West Bengal Minorities' Development and Finance Corporation

A statutory Corporation under Minority Affairs & Madrasha Education Department,

Government of West Bengal
"Amber", DD/27E,Salt Lake City Sector-I, Kolkata-700064, Toll free No:-18001202130

APPLICATION FOR WB PRE MATRIC SCHOLARSHIP 2019-20

Application ID: SSP2019010400304001 Application Date: 19-07-2019
BASIC INFORMATION
Student's Name: SAYEL SHAIKH Father's Name: NURUDDIN SHAIKIH
Date of Birth: 07-03-2009 Mother's Name: RUKSAHANA SHAIKH
Gender: Male Annual Family Income: 48000
Marital Status: Unmarried Guardian's / Husband's Name: NURUDDIN SHAIKH
E-mail Id: Religion: Muslim
Mobile No: 7363914744

ADDRESS INFORMATION
Permanent Address Present Address
Domicile State: WEST BENGAL State: WEST BENGAL
Domicile District: SOUTH 24 PARGANAS District:SOUTH 24 PARGANAS
Block/Municipality:Mandirbazar Block/ Municipality:Mandirbazar
Permanent Address: NILAMBARPUR Present Address: NILAMBARPUR
Post Office: NILAMBARPUR Post Office: NILAMBARPUR
Police Station: MANDIR BAZAR Police Station: MANDIR BAZAR
Pin: 743336 Pin: 743336

ACADEMIC INFORMATION
Previous Academic Information Present Academic Information
Previous Institute Name: NILAMBARPUR SPL Institution Name: NILAMBARPUR SPL CADER F P
CADER FP Current Class / Course Name : III
Previous Class / Course Name: II Current year of Study :III
Previous Year of Study: II Are you a Hosteller: No
Name of the Board of Name of the Board / Council / University : West Bengal Board of
last Exam Passed: West Bengal Board of Secondary Education
Secondary Education Course Duration : 1 Year
Year of Passing Last Exam: 2018
% of Marks Obtained
in Last Examination: 70.00
BANK ACCOUNT DETAILS
Bank:THE WEST BENGAL STATE COOPERATIVE BANK
Branch:BIJOYGUNJ BRANCH
IFSC: WBSC0000025
Savings bank account no.: 101005068208

Declaration:I hereby declare that the details furnished above are true and correct to the best of my knowledge and belief.

___________________
Signature of Student
DECLARATION OF INCOME
(To be given by the parents/ guardians)

Certified that the gross annual income from all sources in respect of my family is Rs.48000 . I further undertake that in the
event of the particulars given in the declaration being found false, I shall refund the whole amount of the Scholarship paid to
the said Scholarship holder SAYEL SHAIKH and the Government's decision in this regard shall be final and binding on me.

__________________________
Signature of the parents/ guardian

Instruction
Student is to submit this ***computer-generated filled-in application form (duly signed) to the educational institution along with
following supporting document:
1. Photocopy of the bank-passbook where the details of bank a/c number,IFSC are mentioned clearly.

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