11112016
1
INDIAN INSTITUTE OF TECHNOLOGY ROORKEE ROORKEE APPLICATION FORM FOR GRANT OF INSTITUTE MERIT-CUM-MEANS (MCM) SCHOLARSHIP FOR THE SESSION 2012-13 Name: JASVINDER SINGH Enrollment Number: 11112016 Category: GEN Class: UG Branch: CH Year: 2 C.G.P.A.: 6.442 S.G.P.A.: 6.571 Number of Semesters registered: 3 Penalised due to unfair means: No Fathers name: Balbeer Singh Fathers Occupation: Service Home addresss: A-28Van Vihar Colony Tonk Road, Jaipur,Rajasthan. Annual Family Income: 310253 Whether in receipt of any Scholarship/Financial aid: No Bank Name: PNB Account Number: 4044001500072816 I declare that the particulars mentioned above are correct. I herewith the latest parental income certificate( Mother and Father both) in the prescribed form. If I get any scholarship/financial aid from any other source, I will intimate the amount of scholarship. I understand that if any of information supplied is found to be incorrect, the amount of scholarship, if any, received by me will have to be refunded and the institute can take any action against me as it may deem fit in the regard. Dated: 10-09-2012 Signature of the student ENCL. Name of bhawan: Rajiv 1. Application Form Yes/No Room No. A-611 2. Affidavit from all the family members Yes/No Mobile No. 7579087575 3. Income certificate by revenue officer Yes/No Email-ID: [email protected] 4. Photocopy of the latest grade sheet Yes/No 5. JEE-2012 rank card only for first year students Yes/No
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Transcript of 11112016
INDIAN INSTITUTE OF TECHNOLOGY ROORKEE ROORKEE
APPLICATION FORM FOR GRANT OF INSTITUTE MERIT-CUM-MEANS (MCM)
SCHOLARSHIP FOR THE SESSION 2012-13
Name: JASVINDER SINGH
Enrollment Number: 11112016
Category: GEN
Class: UG Branch: CH Year: 2
C.G.P.A.: 6.442
S.G.P.A.: 6.571
Number of Semesters registered: 3
Penalised due to unfair means: No
Fathers name: Balbeer Singh
Fathers Occupation: Service
Home addresss: A-28Van Vihar Colony Tonk Road, Jaipur,Rajasthan.
Annual Family Income: 310253
Whether in receipt of any Scholarship/Financial aid: No
Bank Name: PNB Account Number: 4044001500072816
I declare that the particulars mentioned above are correct. I herewith the latest parental income certificate(
Mother and Father both) in the prescribed form. If I get any scholarship/financial aid from any other source, I will intimate
the amount of scholarship. I understand that if any of information supplied is found to be incorrect, the amount of
scholarship, if any, received by me will have to be refunded and the institute can take any action against me as it may
deem fit in the regard.
Dated: 10-09-2012 Signature of the student
ENCL. Name of bhawan: Rajiv
1. Application Form Yes/No Room No. A-611
2. Affidavit from all the family members Yes/No Mobile No. 7579087575
3. Income certificate by revenue officer Yes/No Email-ID: [email protected]
4. Photocopy of the latest grade sheet Yes/No
5. JEE-2012 rank card only for first year students Yes/No
