PNRIF - APPLICATION FOR FINANCIAL ASSISTANCE

Please be advised that, this scholarship/Loan progra= m is intended for poor and merit students only with no bar on caste, religion, region or gender.

1. Full Name (Applicant’s name followed by Su= rname all in CAPITALS):

___________________________________________________= ____________________________

2. Male/Female:

3. AGE & Dat= e of Birth: = &nb= sp; = Place of Birth:

4. Permanent Address:

________________= _______________________________________________________________<= /span>

________________= _______________________________________________________________ = &nb= sp; = &nb= sp; =

PIN: &n= bsp; = ; &n= bsp; = ; &n= bsp; = ; Phone:

5. Address for Correspondence:

________________= _______________________________________________________________<= /span>

________________= _______________________________________________________________ = &nb= sp; = &nb= sp; =

PIN: &= nbsp; &nbs= p; &= nbsp; &nbs= p; &= nbsp; &nbs= p; Phone:

6. Particulars of education completed:

Class	Name of educational institution & complete address= &= nbsp; =	%marks	G/GA/P
6 to 9
Xth=
Inter/HSC/ +2<= o:p>
Bachelor Degre= e
Master Degree<= o:p>

NOTE: G-Govt.School/College; GA-Govt.Aided School/College; &nbs= p; P-Pri= vate School/College

7. Details of co= urse presently studying :

a) Name of the course joining/joined:

Did you get admission through entrance test : Yes / No

b) IF yes, specify the test :

c) Ma= rks obtained & Rank secured :=

d) Na= me of the Institution admitted in/applied to :

e) &n= bsp; Is it a Govt./Govt. Aided/Private Institute :

f) &nb= sp;Tuition fee paid/payable per annum:

8. Details of fa= mily members:

Member<= /p>	Name	Age	Education	Occupation<= /b>	Income p.a in Rs.
Father
Mother
Brother/ Siste= r
Brother/ Siste= r
Brother/ Siste= r

9. Details= of assets in the family = ; &n= bsp; i) Land (Extent & value):

ii) Buildings / Shops: &= nbsp; &nbs= p; &= nbsp; &= nbsp; iii) Others:

10. Particulars = of financial support received from:

Source &n= bsp; = ; &n= bsp; = ; &n= bsp; = ; Amount in Rs. Per annum

Merit Scholarship (s)

Govt. on = poverty/ community basis

Others (please specify)

11. Estimated expenditure on the course study per annum:

a) &nb= sp; Amount in Rs.:

b) Indicate below how the total expen= diture is proposed to be met: (attach any receipts from the institution/college)

12. Mention anyt= hing important that you want PNRIF to know about you and your family:=

I affirm that the above information is true. I also pledge that on completion of my education= and getting employment, I shall repay the amount as per guidelines and support financially the education of other bright and poor students.

&= nbsp; &nbs= p; &= nbsp; &nbs= p; &= nbsp;

Name of the Applicant = = = = &nb= sp; = &nb= sp;Signature

Place &= nbsp; &nbs= p; &= nbsp; &nbs= p; &= nbsp; &nbs= p; &= nbsp; &nbs= p; = Date

I vouch for the information provided in this application by my son/ daughter/ ward.

Name of the parent/guardian = &nb= sp; = = &nb= sp; = Signature

Place = &nb= sp; = &nb= sp; = &nb= sp; = &nb= sp; = Date

SUPPORTING DOCUMENTS

The following supporting documents must be submitted during the interview:

i) = &nb= sp; Certifica= te from the educational Institute must be on the letterhead of the Institute showing complete address, pin code and telephone number and must indicate whether it is a Govt or Govt aided or Private Institute

ii) = &nb= sp; Income Certificate from Mandal Revenue Officer (MRO)

iii) = &nb= sp; Marks she= ets from Xth class onwards

iv) = &nb= sp; Rank secu= red in Entrance Exam

v) = &nb= sp; Tuition f= ee paid/payable per annum

vi) = &nb= sp; Proof of admission to the course presently studying

vii) = &nb= sp; Certifica= te from Head of Institution that no other scholarship is availed of=

viii) = Two recent passport size photographs (black & white OR colour)

ix) = &nb= sp; Any other merit certificates (state ranks etc.)

NOTE – In case of any questions or clarifications while filling up the application form, feel fre= e to contact any PNRIF member/coordinator for help.