Sei sulla pagina 1di 5

K. C. MAHINDRA EDUCATION TRUST

(Public Trust Act-Registration No. E 1245 - Bombay)

APPLICATION FORM FOR MAHINDRA ALL INDIA TALENT SCHOLARSHIP FOR 1 ST YEAR DIPLOMA.

Affix Passport size Photograph with your signature.

Application No.

*

(Above entry to be left blank by the Applicant)

Read this Form carefully. Incomplete Application Form will NOT be considered.

Applicant’s Name in full:

Age

Date of Birth (as recorded in your School Certificate - Encl. attested copy) (*)

Address for Correspondence:

Pin code

Name of the District:

 

Name of the State:

Telephone/Mobile, if any :

 

e-mail id:

Father’s Name

in full :

 

Permanent address

:

Pin code

Name of the District:

Name of the State:

Has anyone else in your family (brother/sister) received the Mahindra All India Talent Scholarship:

Has anyone else in your family (brother/sister) received the Mahindra All India Talent Scholarship: Yes No

Yes

No

Has anyone else in your family (brother/sister) received the Mahindra All India Talent Scholarship: Yes No

Give Details:

Family Information:

Number of family members:

Parents

Name

Level of

Employment /

Income per

Education

occupation

Year

Father

       

Mother

       

No. of Brothers

No. of Sisters

Any other source of income or scholarship? Please state amount and number of years:

TOTAL FAMILY INCOME PER YEAR:

Details of Applicant’s Educational record :

Name of School/ College

Name of

Examination

Stream/

Year

Percentage of marks / CGPA obtained

Board/University

Passed

Subjects

XTH (SSC)

         

(mandatory)

XII (HSC)

         

(If applicable)

Proposed Course of Study

Course duration in

Total College fees you have to pay per year

(Give full details of your Diploma Course)

years

Will you be living in a hostel?

If yes, how much does it cost you every month?

Admission sought at:

Admission secured at:

Yes/No

(Name and full address of the Institute)

[Enclose copy of admission letter duly attested] *

Diploma Course Started from

[Date]

No. of Years Course

CEEP (Common Entrance Exam) Rank (If applicable):

Name and address of two referees (teacher/employer) - under at least one of whom the applicant has studied or worked.

1.

Where did you hear about MAITS?

Ad in NewspaperWhere did you hear about MAITS? College Notice Board Bank Details: Friends Name of the student

College Notice BoardWhere did you hear about MAITS? Ad in Newspaper Bank Details: Friends Name of the student

Bank Details:

MAITS? Ad in Newspaper College Notice Board Bank Details: Friends Name of the student as per

Friends

Name of the student as per bank account:

Name of the bank:

Bank address:

Account no. (Account no. for NEFT transfer):

IFSC Code (Mandatory):

Enclosures:

(Name of publication/newspaper)

Others

Enclosures: (Name of publication/newspaper) Others 1. Testimonial (Recommendation letter) from any one of the

1. Testimonial (Recommendation letter) from any one of the two referees (teacher/employer) mentioned above.

2. A short statement as to your general aptitude and interest, the type of vocation you would like to pursue and your ambitions and aspirations in life.

3. Attested copy of Certificate of Date of Birth as recorded in your School Certificate.*

4. Attested copy of Mark Sheets and Certificates of examinations passed. *

5. Attested copy of Letter from Institution where admission has been secured. * * Candidates who have not secured admission will not be called for the final interview. Therefore candidates should submit a copy of the admission letter as soon as they secure admission.

6. Family Income certificate copy.

7. Self-attested copy of first page of passbook or canceled cheque.

8. Aadhaar Copy. (Mandatory).

Please note that only students who have a bank account can apply for this scholarship.

I hereby declare that the entries in this form are true and if I am selected, I agree to abide by the terms and conditions of the K. C. Mahindra Education Trust, Mumbai.

Date:

Yours faithfully,

Date:

[Name and Signature of Applicant]

[Name and Signature of Father/Guardian].

To the best of my knowledge, what is stated above is correct.

Date :

[Name and Signature of the Institution where you studied last/are studying)

ELECTRONICS FUNDS TRANSFER MANDATE FORM

To K.C.MAHINDRA EDUCATION TRUST, Mumbai.

Sub: Receipt of Scholarship payment through NEFT

I am giving below the details of my bank account for receiving the scholarship Instalment payment through NEFT.

(1) NAME

(2) Bank Name

(3) Bank Br. Address :

(4) Savings Account

(5) IFS Code No:

(6) Students Contact

(7) E-Mail

(8) Aadhar No

I have enclosed the following document to this effect.

(a) Cancelled Cheque leaf or Bank passbook containing details of Bank accounts number, IFS Code

Signature of the Student

 

Please submit the filled in form to the nearest centre in your area. Candidates must submit their forms to ONLY ONE of the following addresses:

1 Ms Jayashree Payimpallai Mahindra & Mahindra Ltd 34/1128 Balakrishna Menon Road Edapally PO Cochin 682024

7

The Coordinator Mahindra & Mahindra Ltd Mahindra Tower, Automotive Sector 1st Floor, 24,25,26 Durga Vihar Colony Durga Pura, Tonk Road Jaipur 302018

2 Mr V Suresh Mahindra & Mahindra Ltd Mahindra Towers, 17/18 Pattulos Road Off Mount Road Chennai 600002

8

The Coordinator Mahindra & Mahindra Ltd, FES Swaraj Division Phase IV Industrial Area SAS Nagar Punjab 160055

3 The Coordinator Mahindra & Mahindra Ltd Mahindra House, Auto Sector T.S. Reddy Complex 1-7-1, Park Lane, SD Road Secunderabad 500003

9

The Coordinator Mahindra & Mahindra Ltd Mahindra Towers, 3rd Floor 2A Bhikaji Cama Place New Delhi 110067

4 Mr. V Suresh Mahindra & Mahindra Ltd Raheja Chambers 1st Floor, Museum Road Bangalore 560001

10

The Coordinator Mahindra & Mahindra Ltd 3rd Floor, Mahindra Tower, Auto Sector Near HAL, Faizabad Road Lucknow 226016

5 The Coordinator Mahindra & Mahindra Ltd Automotive Division 7 KYD Street 3rd Floor Kolkata 700016

11

K.C. Mahindra Education Trust Cecil Court, 3rd Floor Mahakavi Bhushan Marg Behind Regal Cinema, Colaba Mumbai 400001

6 The Coordinator Mahindra & Mahindra Ltd. Auto Sector B/1, 701 to 707 & 712 7th Floor, Palladium, Corporate Road Near Divya Bhaskar Press, Makarba, Ahmedabad 380051