Akhuwat Educational Assistance Program ID : ____________

Date: ____________
Application form for Interest Free Educational Loan (for office use only)

1 photograph

INSTRUCTIONS: Paste here with glue

Dispatched: ________________
Received: ________________
Please follow the instructions carefully (for office use only)

 Fill in the form using a Black Pen.

 Fill the form in CAPITAL LETTERS.

 Please write your name & date of birth in the back of each picture.

 Fill the form completely; INCOMPLETE forms will not be processed.

 Attach all the required documents, forms without the Required Documents will be considered INCOMPLETE.

 YOU SHOULD HAVE AT LEAST 75 % MARKS BOTH IN MATRICULATION & INTERMEDIATE IN ORDER TO
APPLY TO AEAP. Moreover, AEAP is a NEED BASED INTEREST FREE LOAN. Thus only those students who genuinely
financially deserve will be considered for this Program.

CHECKLIST OF THE REQUIRED DOCUMENTS:

Please attach the attested copies of the following documents & return it to the address printed in the box below.
□ Three passport size photographs
□ Applicant CNIC
□ University/Institution Identity Card
□ Hostel Card
□ Father/Guardian CNIC 2 Photographs
□ Bonafide Student Certificate from current University/Institution
□ Level/ SSC (Matriculation) Certificate (issued by BISE) Staple here
□ A Level/ HSSC Certificate (issued by BISE)
□ Latest Examination Result Cards
□ Domicile
□ Income Certificate (Pension Copy incase Father/Guardian is Retired Servant)
□ Utility Bill (latest)
□ Distinction/achievement Certificates in Extra & Co curricular Activities
□ _________________________________
□ _________________________________ Mr. Waseem Asghar
□ _________________________________ 9-A, Upper Mall Scheme
Lahore

1 APPLICANT INFORMATION (Please use BLOCK LETTERS to fill the form)

1.1 Name:
1.2 CNIC 1.3 Date of Birth (dd/mm/yyyy)
1.4 Father’s Name 1.5 Guardian’s Name
1.6 Relationship with Guardian 1.7 Father’s/Guardian CNIC

1.8Present Address
(for mailing)
City: District: Province:

Permanent
1.9
Address
City: District: Province:
1.10 Personal Ph. #: 1.11 Home Ph. No’(s):
1.12 E-mail: (valid E-mail address is required):

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2 ACADEMIC RECORD (see list on page 1 for required documents)

Program School/College (with city name) Board (e.g.FBISE,Isl) Passing year Tot. marks Obt. marks % (e.g.80.80)
2.1 SSC

2.2 HSSC

2.3 ________

2.4 ________

3 CURRENT EDUCATION INSTITUTION (see list on page 1 for required documents)

3.1 Name:
3.2 City: Province: Phone #: Website:
3.2 Discipline/Program: 3.3 Reg. #:
3.4 Duration: __________ years Started on _________________ dd mm yyyy Will end on _____________________ dd mm yyyy
3.5 No. of (semester/year)s complete _________ Current semester/year ___________ Remaining Semester/year(s) ________

3.6 Your current grade in latest Result: ______________

4 OTHER SCHOLARSHIP(s) (providing true information will favor the applicant) (PKR=Pakistan Rupee)

4.1 Are you getting fee concession from Institution? If yes, please mention the % or amount of concession.
Yes No

4.2 Are you receiving or applied for Scholarship/loan to another If yes, please provide following info.
organization? Yes No Name of Scholarship/organization: _____________________
Amount of Scholarship/loan: ________ PKR

5 EDUCATION EXPENSES (PKR or ___) (please attach attested copy of fee card or fee deposit slip of last payment)
5.1 College/Univ. fee: _________ Monthly Quarterly Semester-wise Annual-wise
5.2 Books expense: _________ Monthly Quarterly Semester-wise Annual-wise
5.3 Stationary expense: _________ Monthly Quarterly Semester-wise Annual-wise
5.4 Hostel fee*: _________ Monthly Quarterly Semester-wise Annual-wise
5.5 Mess (average)*: _________ Monthly Quarterly Semester-wise Annual-wise
5.6 Other ( ): _________ Monthly Quarterly Semester-wise Annual-wise
5.7 Total Education expense: _________ Monthly Quarterly Semester-wise Annual-wise
*only if you’re residing in College/University hostel & this fee is not included in Para 5.1). Attach attested copy of Hostel Card.

6 SUPPORT FOR EDUCATION EXPENSES (PKR or ____)

6.1Contribution from your family: __________
6.2Contribution from other(s), (person, relative, scholarship, loan) How much? __________
Name:_______________________________________________________ □ Monthly □Quarterly □ Semester □ Annual
Other(s): ____________________________________________________ Contributing since: _________________ (mm yyyy)

6.3 Do you teach Tuition(s): Yes No If yes, how much do you earn monthly: __________
6.4 Total: __________ Monthly Quarterly Semester-wise Annual-wise

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7 YOUR REQUEST FOR INTEREST FREE LOAN (PKR or _____)
(Please provide genuine need only. Fill it very carefully. If you feel any difficulty, please feel free to contact us)
7.1 College/Univ. fee: ____________ 7.2 Books expense: _________
7.3 Stationary expense: ____________ 7.4 Hostel fee: _________
7.5 Mess (average): ____________ 7.5 Other ( ): _________
5.4 Total Loan need: ____________ Monthly Quarterly Semester-wise Annual-wise

8. MODE OF REPAYMENT:
8.1 When will be able to repay?
8.2 Duration of repayment*. (in years)
* Maximum four years allowed for students who need support for their entire academic period.

9 BANK ACCOUNT INFORMATION: (for transaction of loan installments to be given to the student)

9.1 Title of Account

9.2 Bank Name
9.3 Branch Code
9.4 Account Number

b. INCOME:
Income source Father’s Guardian’s/Brother’s & Others
sisters
Profession
Annual Income

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12 DOCUMENTAION BY THE INSTITUTION:

It is certified that Mr./Ms _______________________________ S/O D/O __________________________________

is student of _______________________________________ under Registration Number ____________________.
And that the above information provided in Para 1,2 and 3 is correct to our best of knowledge and information.

Mr. Ms _____________________________’s application for Interest Free Loan is recommended.

HEAD OF INSTITUTION/DEPARTMENT
Name and Signature with stamp

(FOR STUDENTS RESIDING IN INSTITUTE’S HOSTEL)

The above named student is residing in Room No.__________of _______________. He/ She has been residing in this
hostel since_____________.

HOSTEL WARDEN (CONCERNED)

Name and Signature with Stamp

____________________ __________________________
Applicant’s Signature Father’s/Guardian’s Signature

Date: _____/_____/_____ Date: _____/_____/_____

dd / mm / yy dd / mm / yy

For enquiries contact us at:

Phone: 0321-4916686
E-mail: redglaxy2000@gmail.com

Note: In case of providing false information, candidate will be disqualified and his/her application will not be
considered.

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