NATIONAL PRINTERS AND BINDERS

SHOP NO. 5, GATE NO. 1, INTEGRAL MAIN CAMPUS, LUCKNOW

CONTACT NO. 9721384005, 7800108501

NATIONAL SCHOLARSHIP PORTAL 2.0

GENERATED APPLICATION ID____________________________________PASSWORD:-_______________

Fresh Renewal

REGISTRATION DETAILS:-
Paste or Staple
State Of Residence:-___________________________ your Recent
passport size
Name Of The Student:-_________________________ photograph
Date Of Birth

Gender Previous Passing Year

Single Girl Child Previous year Percentage

Religion Is University 1st/2nd Rank Holder

General Or OBC 10th Class Roll No.

Father Name:-________________________________ 10th Class Board

Mother Name_________________________________ 10th Passing Year

Annual Family Income 12th Or Diploma

Aadhar Number 12th or Diploma Roll No.

Mobile Number 12th or Diploma Class Board

Email Id:-____________________________________ 12th or Diploma Passing Year

Day Scholar Or College Hostel Current Admission Fee

TO BE
CURRENT ACADEMIC DETAILS:- Current Tution Fee FILLED BY
INSTITUTE
Misc.Fee
Institute Name:-_______________________________

Present Class with Branch:-______________________ BASIC DETAILS:-

Present Class Year (Ex-1st Yr. Etc.) Single Or Married

Regular Or Private Parents Profession

Present Class Start Date IFSC Code

Previous year Board/University Bank Account Number

Previous year Course Bank Address:-_______________________________

(For Next option see column no. 2.........)

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 NATIONAL PRINTERS AND BINDERS
SHOP NO. 5, GATE NO. 1, INTEGRAL MAIN CAMPUS, LUCKNOW
CONTACT NO. 9721384005, 7800108501
CONTACT DETAILS:-

State District:-

Block /Taluka Pincode:-

Residence Full Address .:-__________________________________________________________________

_

MANDATORY DOCUMENTS TO UPLOAD ON THE PORTAL:-

1. Domicile Certificate/ Nivas Praman Patra

2. Student Photograph

3. Affidavits

4. Self attested certificate of pervious academic mark sheet

5. Fee receipt of current course year

6. Scanned copy of Aadhar card/Enrollment

7. Income certificate issued by the designated state/UT authority

8. Passbook of bank account

v Instructions:-
· Please check the details of your offline form.
· Use blue ball pen to fill the form.
· Please collect the form within 15 days after online submission from the shopkeeper
and submit the hard copies in the institute's scholarship counter otherwise you will
not be able to receive the scholarship amount in your bank account.
· Students have to verify their fees and Bonafide form from the institute after filing
the offline form.

FOR NATIONAL PRINTERS AND BINDERS

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 SELF DECLARATION OF FAMILY INCOME UNDER POST MATRIC SCHOLARSHIP
(CLASS XI AND ABOVE)/MERIT-CUM-MEANS SCHOLARSHIP SCHEME
OF MINISTRY OF MINORITY AFFAIRS, GOVERNMENT OF INDIA

I, ____________________________Son/Daughter/of___________________________
Resident of (full address)__________________________________________________
______________________________________________________________________
do hereby solemnly affirm and declare as under :-
a) That I am citizen of India.
b) That annual income of my family from all sources is Rs ………………(in words
also) ……………………………………………………………………………………
c) I declare that my father/mother/both* is/are earning Member(s) in my family.

2. I certify that the above information given by me is true.

3. In case this information furnished by me is found false, the financial assistance
awarded to me may be recovered with penal interest and I will be liable to a legal action
against me in accordance with law.

Signature of Candidate:__________________________
Name of Candidate: ____________________________

Name of School/Institution:_______________________

Enrollment No. in the School/Institution:_____________

Academic Year:________________________________

*Strike off the non-applicable part in the underlined clause above.

 SELF DECLARATION OF MINORITY COMMUNITY BY STUDENTS UNDER
POST MATRIC SCHOLARSHIP (CLASS XI AND ABOVE)/MERIT-CUM-
MEANS SCHOLARSHIP SCHEME

DECLARATION

I, ____________________________Son/Daughter/of________________________

Resident of (full address) __________________________________________________

______________________________________________________________________

hereby declare that I belong to the___________________________________________

(Muslims/Sikhs/Christians/Buddhists/Jains and Zoroastrians (Parsis) which is a notified
minority community as per Section 2(c) of National Commission for Minorities Act,
1992).

Date:__________
Place:_________

Signature of Candidate: ______________

Name of Candidate: _________________
 INSTITUTION VERIFICATION FORM

Verification/information to be furnished by the Head of

institution/college:

It is certified that the information provided below by _________________ who is

admitted in ________________ course for the academic session ___________ in
______________ is correct. He/ She is a hosteller/day scholars of the college.

Last year marks details:

Fee details current year:

In case the information filled in these columns is not correct, then the institute
should indicate that separately.
___________________________________________________________________________
___________________________________________________________________________

For Renewal of Scholarship:

It is certified that the student has not changed the course of study and/or the
institution of the study for which the scholarship was originally awarded /has
changed the course of study and/or institution with prior approval of the state
government (Please strike out which is not applicable).

Please ensure the information given by you is factually correct. In case of any
discrepancy noticed later, your application is likely to be rejected.

Date: Signature of the head of the institution/college

Place:
with official seal

Note:
(i) The verification by institution is mandatory for consideration of the
application.
(ii) Students are directed to take the print out of ‘Institution Verification
Form’ get it verified by their institution, scan & upload it”, in order to
apply for minority Scholarship.