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NU/AD/11/02/v1.

SrNo:___________

FinancialAssistanceForm
Checktherightschemeforfinancialassistance Scholarship Interestfreeloan
APPLICANT'SNAME

Associate College of the

30KmTalagangRoad,Mianwali,www.namal.edu.pk,admissions@namal.edu.pk,Tel:+92459816816

SECTIONA:FAMILYDETAILS
FATHER'SNAME: GUARDIAN'sNAME: C.N.I.C# ORGANIZATION: GRADE: PROFESSION: OFFICIALADDRESS: STATUS: Alive
Deceased

Father'sAge:

Years

Ifyourfatherisnotalivethengivethefollowinginformationaboutyourguardian.

DESIGNATION

TELEPHONE:

OFF

CELL

RES MembersDependentonyourFather/Guardian:

GROSSMONTHLYINCOME: NUMBEROFFAMILYMEMBERS:

MEMBERSLIVINGWITHYOU:

NUMBEROFEARNINGMEMBERSOFTHEFAMILY: MONTHLY INCOME BankName Acc# Current Balance

Pleasefillthedetailsofearningmembersbelow:
NO: 1 2 3 4 5 NAME RELATION PROFESSION ORGANIZATION DESIGNATION

*PleaseattachthebankstatementsoflastSixmonths
Givedetailsofthebrothers/sisters/othersstudying
NO: 1 2 3 4 5 NAME RELATION INSTITUTE FEEPERMONTH CLASS/ STAGE

SECTIONB:ACCOMODATIONDETAILS
Bungalow Flat House Selfowned Familyowned Govtowned Electricity Rented Gas Phone Water

TYPEOFACCOMODATION:
Self Family Govt Others

STATUS: NUMBEROFROOMS: LASTSIXMONTHS AVERAGEBILL:

RENTPAIDBY: HOUSEPLOTSIZE

SECTIONC:DETAILSOFASSETS
Yes No Residential Commercial Agriculture Others

DOESYOURFAMILYOWNLAND/PLOT? LOCATIONOFLAND/PLOTOWNED: AREAOFTHELAND/PLOTOWNED:


InRupees

TYPEOFTHEPLOT/LANDOWNED:

INCOMEOFTHELAND/PLOTOWNED:
Yes

perAnnum
No

WORTHOFTHEPROPERTYOWNED:
Car Bus Others

DOESYOURFAMILYOWNANYTRANSPORT/VEHICLE? BRANDNAME: DETAILS: TAXPAID( Attachcopyoflasttaxpaid): NTN#: MODEL: IncomefromTransport:


PerMonth

TRANSPORTTYPE NUMBEROFCATTLE: TOTALASSETSWORTH: Whydoyouneedfinancialassistance?

SECTIOND:References:Notabloodrelativebutknowntoyouforatleastthreeyears
1) TELEPHONE: 2) TELEPHONE: OFF CELL RES OFF CELL RES

SECTIONE:ACADEMICRECORDDETAILS:Fillinformationgivenbelowonly,noextrainformationisrequired.Incompleteinformationwillresultindisqualificationforadmission.
Certificate /Degree SSC/ O SSC/'O' Level HSSC/'A' Level/DAE Other(s) Degree Title Yearof Passing %Marks English %Marks Mathematics %MarksPhysics %Marks Comp.Sc. Total% Marks/CGPA Board/University

SECTIONF:DECLARATION
Iherebysolemnlyundertake/declarethatIhavepersonallyfilledinthisapplicationformandtheinformationcontainedthereiniscompleteandaccurate tothebestofmyknowledgeandbelief.IunderstandthatwithholdingorgivingfalseinformationwillmakemeineligibleforscholarshipatanystageandI willpaybackalltheamount.IfurtherunderstandthatImayberequiredtoappearforaninterviewrequestedbytheCollegeAdmissionCommitteeasa conditionforthefinancialassistancetotheprogrammeofstudyforwhichIhaveapplied.

Parent/Guardian'sSignature Date:

Applicant'sSignature Date:

GazettedOfficer'sSignature Date:

Pleaseensurethatyouhaveattachedallthefollowingdocuments:
OriginalBankdepositslipofRs:1000/forfinancialassistanceform. Copyofbillsofgas,electricityandtelephone. Proofofincome&incometaxpaidduringlasttwoyears. Bankstatementoflastsixmonths.

For Office Use

Comments:
FeePerYear Scholorshipperyear Loanperyear Payableperyear

AdmissionOfficer'sSignature

AdmissionTutor'sSignature

DeputyViceChancellor'sSignature 2

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