bank account of SBI or PNB for Electronic Clearing Services ((PLEASE ATTACH A

PHOTOCOPY OF PASS BOOK, CROSSED BLANK CHEQUE SHOWING YOUR ACCOUNT NUMBER TO BE FORWARDED, EVEN IT IS SUBMITTED EARLIER).

Name of account holder

Bank Name

LEAVE BLANK SPACE BETWEEN WORDS Branch Name

Male Female

Name of ESM / Ex-Coast Guard Rank Service Number

House No. Street No. & Name Tehsil & Post Distt State Pin Code

25

Branch Address

State

Bank Tel. No.

Branch Code

MICR (9 digit) No. (PLEASE ATTACH A PHOTOCOPY OF CHEQUE & PASS BOOK)

Account No.

REPEAT

Account No.

Place:_____________________ ________________________________ Date:______________________ Full Name & Signature of the ward / widow

It is certify that the information submitted by my child / self is correct.

Place :_____________________ _____________________________ Date : _____________________ Full Name & Signature of the Parent

LEAVE BLANK SPACE BETWEEN WORDS

26

Please Fill Properly Your Full Year (Both Semester’s) Marks

1. It is certified that Ms. / Mr._____________________ is a Bonafide student

of __________________________________ college. He / she is studying in the

I / II / III / IV / V year of the two / three / four / five years _______________

course. He / she had joined this college in the academic year 20___ - ___ and

the course will be completed in the month of ____________ 20___ - ___.

2. This is also certified that Ms. / Mr. ___________________________

__________ has successfully completed his / her 1st / 2nd / 3rd / 4th / 5th year and

scored

Year Marks Obtained Out of Percentage

1st Year (1st & 2nd sem) ____________ ______ _________

2nd Year (3rd & 4th sem) ____________ ______ _________

3rd Year (5th & 6th sem) ____________ ______ _________

4th Year (7th & 8th sem) ____________ ______ _________

5th Year (9th and 10th sem) ____________ ______ _________

3. He / she is continuing the course in 2nd / 3rd / 4th / 5th

4. This is also certified that student is getting Rs _____ per month / year (If not

year.

getting write N/A) scholarship / stipend from this Institute / College or any other

sources.

5. His / Her renewal of scholarship is hereby recommended. His / her account

no. is ___________________________________

Office Seal:

Signature of Principal / Dean / Registrar

Date: ________________

Place: _______________

27

ADDRESS OF DEPTT OF SAINIK WALFARE / RAJYA SAINIK BOARDS & DIRECTORATE GENERAL OF COAST GUARD

Sl No Address of RSB For Detail, Pl contact RSB

1 ANDAMAN & NICOBAR ISLANDS (UT)

Secretary Rajya Sainik Board A & N Administration, Secretariat Port Blair - 744 101

Port Blair- 03192-235621 (O) 03192-235621(F) secretaryrsbandnic@gmail.com

2 ANDHRA PRADESH

Director Deptt of Sainik Welfare Block IV, II Floor, Gruhakalpa Premises, MJ Road, Nampally, Hyderabad - 500 001

Hyderabad 040-24736890 (F) 040-24747991 (O) apsainik@gmail.com

3 ARUNACHAL PRADESH

Director Dte of Relief, Rehabilitation & Settlement, Govt of Arunachal Pradesh, New Itanagar-791110

Itanagar- 0360-2212282 (O) 0360-2212282 (F) 0360-2213615 (F) rsbaruna@gmail.com

4 ASSAM

Director Dte of Sainik Welfare, Sainik Bhavan, House No-74, Lachit Nagar, Guwahati - 781 007

Guwahati- 0361-2522229 (O) 0361-2522229 (F) rsbassam@gmail.com

5 BIHAR

Director Sainik Kalyan Nideshalaya Home Deptt, Old Secretariat Barrack No.10, Patna – 800015

Patna 0612-2217301 (O) 0612-2217301 (F) directorsknbihar@gmail.com

6 CHANDIGARH (UT)

Zila Sainik Welfare Officer Zila Sainik Welfare Office (UT) Opposite Aroma Hotel, Sector-21-D, Chandigarh - 160 022

Chandigarh 0172-2701947 (O) 0172-2700317 (O) 0172-2726325 (F) zsw_chd@yahoo.com

7 CHHATTISGARH

Director Deptt of Sainik Welfare, CG Near Collectorate Parisar, Behind Home Guard Office Raipur - 492 001

Raipur 0771-2445165 (O) 0771-2427449 (O) 0771-2420084 (F) dirsw.cg@gmail.com

28

8 DELHI Secretary Rajya Sainik Board Opp Tis Hazari Court No.1, Rajpur Road, Delhi-110 054

Delhi- 011-23991876 (F) 011-23969260 (O) rsbdelhi@nic.in

9 GOA Secretary Deptt of Sainik Welfare Collectorate Building Panaji - 403 001

Panaji 0832-2227138 (O) 0832-2227138 (F) secyrsbgoa@gmail.com

10 GUJARAT

Director Directorate Sainik Welfare & Resettlement, Gujrat State Gaurav Senani Bhavan, Shahibaug-Airport Road, Shahibag, Ahmedabad-380001

Gandhinagar 079-22868347 (O) 079-22868348 (O) 079-22868346 (F) dir_sw@gujarat.gov.in rsb_guj@rediffmail.com

11 HARYANA

Secretary Rajya Sainik Board Sainik Bhawan, Sector 12, Shaheed Capt Rohit Kaushal Marg, Panchkula - 134 109

Panchkula 0172-2560462 (O) 0172-2560462 (F)) sainikparivar@yahoo.com

12 HIMACHAL PRADESH

Director Deptt of Sainik Welfare Govt of Himachal Pradesh Hamirpur - 177 001

Hamirpur- 01972-221854 (O) 01972-224659 (O) 01972-225643 (F) dir_sw_hp@nic.in

13 JAMMU AND KASHMIR

Director Deptt of Sainik Welfare Ambphalla, Jammu - 180005

Jammu 0191-2561547 (O) 0191-2575362 (F) jkrsbsecy@yahoo.in

14 JHARKHAND Director Sainik Kalyan Nideshalaya Ranchi (Jharkhand)

Ranchi- 0651-2330178 (O) 0651-2331434 (F) jharkhand_skn@yahoo.in

15 KARNATAKA

Director Deptt of Sainik Welfare & Resettlement, Fd Mshl KM Cariappa, Bhavan, No 58, Fd Mshl KM Cariappa Road, Bangalore - 560 025

Bangalore- 080-25589459 (O) 080-25589459 (F) dirdswrblr@gmail.com

29

16 KERALA Director Deptt of Sainik Welfare Vikas Bhavan, Thiruvananthapuram - 695 033

Thiruvananthapuram 0471-2304980 (O) 0471-2304980 (F) directordswkerala@yahoo.com

17 MADHYA PRADESH

Director Deptt of Sainik Welfare Southern Shopping Centre Guru Teg Bahadur Complex, TT Nagar, New Market, P.B.NO 364, Bhopal - 462 003

Bhopal- 0755-2553992 (O) 0755-2577209 (F) dswoffice@mp.gov.in

18 MAHARASHTRA

Director Deptt of Sainik Welfare Maharashtra State ‘Raigad’, Opp National War Memorial, Solapur Road, Ghorpadi, Pune-411 001

Pune- 020-26332763 (O) 020-26332764 (O) 020-26334427 (O) mahasainik@dataone.in dsw@mahasainik.com

19 MANIPUR

Secretary Rajya Sainik Board Sainik Rest House Opp. Lamphel Police Station, PO-Lamphel, Imphal-795004

Imphal- 0385-2416228 (O)

20 MEGHALAYA

Director Dte of Sainik Welfare Public Service Commission Building Beyond DC Building Shillong - 793 001

Shillong- 0364-2225613 (O) 0364-2225613 (F) rsbmegha@rediff.com

21 MIZORAM Director Deptt of Sainik Welfare & Res, Tuikual ‘A’, PB No. 119 Aizawl - 796 001

Aizawl- 0389-2322732 (O) 0389-2322732 (F) rsbmizoram@yahoo.in

22 NAGALAND Secretary Rajya Sainik Board, Home Deptt, Home Br, Nagaland Civil Sectt., Kohima - 797 001

Kohima- 0370-2270029 (O) 0370-2270029 (F) secyrsb-ngl@nic.in

30

23 ORISSA Secretary Rajya Sainik Board, Nageswar Tangi, Lewis Road, Bhubaneshwar-751002

Bhubaneshwar 0674-2432268 (O) 0674-2435998 (F) secyrsbors@rediffmail.com secyrsbbbsr@gmail.com

24 PUDUCHERRY (UT)

Director Deptt of Sainik Welfare Jawan Bhavan Complex, Lawspet Main Road, Pakkamudayanpet, Puducherry - 605 008

Puducherry 0413-2253107 (O) 0413-2250575 (F) dswpuducherry@gmail.com

25 PUNJAB Director Dte of Sainik Welfare, Punjab Punjab Sainik Bhawan, Sector 21-D, Chandigarh - 160 022

Chandigarh 0172-2701845 (O) 0172-2707345 (F) 0172-2706014 (F) dswpb@rediffmail.com ddhq@rediffmail.com ddmpb@rediffmail.com

26 RAJASTHAN Nideshak Sainik Kalyan Vibhag Secretariat Building, North Block, Jaipur - 302 005

Jaipur- 0141-2227897 (O) 0141-2227650 (F) rajasthansainik@yahoo.com

27 SIKKIM Secretary Rajya Sainik Board, Sikkim Paljor Stadium Road, Gangtok-737 101

Gangtok- 03592-202534 (O) 03592-221456 (O) 03592-221456 (F) rsbsikkim@ymail.com

28 TAMIL NADU Joint Director Dte of Ex-Servicemen’s Welfare 22, Raja Muthiah Salai, Choolai Chennai - 600 003

Chennai- 044-26691747 (O) 044-26691886 (O) 044-26691886 (F) exweldte@tn.gov.in

29 TRIPURA

Secretary Rajya Sainik Board, Nehru Office Complex, Gorkhabasti, P.O. Kunjaban, Agartala - 799 006 West Tripura

Agartala 0381-2326507 (O) 0381-2326507 (F) rsb_sainikboard@rediffmail.com rsb.tripura@gmail.com

31

30 UTTAR PRADESH

Director Dte of Sainik Kalyan Evam Punarvas, Kariappa Bhawan, Kaiserbagh, Lucknow - 226 001

Lucknow- 0522-2625354 (O) 0522-2625354 (F) 0522-2305107 (F) directorsainikkalyan@yahoo.com

31 UTTARAKHAND

Director Sainik Kalyan Evam Punarvas Uttarakhand, 15C, Kalidaas Marg, PO-Haathibadkala, Dehradun - 248121

Dehradun- 0135-2744208 (O) 0135-2743773 (F) 0135-2741481 (O) dskddn@gmail.com

32 WEST BENGAL Secretary Rajya Sainik Board, Block 'I' (First Floor), Writers’ Building Kolkata - 700 001

Kolkata- 033-22141347 (O) 033-22144643 (F) 033-22143220 (O) rsbkolkata@yahoo.com rajyasainikboardwestbengal@gmail.com

FOR EX-INDIAN COAST GUARDS ONLY

01 COAST GUARD Directorate General of Coast Guard Headquarter National Stadium Complex New Delhi-110001

011-23074132 (O) 011-23386766 (F)

Note: Dadar Nagar Haveli: ESM of these states can submit their Prime Minister Application form to Gujrat RSB. Daman & Div Lakshadweep: ESM of this state can submit their Prime Minister Application form to

Kerala RSB.