APPLICATION FOR SCHOLARSHIP - 2018

Note:
1. Incomplete and/or late received applications will not be processed.
2. Students studying in lavish institution will not be entertained.
3. Application form to be filled in with black pointer.
4. Before filling the application, form student must read instruction given on page # 3.

CATEGORY ( Tick the relevant)

Orphan
Disable
✓ Need based

APPLICANT PERSONAL
1. Applicant’s name:
INFORMATION Mushahid Hussain 2. Father’s name: Muhammad Panjal__________
3. Applicant’s CNIC No: 45208-0670166-7 4. Father’s CNIC No: 45208-3367001-9___
5. Cell # (Student): +92-3113592191 6. Cell # (Father): +923322737250
7. Date of birth: _05_/_02_/2001 8. Email: mushahidbh110@gmail.com
9. Present postal address: Dilshad Electric Store Near LCS office High School Road Ranipur District:
Khairpur
10. Permanent postal address: Dilshad Electric Store Near LCS office High School Road Ranipur District:
Khairpur

EDUCATION INFORMATION
11. Class: _DAE_ First year Course of study: DAE (Civil Technology) Year/Semester: _1st year
8. Institution: Sachal Technical Institute Gambat
9. Course start date: November 2017 Course end date: _January 2020 Any distinction: __________________
10. Monthly fee: 1250 rupees (15000 rupees yearly) Hostel expenses: __________

PREVIOUS EDUCATION RECORD

Degree Year Percentage
Matriculation 2015 75.76%
Intermediate 2017 71.45%

FAMILY & FINANCIAL INFORMATION

15. Father’s/Guardian’s name: Muhammad Panjal Monthly income: 21500/month
16. Father’s/Guardian’s professional status: ( Tick the relevant)
Govt. employee
Private employee
✓ Self employed
Retired
Abroad
Un-Employed
Disabled

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17. If father/mother/guardian/brothers/sisters are serving then give details: (Please attach extra page if more than one
family members are serving)
a. Name: _______Muhammad Panjal Cell #: +923322737250
b. Name of department /company/employer: Shop_____
c. Address: Shop near LCS office High School Road Ranipur
d. Tel (Off): ________________________________ Cell #: (Employer)____________________________
e. Designation & grade: ______________________ Total monthly salary: 21500/
(Attach the relevant proof i.e. pay slip, copy of pension book etc.)
18. Total members in the family: (Applicant, his parents, brothers and sisters will be considered as family) 7member
19. Details of siblings studying including the applicant’s own detail: (In case you have more details to enter please use
extra page)

Sr. Name Class/Course Educational Institute with Address Total Fee

Semester
Gender
# Per Month

1 Mushahid Hussain M Diploma 1st Sachal Technical Institue 1500/

Gambat
2 Shakeel Ahmed M B. E 8th Mehran UET Jamshoro 3000/
3
4
5

20. Total fees & tuition charges of all siblings (Per month): 4,000/month
21. Details of any other supporting person who is giving you a helping hand in your education.
Name: N/A Relation: _____________ Cell #: ________________ Amount being paid: _______
22. If you or any other sibling is getting financial support from any other government or non-government organization
give its details:

Name of beneficiary: ____________________ Organization: __________________ Amount being paid:

________

REFERENCES
23. Provide details of two persons as references to certify your given details. The said persons should be educated and
they should be well aware of your family circumstances:

1. 1. Name: Imdad Ali 2. Name: Shakeel Ahmed

Profession/Occupation: Vaccinator Profession/Occupation: _Student
CNIC #: 45208-8387695-5 CNIC #: _45208-0660666-7
Cell #: +923332919510 Cell #: _+923000433479_

CERTIFICATION
24. Certification by the student and his/her father/guardian
It is certified that all particulars given above are correct.

Student’s signature: Father’s/Guardian’s signature: Date: 26 Jan2018

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INSTRUCTION FOR STUDENTS
This page is only for the guidance of applicants and not to be sent with the application form.

Following attested documents must to be scanned and sent to imam-e-zamana-

scholarship@hotmail.com
✓ Student’s CNIC.
✓ Father’s/guardian’s CNIC.
✓ 1 recent photograph.
✓ Father/mother/brother/sister’s pension book/salary slip/income certificate.
✓ All previous exams’ result.
✓ Fee slip (Last semester/year)
✓ Hostel certificate (if applicable)
✓ Bonafide certificate
✓ References CNIC

All the documents submitted are original/