Pm Scolarship 2009-10

8/2/2019 Pm Scolarship 2009-10

1/34


2/34

RecentPhotographOf Student

(Write your name &ESM/widow

particular onreverse)

Selection Serial Number (To be allotted by KSB) ......................

APPLICATION FOR PRIME MINISTERS SCHOLARSHIP FOR THE YEAR 200_ - ___.

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 ()

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)RSB

ZSB

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

LEAVE BLANK SPACE BETWEEN WORDS

Male Female

House No.

Street No. & Name


3/34

b) Permanent Address :-

6. Telephone Number.

STD Code

Land Line No.

Mobile No.

E-Mail (mandatory)

7. Ex-servicemen Category - (Mention category as per Para 6 of the brochure and attachsupporting documents duly attested).


Tehsil

District

State

Pin Code

House No.

Street No. & Name

Tehsil

District

State

Pin Code


4/34

8. Ex-servicemans Particulars:-

a) Name of ex-serviceman

b) Service No.

c) Rank

d) Type of Service (Tick one) Army Air Force Navy

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

a. Name of Course/MEQ

b. Year in which exam passed

c. Total Marks (in words)

(in figure)

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 anygovt. / Private source for the course to which the scholarship applied for. If yes, then state the amount andsource

Yes No

Amount

Source

11. Name of the Course(as per specimen)


12. Duration of Course in Years in figureand months

in words


5/34

13. Date of Commencement and Approximate Date of Completion.

D D M M Y Y Y Ya) 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 Addressof college

State

Pin Code

Tel No. (withSTD Code)

E-Mail ID (if any)

College Website

15. Regulatory bodies/ Council. (For example all engineering degrees and management degreecourses are recognized by AICTE & UGC and all medical degree are recognized by Medical Councilof 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 certificate orattached by the RSB/ZSB/Record Office.


Sl. No. Name of Child Gender Date of Birth


6/34

17. Details of brother/sister availing the PMs Scholarship, if any. (Including yourself if grantedearlier)

Sl.No.

Selection SerialNo. given by

KSB

Name of thebrother/sister

Course ofStudy

Academic yearin which applied

Amoureceived s

18. Details of Students Bank account for payment of Scholarship through Electronic ClearingService.

Name of account holder

Bank Name

Branch Name

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.


19. Details of Demand Draft.Issue D D M M Y Y Y

YDemand Draft No. Date

Amount (Rs.) in figure


7/34

Amount (Rs.) in word

Issuing Bank Name

Issuing Bank Branch

20. 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 PMs ScholarshipScheme, besides recovery of scholarship already paid. I also undertake to abide by theconditions 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) ______________________

CERTIFICATE FROM RSB / ZSB

It is certified that PM Scholarship application form for academic year 20___ - ___

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: Director, RSB / ZSB

Place : ________________

Date : ________________


8/34

SPECIMEN COPY OF BONAFIDE CERTIFICATE

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.__________________ (If not getting

write N/A) stipend from this Institute / College or any other sources. l

Office Seal: Signature of Principal / Dean / Registrar

Date:- ______________

Place:-_____________


9/34

SPECIMEN COPY OF EX-SERVICEMEN CERTIFICATEEX-SERVICEMEN CERTIFICATE

(In lieu of Discharge Book)

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

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 died on (if applicable) : _______________________________________

12. Cause of death & : _______________________________________ Whether Attributable

13. 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-servicemenand found to be correct.

Office Seal: Dir RSB/ZSB/OI/C Record Office

Date: ________________________

Place: ______________________


10/34

PRIME MINISTERS SCHOLARSHIP SCHEME ACKNOWLEDGEMENT SLIP

OFFICE COPY

Your Renewal 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)

Tear off Tear off

ACKNOWLEDGEMENT SLIP

STUDENT COPY

Your Renewal form dated_________ has been received on__________. The




Note: This copy duly stamped and signed by RSB given to the student by hand or bypost.


11/34

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

PROFORMA FOR RENEWAL OF SCHOLARSHI P UNDER PRI ME MI NI STERSSCHOLARSHI P SCHEME

(To be send only if selected for scholarship)1. Name of the applicant (Ward/widow):

2. Selection serial No. given by KSB:

3. Particular of ESM:

4. 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)

5. Details of Bank account of SBI or PNB for Electronic Clearing Services ((PLEASE ATTACH APHOTOCOPY OF PASS BOOK, CROSSED BLANK CHEQUE SHOWING YOUR ACCOUNT NUMBER TO BE FORWARDED, EVEN IT IS SUBMITTED EARLIER).

Place: ________________________________ Date: Full Name & Signature of the ward / widowIt is certify that the information submitted by my child / Self is correct.

Place : _____________________________

Date : Full Name & Signature of the ParentLEAVE BLANK SPACE BETWEEN WORDS

Name of ESM

Rank Service Number

House No.

Street No. & Name

Tehsil & Post

DisttRSB

Pin Code

Name of account holderand account number


12/34

SPECIMEN COPY OF BONAFIDE CERTIFICATE FOR RENEWAL

CERTIFICATE FOR RENEWAL OF PM SCHOLARSHIP

1. It Is certified that Ms. / Mr ._____________________ is a 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 two / three

/ four / five years _______________ course in ____________________ branch (if any).

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 1 st / 2 nd / 3 rd / 4 th / 5 th year and scored

________ % / Grade__________ (Total marks obtained were _____________ out of

____________) and he / she is continuing the course in 2 nd / 3 rd / 4 th / 5 th year .

Office Seal:

Signature of Principal / Dean / Registrar

Date: ________________

Place: _______________


13/34

CHECKLIST FOR RENEWAL OF SCHOLARSHIPDOCUMENTS TO BE ATTACHED:

(a) A Bonafide certificate from the College/Institute indicating that the candidatecontinues to study in the subject course and showing his / her percentage of marksfor which the Prime Ministers Scholarship has been sought (As per the specimenattach).

(b) Candidate to attach a self addressed envelope, duly stamped to receive theacknowledgement of renewal form by post.

________________________________

Full Name & Signature of the Candidate


14/34

PRIME MINISTERS SCHOLARSHIP SCHEME


OFFICE COPY

Your Application Form dated_________ has been received on__________. The




Tear off Tear off


STUDENT COPY

Your Application Form dated_________ has been received on__________. The




15/34


Note: This copy duly stamped and signed by RSB given to the student by hand or bypost. (Envelope enclosed along with the application may be used.)

MINISTRY OF DEFENCE Department of Ex-Servicemen Welfare

PMS SCHOLARSHIP SCHEME

FORDEPENDENT WARDS OF EX-SERVICEMEN /

WIDOWS

Brochure-Cum-Application Form For Academic Year 2009-10

Application Form consists of Col No 1 to 20, Renewal Form and list of RSB at stateand UT level. (Brochure-Cum-Application consists of 31 pages)


16/34

KENDRIYA SAINIK BOARDWest Block-IV, Wing-VII, 2 nd Floor

R K Puram, New Delhi-110066Website: www.mod.nic.in

Tele : 011- 26715250E-Mail : [email protected]

Note: This application form (page number 13 to 22 alongwith required documentsonly) is to be deposited by individual to RSB. Applications dulyrecommended by RSBs shall only be considered by KSB. Therefore,candidates are advised not to forward applications direct to KSB as the sameshall not be considered.

PRIME MINISTERS SCHOLARSHIP SCHEME

1. Introduction.

To encourage higher technical and professional education for the dependent wardsof ESM and their widows (below officer rank only) and dependent wards / widowsof ex-servicemen who died in harness due to causes attributed to military service,irrespective of the rank, Prime Ministers Scholarship Scheme has been introducedfrom the Academic year 2006-07.

2. Scholarships Available.

A total number of 4000 scholarships will be allotted.

3. Students eligible for the scholarship.

(a) Dependent wards of ex-servicemen and their widows (below officer rankonly)

(b) Dependent Wards/widows of ex-servicemen who died in harness due tocauses attributed to military service, irrespective of the rank.

(c) The scheme is open only for widows and wards of ESM.

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 inharness due to causes attributable as at (b), there will be no rank restriction.

4. How to Apply For Scholarship.

One candidate to submit only one application form for one course, if anycandidate submit two application for more than one course, both the
http://www.mod.nic.in/mailto:[email protected]:[email protected]://www.mod.nic.in/


17/34

applications will be rejected. Forms are to be downloaded from the websitewww.mod.nic.in . Application forwarded on any other format will not be considered.

Application to be forwarded on plain A4 size paper (typed or handwritten) in theprescribed format duly completed in all respects with superscription on theenvelope Prime Ministers Scholarship Scheme.

Documents to be attached alongwith PMSS application form are as follows:-

(a) Photocopy of ESM valid I card duly certified by RSB / ZSB.

(b) Extract of ESM discharge book as per specimen. (Refer page number 22)

(c) Matriculation certificate duly attested.

(d) Minimum Entry Qualification certificate duly attested. (10+2 Marksheet or

full Graduation Marksheet which ever is applicable)

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

(Refer page number 21)

(f) Demand Draft of Rs. 30/- not made before 20 th December 2009.

Note: Failure to attach any above mentioned documents / certificate will lead torejection.

5. Selection Procedure.

Applications will be short listed based on Ex-servicemen category (as given in para6) 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 personnel killed in action.

Category 2 Wards of ex-servicemen disabled in action and boarded out ofservice with disability attributable to military service.

Category 3 Wards/widows of defence personnel who died while in servicefor causes attributable to military service.

Category 4 Wards/widows of Defence personnel disabled in service withdisability attributable to military service.

Category 5 Wards of ex-servicemen in receipt of gallantry awards.

Category 6 Wards of ex-servicemen (PBOR).
http://www.mod.nic.in/http://www.mod.nic.in/


18/34

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 governmentregulatory bodies, such as All India Council for Technical Education, MedicalCouncil of India, UGC etc. The scheme is open for courses mentioned above inrecognized institutions (in India only). Students studying abroad are not eligiblefor this scheme. Students getting stipend for the professional degree course arealso not entitled. The candidates may avail only one time facility for firstdegree course (Professional) i.e. graduate level only under PMSS.

8. Scholarship for Integrated Courses.

The facility under PMSS is restricted for professional courses only duly recognizedby the respective Government regulatory bodies such as All India Council forTechnical 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 courseis different e.g. for MBBS and B E it is 10+2 where as it is graduation for B Ed andMBA. A candidate must have minimum 60% marks in MEQ to be considered forscholarship.

10. Duration of Scholarship.

Two to five years as approved by the concerned regulatory body (Except one yearfor B Ed and five and half years for MBBS).

11. Amount of Scholarship.

a) The amount of scholarship would be as follows:

(i) Rs. 1250/- per month for boys Paid after successful completion ofeach

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

12. Renewal of Scholarship.

Candidate shall submit new Renewal Form along with two acknowledgement slipand Bonafide Certificate duly signed by the Principal / Dean / Registrar of theinstitution / college to the respective RSBs either in person or by post for renewalof scholarship for the subsequent academic year. RSBs will scrutinize and checkthe application forms and forward the same complete in all aspects to KSBimmediately. RSBs will issue acknowledgement slip to the candidates at the timeof submission of the application in person otherwise dispatch by post to them.Candidate to attach a self addressed envelope, duly stamped to receive theacknowledgement of renewal form by post. For easy comprehension anillustration has been given below:-

Student admitted in B Tech. Se tember 2008


19/34

Incomplete form / pages / column / documents will lead to rejection orreturned to RSB unactioned.

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

IMPORTANT INSTRUCTIONS FOR PMS SCHOLARSHIP SCHEME

(a) PM SCHOLARSHIP SCHEME is to be written in superscript on top

of the Envelope for any correspondence with KSB & RSB.(b) Checklist duly signed by student & parent is to be attached on the top ofthe application form.

(c) Applications alongwith relevant documents & certificates are to be depositedto respective Rajya Sainik Board, latest by 15 th Feb 2010 . Incompleteapplication form and non submission of required document is liable to berejected and will be returned unactioned . The application will be received by theRSBs and will be acknowledged with a seal and date of receipt.

(d) The concerned RSBs may scrutinise / check the application forms withregard to their eligibility criteria from all aspects prior to forward the same toKSB.

(e) Candidates and RSBs to note that all applications received after thedue date will not be considered and returned unactioned.

(f) List of selected candidates will be forwarded to RSBs after the meritlist is finalized by the BOO at KSB .

Marks in 10+2. 61%Applied for PMSS. Before 31 December 2009Finds his name in the list of 4000 successful candidatesselected for grant of PMSS.

June 2009

Applied for first renewal of Scholarship by submitting firstyear / first two semester result.

October 2009

Granted first installment. December 2009

Applied for second renewal of Scholarship by submittingsecond year / second two semester result.

October 2010

Granted second installment. December 2010Applied for third renewal of Scholarship by submittingthird year / third two semester result.

October 2011

Granted third installment. December 2011Applied for fourth renewal of Scholarship by submittingfourth year / fourth two semester result.

October 2012

Granted fourth installment. December 2012


20/34

(g) Three stamped (Rs. 5 each) blank envelopes of 27x12 cms and onestamped (Rs. 35) blank envelope of 35x25 cms are to be attached with eachapplication so as to facilitate correspondence with the candidate by KSB/RSB.

(h) The scholarship is admissible for only two children of ESM . Particularsof all children should be indicated in column 17 of application form. This should bein uniformity with the discharge book / certificate of the ESM.

(i) The amount of scholarship, including any other scholarship or financialassistance from any other source will not exceed the total grant of assistanceavailable under this scheme.

(j) The payment of scholarship will be granted after the successful completionof each academic year and on the submission of the renewal form (in original), asper the percentages mentioned in Criteria for eligibility. In case, KSB ask astudent to submit the mark sheet for the full year, a student is liable to produce thesame, failing which the scholarship will be held up.

(k) Candidature of a student shall stand automatically rejected if, at any

stage, it is discovered that he / she has secured scholarship fraudulently bymaking false statement or misrepresentation of facts. Candidate shall haveto refund the amount already given, if any.

(l) The attached photocopies of the supporting documents should be dulyattested by gazetted officer (unattested documents will not be considered) . Incase of legally adopted son/daughter or child born after retirement, the certificatesare to be attached with the application form duly attested by Secretary, RSB / ZSB.

(m) 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 (RSB & KSB will not be calculating the percentage ofmarks).

(n) All candidates to open individual bank accounts in the nearest State Bankof India branch or Punjab National Bank which has electronic clearancesystem / Core Banking, to facilitate transfer of the scholarship amount . Accountnumber of the sister concern bank will not be accepted. i.e State Bank ofTravancore, State Bank of Bikaner & Jaipur, etc . Candidate to attach a attestedphotocopy of passbook, showing name and account number of the individual. Acancelled leaflet of a blank crossed cheque will duly authenticate the account

number. A joint account with parent will also fulfill the requirement .

(o) The candidates should have secured a minimum of 60% marks at 10+2 / MEQ level or equivalent and have to secure minimum of 50% marks,uninterrupted for continuation of scholarship in every year for the duration ofcourse up to a maximum period of 5 years as prescribed for that programme ofstudy. A person granted scholarship for one programme would not be entitled forscholarship for another programme.

(p) In case of change of any address, course, college, it is to be intimatedimmediately to Kendriya Sainik Board & Rajya Sainik Board in writing. Always


21/34

mention selection serial number, name of applicant and ESM particular for anycorrespondence with KSB & RSB after getting selected for the scholarship.

(q) The Ministry of Defence, Government of India can suitably modifythese instructions to remove anomalies, if any, for successfulimplementation of the scheme, as may be necessary from time to time andwill be applicable to all students under the scheme.

(r) Ex-servicemen entitlement will be governed as per the existing definition ofex-servicemen, as amended from time to time. The definition is available in theguide book available with the RSB/ZSB.

(s) The application form should be downloaded from the official website ofMOD, i.e. www.mod.nic.in . The application form should be submitted to therespective Rajya Sainik Board, (List of RSBs is attached along with thebrochure) duly completed, along with a Demand Draft ( Repeat ) Demand Draftonly for Rs.30/- in favour of Secretary, Kendriya Sainik Board , payable at NewDelhi. In case of any difficulty in obtaining the form, the same can be obtained

from the Secretary / Director Rajya Sainik Board. The Demand Draft should notbe issued before 20 th December 2009 (the Demand Draft is not refundable inany case).

(t) While filling the application form, leave 1 (one) box blank between 2 (Two)words. Column wise guidelines are explained further for filling up the applicationform.

COLUMN WISE GUIDE LINES FOR FILLING UP OF APPLICATION FORM

(i) Column -1. Fill your name as in matriculation certificate only :-

(Not to be filled in any other format.)

1 st Name A J A YMiddle Name S I N G HSurname R A N A

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

Male Female

(iii) Column 3. Date of Birth as shown in matriculation certificate only.

For Example:- (10 June 1982)

D D M M Y Y Y Y1 0 0 6 1 9 8 2
http://www.mod.nic.in/http://www.mod.nic.in/


22/34

(iv) 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.

(v) Column 5. Write your permanent address and correspondence address inblock letters.

(vi) Column 6. Write phone number along with STD code and email ID for any

query (email ID is must) .

(vii) Column 7. Category as per para 6 to be written (attach the required

document, if any). Category 1 (One).

Category - 1 O N E

(viii) Column 8. Full Particulars of Father/ Ex-Serviceman 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

(ix) 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


23/34

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

(x) Column 10. Tick as applicable.

Yes No

(xi) Column 11 . The student is to specify the course which he / she is

presently studying. (Example:- B TECH )

B T E C H

(xii) Column 12. Duration of the course both in numbers and figures to be

mentioned. For example 5 years 6 months.

(In figure)

Y Y M M

0 5 0 6

(In word)

F I V E Y E A R S A N D S I XM O N T H S

(xiii) Column 13. Write date of commencement & completion of course as

shown below:

(Course Commencement / Date of Admission)

D D M M Y Y Y Y0 1 0 7 2 0 0 7

(Course completion)

D D M M Y Y Y Y3 1 1 2 2 0 1 2


24/34

(xiv) 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 EO 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 Aof 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 (if any) a i t _ a j m e r @ r e d i f f m a il . c o M

College Website w w w . a i t a j m e r . c o m

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

A I C T E

(xvi) Column 16. Furnish the particulars of your all children as per specimen

given:-

Sl. No. Name of Child Gender Date of Birth Age1 Prakash Singh Rana M 10/10/1982 27 Years2. Satish Singh Rana M 12/05/1984 25 Years3. Ajay Singh Rana M 03/07/1987 22 Years4. Komal Rana F 14/02/1989 20 Years


25/34

(xvii) Column 17. Given details of the scholarship availed by your brother /

sister in the past, if not availed write Not Applicable.

Sl.No.

SelectionSerial No.

given by KSB

Name of thebrother/sister

Course ofStudy

Academic yearin whichapplied

Amoreceived s

1. 6359 Satish Singh Rana B Tech 2007-09 15000

(xviii) Column - 18 Please write the full details of bank account of the student and

attach the photocopy of passbook and cancelled cheque as required to verify the

correctness of the account number (individual student account is preferred.

However, a joint account with the father / mother is also accepted).

Name of account holder A J A Y S I N G H R A N A

Bank Name S T A T E B A N K O F I N DI A

Branch Name A J M E R

Branch Address A J M E R I N S T I T U T E O F TE C H N O L O G Y

State R A J A S T H A N

Bank Tel. No. 0 1 4 5 - 2 3 0 0 6 2 2

Branch Code 0 5 1 4

MICR (9 digit) No. 5 1 8 0 0 2 0 0 7

(PLEASE ATTACH A PHOTOCOPY OF CHEQUE & PASS BOOK)

Account No. 3 0 2 0 0 1 5 2 4 6 8

REPEAT

Account No. 3 0 2 0 0 1 5 2 4 6 8


26/34

(xix) Column 19. Fill up attached Demand Draft particulars.

Issue D D M M Y Y YY

Demand Draft No. 0 2 3 1 5 0 Date 1 4 1 2 2 0 0 9

Amount (Rs.) in figure 3 0

Amount (Rs.) in word T H I R T Y

Issuing Bank Name S T A T E B A N K O F I N D I A

Issuing Bank Branch A J M E R

Note: Application form from page number 13 to 22 along with required documents only to be forwarded.

CHECK LI ST OF DOCUMENTS TO BE ATTACHED W I TH

THE APPLI CATI ON FORM

1. Candidates / ESM are to ensure that the following documents areattached (as applicable) along with the Application Form (non submission ofthese certificate will lead to rejection and application will be returnedunactioned) .

(a) Attested copy of Ex-Serviceman/Widow I-card issued byRSB/ZSB. This is an important document to be attached.

(b) Extract of ESM discharge book as per specimen.

(c) If child born after discharge then affidavit is to be submitted by ESM,that child is dependent on him and he / she is a ward of ESM.


27/34

(d) 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

(iv) Category 4: Part II Order(v) Category 5: Award Certificate

(e) Attested photocopy of matriculation or equivalent examinationcertificate for verification of date of birth.

(f) Attested photocopy of mark sheet of MEQ as applicable (e.g. 10plus 2, graduation / diploma etc). In case the MEQ is graduation / diploma,then complete mark sheet is required to be submitted.

(g) In case of MBA/MCA applicants, attested copy of minimum entryqualification certificate. i.e Graduation

(h) Bonafide studentship certificate to be issued byRegistrar/Dean/Principal of College/Institution pertaining to course for whichscholarship is claimed (As per specimen attach).

(i) Demand Draft of Rs. 30/- (Rupees Thirty only) attached.(Application form without Demand Draft will not be processed and

Demand Draft should not be made before 20th

December 2009.)

(j) Photocopy of passbook showing name, account number withphotograph of individual and cancelled leaflet cheque. ( Scholarship willnot be sent in absence of photocopy of passbook)

Date: _____________________

_______________________________Place: ____________________ Full Name & Signature ofCandidate


28/34

_______________________________________

Checked / counter singed by ESM / Widow

DEPTT OF SAINIK WALFARE/RAJYA SAINIK BOARDS

Sl No Address of RSB For Detail, Pl contact RSB

1ANDAMAN &NICOBARISLANDS (UT)

Col KV Cherian (Retd)SecretaryRajya Sainik BoardA & N Administration, SecretariatPort Blair - 744 101

Port Blair-

03192-235621 (O)03192-235621(F)03192-320360 (R)

09434281518 (M)

[email protected]

2 ANDHRAPRADESH

Brig CS Vidyasagar (Retd)DirectorDeptt of Sainik WelfareBlock IV, II Floor, GruhakalpaComplex, MJ Road, Nampally,Hyderabad - 500 001

Hyderabad

040-24736890 (O)040-27990144 (R)040-24747991 (F)09440401470 (M)

[email protected]

3 ARUNACHALPRADESH

Shri K KholieDirectorDte of Relief, Rehabilitation &Settlement, Govt of ArunachalPradesh, New Itanagar-791110

Itanagar-

0360-2212282 (O)0360-2290778 (R)0360-2212282 (F)0360-2213615 (F)09436041927 (M)
mailto:[email protected]:[email protected]:[email protected]:[email protected]


29/34

4 ASSAM

Cmde K C Choudhury (Retd)DirectorDte of Sainik Welfare, SainikBhavan, Lachit NagarGuwahati - 781 007

Guwahati-

0361-2522229 (O)0361-2412196 (R)0361-2522229 (F)

[email protected]

5 BIHAR

Shri Md. Saood, BASDirectorSainik Kalyan NideshalayaHome Deptt, Old SecretariatBarrack No.10, Patna 800015

Patna

0612-2217301 (O)0612-2217301 (F)0612-2280333 (R)

6 CHANDIGARH(UT)

Lt Col Raj Kumar Singh (Retd)

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

Chandigarh

0172-2701947 (O)0172-2700317 (O)0172-2726325 (F)0172-2721064 (R)09888880566 (M)

[email protected]

7CHHATTISGARH

Col K L Yadav (Offg) (Retd)DirectorDeptt of Sainik Welfare, CGNear Collectorate Parisar, BehindHome Guard OfficeRaipur - 492 001

Raipur

0771-2445165 (O)0771-2427449 (O)0771-2352529 (R)0771-2420084 (F)09893164219 (M)

[email protected]

8 DELHI

Gp Capt RK Sharma (Retd)SecretaryRajya Sainik BoardOpp Tis Hazari CourtNo.1, Rajpur Road, Delhi-110 054

Delhi-

011-23991876 (F)011-23969260 (O)09818953191 (M)

[email protected]

9 GOA

Maj Venugopal Nair (Retd)SecretaryDeptt of Sainik WelfareCollectorate BuildingPanaji - 403 001

Panaji

0832-2227138 (O)0832-2443236 (R)0832-2227138 (F)09420686834 (M)

[email protected]
mailto:[email protected]:[email protected]:[email protected]:[email protected]:[email protected]:[email protected]:[email protected]:[email protected]:[email protected]:[email protected]


30/34

10 GUJARAT

Lt Col Kishor Sinh Gohil (Retd)DirectorDistt Sainik Welfare office &Resettlement, Bachat Bhawan,Ground Floor, Opp - Jyoti Sangh,Relief Road, Ahmedabad-380001

Gandhinagar

079-23251295 (O)079-23251296 (O)079-23251298 (O)079-23251294 (F)079-23245346 (R)079-25508539 (O)

[email protected]

11 HARYANA

Brig KS Budhwar (Retd)SecretaryRajya Sainik BoardSainik Bhawan, Sector 12,Shaheed Capt Rohit KaushalMarg, Panchkula - 134 109

Panchkula

0172-2560462 (O)0172-2562102 (R)0172-2560462 (F)0172-2560321 (O)09888527189 (M)

[email protected]

12 HIMACHALPRADESH

Maj Jogi Dass Mankotia (Retd)DirectorDeptt of Sainik WelfareGovt of Himachal PradeshHamirpur - 177 001

Hamirpur-

01972-221854 (O)01972-224659 (O)01972-225961 (R)01972-225643 (F)09418090708 (M)

13 JAMMU ANDKASHMIR

Brig RS Langeh, VSM (Retd)DirectorDeptt of Sainik WelfareAmbphalla, Jammu - 180005

Jammu

0191-2561547 (O)0191-2465141 (R)0191-2575362 (F)09419180672 (M)

14 JHARKHAND

Col AP Singh (Offg) (Retd)DirectorSainik Kalyan NideshalayaRanchi (Jharkhand)

Ranchi-

0651-2330178 (O)0651-2330469 (R)0651-2331434 (F)09431105964 (M)

[email protected]

15 KARNATAKA

Col CM Uthaiah (Retd)DirectorDeptt of Sainik Welfare &Resettlement,Fd Mshl KM Cariappa, Bhavan,No 58, Fd Mshl KM CariappaRoad, Bangalore - 560 025

Bangalore-

080-25589459 (O)080-28445706 (R)080-25589459 (F)09886205130 (M)

[email protected]
mailto:[email protected]:[email protected]:[email protected]:[email protected]:[email protected]:[email protected]:[email protected]:[email protected]


31/34

16 KERALA

Shri KK Govindan NairDirectorDeptt of Sainik WelfareVikas Bhavan,Thiruvananthapuram - 695 033

Thiruvananthapuram

0471-2304980 (O)0471-2472401 (R)0471-2304980 (F)0471-2329279 (R)

[email protected]

17 MADHYAPRADESH

Brig Pramod Kumar (Retd)DirectorDeptt of Sainik WelfareSouthern Shopping CentreGuru Teg Bahadur Complex, TTNagar, New Market,P.B.NO 364, Bhopal - 462 003

Bhopal-

0755-2553992 (O)0755-2666081 (R)0755-2577209 (F)09993030601 (M)

[email protected]

18 MAHARASHTRA

Col Suhas S Jatkar (Retd)DirectorDeptt of Sainik WelfareMaharashtra State Raigad, OppNational War Memorial, SolapurRoad, Ghorpadi, Pune-411 001

Pune-

020-26332763 (O)020-26332764 (O)020-26850613 (F)09422314276 (M)

[email protected]

19 MANIPUR

Lt Col H Sharat Singh (Retd)SecretaryRajya Sainik BoardSainik Rest HouseOpp. Lamphel Police Station,Imphal-795004

Imphal-

09862672547 (M)

20 MEGHALAYA

Brig WJB Sturgeon, YSM, SM(Retd)DirectorDte of Sainik WelfarePublic Service CommissionBuilding Beyond DC BuildingShillong - 793 001

Shillong-

0364-2225613 (O)0364-2536574 (R)0364-2225613 (F)09436101551 (M)

[email protected]

21 MIZORAM

Col John Zama, SM (Retd)DirectorDeptt of Sainik Welfare & Res,Tuikual A, PB No. 119Aizawl - 796 001

Aizawl-

0389-2322732 (O)0389-2322732 (F)0389-2325811 (R)09436142593 (M)

[email protected]


32/34

22 NAGALAND

Brig Brij Pal Singh (Retd)SecretaryRajya Sainik Board, Home Deptt,Home Br, Nagaland Civil Sectt.,Kohima - 797 001

Kohima-

0370-2270029 (O)0370-2270029 (F)0370-2221991 (R)09436830124 (M)

[email protected]

23 ORISSA

Col (Dr) DK Das (Retd)SecretaryRajya Sainik Board, NageswarTangi, Lewis Road,Bhubaneshwar-751002

Bhubaneshwar

0674-2432268 (O)0674-2435998 (F)0674-2721156 (R)09937940807 (M)

[email protected]

24 PUDUCHERRY(UT)

Col Jacob Mathen Anand (Retd)DirectorDeptt of Sainik WelfareJawan Bhavan Complex, LawspetMain Road, Pakkamudayanpet,Puducherry - 605 008

Puducherry

0413-2253107 (O)0413-2250575 (F)09443228260 (M)

[email protected]

25 PUNJAB

Brig IS Gakhal (Retd)DirectorDte of Sainik Welfare, PunjabPunjab Sainik Bhawan, Sector21-D, Chandigarh - 160 022

Chandigarh

0172-2701845 (O)0172-2740991 (R)0172-2707345 (F)09814297113 (M)

[email protected]

26 RAJASTHAN

Col Phool Singh Mehla (Retd)(Offg) NideshakSainik Kalyan VibhagSecretariat Building, North Block,Jaipur - 302 005

Jaipur-

0141-2227897 (O)0141-2227650 (F)0141-2356464 (R)09314933120 (M)

[email protected]

27 SIKKIM

Lt Col PB Gurung (Retd)SecretaryRajya Sainik Board, PaljorStadium Road, Gangtok-737 101

Gangtok-

03592-202534 (O)03592-221456 (O)03592-202156 (R)03592-221456 (F)09434448861 (M)


33/34

28 TAMIL NADU

Capt S M Aslam, (Retd)Joint DirectorDte of Ex-Servicemens Welfare22, Raja Muthiah Salai, ChoolaiChennai - 600 003

Chennai-

044-26691747 (O)044-26691342 (O)044-22331052 (R)044-26691886 (F)09444823182 (M)

[email protected]

29 TRIPURA

Lt Col Mohit Ghosh (Retd)SecretaryRajya Sainik Board, Nehru OfficeComplex, Gorkhabasti, P.O.Kunjaban, Agartala - 799 006West Tripura

Agartala

0381-2326507 (O)0381-2323795 (F)0381-2319005 (R)09436510584 (M)

[email protected]

30 UTTARPRADESH

Shri AK Chaturvedi, PCS

(Additional Charge)DirectorDte of Sainik Kalyan EvamPunarvas, Kariappa Bhawan,Kaiserbagh, Lucknow - 226 001

Lucknow-

0522-2625354 (O)0522-2625354 (F)0522-2305107 (F)0522-2391701 (R)09415404142 (M)

31 UTTARAKHAND

Brig AN Bahuguna, KC, YSM,VSM (Retd)DirectorNideshalaya Sainik KalyanUttarakhan, Kalidas margP O- Haathi BadkalaDehradun - 248121

Dehradun-

0135-2744208 (O)0135-2743773 (F)0135-2741481 (O)0135-2670813 (R)09358254621 (M)

[email protected]

32 WEST BENGAL

Col PR Pal (Retd)SecretaryRajya Sainik Board, Block 'F'(First Floor), Writers BuildingKolkata - 700 001

Kolkata-

033-22141347 (O)033-22144643 (F)033-22143220 (O)09874535628 (M)

rajyasainikboardwestbengal@gmom

Note:

Dadar Nagar Haveli: ESM of these states can submit their Prime Minister application formto

Gujrat RSB.Daman & Div
mailto:[email protected]:[email protected]:[email protected]:[email protected]:[email protected]:[email protected]


34/34

Lakshadweep: ESM of this state can submit their Prime Minister application form toKerala RSB.

Pm Scolarship 2009-10

Documents

Transcript of Pm Scolarship 2009-10