West Bengal Minorities' Development and Finance Corporation

A statutory Corporation under Minority Affairs & Madrasha Education Department, Government of West Bengal
"Amber", DD/27E,Salt Lake City Sector-I, Kolkata-700064, Toll free No:-18001202130

AIKYASHREE (FRESH)
APPLICATION FOR WB PRE MATRIC SCHOLARSHIP 2023-24
Application ID: SSP2023011100628828 Application Date: 21-09-2023
BASIC INFORMATION
Student's Name: RAMIYUN MALLICK Father's Name: SUFIDUL MALLICK
Date of Birth: 22-03-2016 Mother's Name: SELIMA BIBI
Gender: Female Annual Family Income: 60000
Marital Status: Unmarried Guardian's / Husband's Name: SUFIDUL MALLICK
E-mail Id: [email protected] Religion: Muslim
Mobile No: 8670717885 Aadhar No XXXXXXXX6661
Name as per Aadhaar: RAMIYUN MALLICK
Bangla shiksha ID: 04069622000062
ADDRESS INFORMATION
Permanent Address Present Address
Domicile State: WEST BENGAL State: WEST BENGAL
Domicile District: PASCHIM MEDINIPUR District:PASCHIM MEDINIPUR
Block/Municipality:Chandrakona - I(BLOCK) Block/ Municipality:Chandrakona - I(BLOCK)
Permanent Address: INDA Present Address: INDA
Post Office: DINAPUR Post Office: DINAPUR
Police Station: CHANDRAKONA Police Station: CHANDRAKONA
Pin: 721242 Pin: 721242
ACADEMIC INFORMATION
Previous Academic Information Present Academic Information
Institution District :PASCHIM MEDINIPUR
Institution Name: Inda Pry. School
Institution UDISE/AISHE/NCVT Code : 19201801001
Current Class / Course Name : I
Current year of Study :I
Are you a Hosteller: No
Name of the Board / Council / University : WEST BENGAL BOARD OF
PRIMARY EDUCATION
Course Duration : 1 Year
BANK ACCOUNT DETAILS
IFSC: SBIN0009136
Savings bank account no.: XXXXXXX7798
Name as per bank Account: SELIMA BIBI (Mother)
Declaration:I hereby declare that the details furnished above are true and correct to the best of my knowledge and belief and I
have not applied for any other scholarship/stipend, etc. from any other government sources(one-student-one-
scholarship).NB:The application of student applying for more than one scholarship application/scheme is liable to be rejected.

___________________
Signature of Student
DECLARATION OF INCOME
(To be given by the parents/ guardians)

Certified that the gross annual income from all sources in respect of my family is Rs.60000 . I further undertake that in the
event of the particulars given in the declaration being found false, I shall refund the whole amount of the Scholarship paid to
the said Scholarship holder RAMIYUN MALLICK and the Government's decision in this regard shall be final and binding on
me.

__________________________
Signature of the parents/ guardian
Instruction
Student is to submit this ***computer-generated filled-in application form (duly signed) to the educational
institution along with following supporting document within 7 days:

1. Photocopy of the bank-passbook where the details of bank a/c number,IFSC are mentioned clearly.

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