Scribd
Upload
85 views4 pages

Application Form For The NEC Stipend and Book Grant

This document is an application form for the NEC stipend and book grant scholarship. It collects information such as the applicant's personal details, educational qualifications, bank details, institute details, and declarations. The applicant, Mintu Konwar, is applying for an MCA program at Dibrugarh University, providing details of their BCA qualifying degree and current enrollment at the university from 2018-2020. The form requires signatures from the applicant, institute head, and other declarations.

Uploaded by

laneyelkins
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
85 views4 pages

Application Form For The NEC Stipend and Book Grant

This document is an application form for the NEC stipend and book grant scholarship. It collects information such as the applicant's personal details, educational qualifications, bank details, institute details, and declarations. The applicant, Mintu Konwar, is applying for an MCA program at Dibrugarh University, providing details of their BCA qualifying degree and current enrollment at the university from 2018-2020. The form requires signatures from the applicant, institute head, and other declarations.

Uploaded by

laneyelkins
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
You are on page 1/ 4

Nec Application Form http://dteassamexam.in/nec2019/index.php/welcome/scholarship_applica...

Application form for the NEC stipend and book grant.

1 of 4 10/14/2019, 2:08 PM
Nec Application Form http://dteassamexam.in/nec2019/index.php/welcome/scholarship_applica...

Level of study PG
Course Name MCA Registration no 20190100964

Applicant Surname KONWAR


Applicant first name MINTU
Fathers Name Sarat Konwar
Gender Male
Mother‘s/ Guardian‘s Name Renu Konwar
Contact No. 7002808428
E-Mail [email protected]

Communication Address

Address line 1 Prasanna Gogoi Hostel


Address line 2 Dibrugarh University
Post office Dibrugarh University
District Dibrugarh
State Assam
Pin 786004

Name of the qualifying examination


BCA
passed
Board/university Dibrugarh University
Total marks 3200 Mark scored 2317
Percentage of marks secured 72.41 %

Caste Category OBC

Date of Admission 02-07-2018


Date of commencement of the course 01-08-2018
Expected date of completion 30-06-2020

Details of educational institute where the student is currently studying


Name of the institute Dibrugarh University
Address
Address Centre for Computer Science and
Line 1 Application
Address
Dibrugarh University,Dibrugarh
Line 2
Pin 786004

Bank Details of Applicant


Name (as recorded at Bank) Mintu Konwar
Account No. 33853523639
Name of Bank State Bank Of India

2 of 4 10/14/2019, 2:08 PM
Nec Application Form http://dteassamexam.in/nec2019/index.php/welcome/scholarship_applica...

Place:_______________ Countersigned
Date:________________ Place:________________
Date:__________________
(Signature of student) Signature & Seal of the Head of the Institute

Non-Duplication Certificate

Certify That the Applicant is not receiving any financial assistance/scholarship from any other source
except the NEC Scheme.

Signature of the Principal/Register/Dean


Place:
Date:
(Seal)

3 of 4 10/14/2019, 2:08 PM
Nec Application Form http://dteassamexam.in/nec2019/index.php/welcome/scholarship_applica...

ANNEXURE-A

RECOMMENDATION BY HEAD OF THE INSTITUTE


(NOTE: Candidate should not write anything in this Section)

Recommendation for NEC Stipend & Book grant. The applicant Sri/kum/Smti __________________________________________________is
studying _________________________________ course(specify subject) at_____________________________________________________
(Name of the institute which is/ is not recognized by AICTE or any similar Central/ State Govt. organization. A copy of recognition letter is
enclosed herewith. Further the student was admitted to the course mentioned above ___________________________________ on_____/____
/20____ and the date of commencement of the course was_____/______/20_____ The normal date of completion of the Course is _______/
_______/20________

Date:_________________________ (Signature)
Principal/ Director/ Registrar/ Dean or any other Officer authorized to certify
(Seal).
ANNEXURE-B

PERMANENT RESIDENT CERTIFICATE


Shri/ Kum/ Smti___________________________________________________________________ Son/Daughter/Wife of
Shri_________________________________________________________ Post Office_______________________________
Village/Town______________________________ District_______________________________ is a permanent resident in the District
________________________in the state_____________________________ of ____________________________ This PRC is for higher
study purpose only.

Date:_________________________ Signature of the Deputy Commissioner


Place:___________________________ (Seal)
ANNEXURE-C
I hereby give an undertaking that I shall serve at any place in the State of Assam on successful completion of the course for a minimum period
of 5(five) years. If an opportunity arises N.E.C. will not have any liability to provide any job to me.

Further I do hereby solemnly affirm and declare that all the statements stated above are correct and true to the best of my knowlege and belief
therein. In the event of any information/document given by me is found to be false detected at any stage I shall be liable to be punished as per
law established.

Place:___________________________ Signature and full name of the candidate


Date:_________________________
ANNEXURE-D
We hereby give an undertaking that in the event of committing breach of terms and conditions of NEC stipend/book grant and if information
given by the candidate is found to be false the whole of the amount given to the student shall become payable jointly or severally by the student
and the surety.

Signature of the 1st Witness Full name of the parent/local Guardian


Name(in capital letters)
Address in full Signature of the student
Date:______________
Signature of the 2nd Witness
Name(in capital letters) Signature of the surety
Address in full Date:

4 of 4 10/14/2019, 2:08 PM

You might also like