WEST BENGAL CHIEF MINISTER RELIEF FUND SCHOLARSHIP

Application Form
To,
The Honourable
Chief Ministers
Govt. Of West Bengal
'Nabanna'
325, Sarat Chatterjee Road
Howrah - 711 102

NameFather`S NameDate of Birth-

CAST-

Female
Gender- Male
Permanent Address-

GEN

SC

ST

OBC

Religion-

P.O
P.S
DIST/ CITY

PIN

Details of Education Qualification:

Name of Examination

Board/University

Passing Year

Marks Obtained

Class/Div/Grade

% of Marks

Present Course Details:

Course Name
Duration
Session
Name of Institute
Institute Address

Bank Information:
Account Holder Name
Bank Name
Branch Name
IFSC Code
Account Number
I do hereby certify that the above particulars are correct and true to the best of my knowledge and belief.

Date:
Place:

___________________________________
Signature of the applicant

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Recommendation from MLA

Monthly family income of the student.
This is to certify that entire family income of Shri / Smt............................................................
....................................................(Parent's Name) Father/ Mother of Mr./Ms..........................
......................................................... (Student Name) Resident of ..........................................
................................................................................................................................................
.............................................................................................................................................is
Rs................................ (Rupees..........................................................................) per annum.
His/her Business occupation is ..............................................(mention the post)(Pvt./Govt.) /
Business / Farming / Labour etc. He/ She has no other occupation and income and there is
no other earning member in his / her family.

Date:

_________________________________
Signature of the Student

--------------------------------------------------------------Competent issuing authority Signature with Seal

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SELF DECLARATION
I am ............................................................................................, Son. / Daut. of ..................
............................................................, Vill ...........................................................................,
Post ........................................................, P.S ........................................................................,
Dist. .............................................................., Pin ........................................................., do
here by decleared that I have been reading in Class ........................................ and My
Current academic seasion is 2016-2017 at .............................................................................
................................................................................................................................................
................................................................................................................................ (School /
College / University Name & Address). I have not received any kind of scholarship of
financial assistance for my education from any Govt. Department or any private agencies
during this year.

Date:

_________________________________
Signature of the Student

.........................................................................
Counter singed bt Head of Institution with Seal

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Eligibility & Others Details

Eligibility:
Assistance from Chief Ministers Relief Fund and Chief Ministers Discretionary Fund is given to the student
Who is a permanent resident of the State of West Bengal.
Who is studying in any institutions of the State after passing out the State Board /Council of Secondary
Education or a State aided University in West Bengal.
Who has got 65% marks in aggregate in Madhyamik Examination [for H.S. level] or 60% in aggregate in H.S.
Examination [ for U.G. level] or 55% Marks in the Honours Subject [for P.G. level]
Who do not enjoy any other governmental(central/state) scholarship or stipend for the same course or stage
of study.
Whose annual family income does not exceed Rs. 60000/-.
Impotent Information & Document :
Copies of Mark Sheets of all previous examinations passed.
Copies of Rank Card & Allotment letter of Selection Committee (only for JEE or Equivalent Examination)
Copy of Monthly Family Income Certificate from any one mentioned within the bracket (DM/ SDO/BDO /
Group-A Govt. Officer not below the rank of Joint B.D.O./ Executive Officer in case of Municipality/ Deputy
Commissioner of Corporation).
Copy of Recommendation from MP/MLA stating monthly family income of the student.
Self declaration of the student under his/her signature regarding present course of study mentioning
year/semester and receipt of any scholarship / aid/assistance, duly countersigned by the head of the Present
institution with seal .Photo copies of all the documents are required to be attested by Group-A Govt.Officer.
Self Bank Account Details (IFSC Code, Branch Code, Branch Name, Account Number, Bank Name) with Photo
copy of Bank Pass Book.

How to Apply

Visit Unofficial website- www.examdrive.in

Click to Scholarship Tab.
Download Application Form.
Print out Application from.
The Application from is correctly & completely filled up.
Attach with Application from all relevant Document.
Send Application from with Document through Ordinary Post / Dropbox to the Address of Nabanna, 14th Floor,325 Sarat Chatterjee Road, Shibpur, Howrah- 711 102.
Incomplete application will be canceled.

Any Others Information Visit Official Website www.wbcmo.gov.in

Application Download from www.examdrive.in