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 2022-23
Application ID: SSP2022011800456475 Application Date:08-10-2022
BASIC INFORMATION
Student's Name: MD AAHIL Father's Name: MD FAIYAZ
Date of Birth: 14-06-2013 Mother's Name: RAZIA SHABNAM BEGUM
Gender: Male Annual Family Income: 60000
Marital Status: Unmarried Guardian's / Husband's Name: MD FAIYAZ
E-mail Id: Religion: Muslim
Mobile No: 9831399038 Aadhar No : XXXXXXXX8393

ADDRESS INFORMATION
Permanent Address Present Address
Domicile State: WEST BENGAL State: WEST BENGAL
Domicile District: KOLKATA District:KOLKATA
Block/Municipality:Kolkata MC(MUNICIPALITY) Block/ Municipality:Kolkata MC(MUNICIPALITY)
Permanent Address: 6/H/3, IBRAHIM ROAD
Present Address: 6/H/3, IBRAHIM ROAD
Post Office: KHIDDERPORE
Post Office: KHIDDERPORE
Police Station: EKBALPORE
Pin: 700023 Police Station: EKBALPORE
Pin: 700023

ACADEMIC INFORMATION
Previous Academic Information Present Academic Information
Previous Institute Name: ST. THOMAS BOYS' SCHOOL Institution District :KOLKATA
Previous Class / Course Name: III Institution Name: ST. THOMAS BOYS' SCHOOL
Previous Year of Study: III Current Class / Course Name : IV
Name of the Board of
Current year of Study :IV
last Exam Passed: Council for the Indian School
Are you a Hosteller: No
Certificate Examinations
Year of Passing Last Exam: 2022 Name of the Board / Council / University : Council for the Indian
% of Marks Obtained School Certificate Examinations
in Last Examination: 90.00 Course Duration : 1 Year
BANK ACCOUNT DETAILS
IFSC: UBIN0536326
Savings bank account no.: XXXXXXX6223
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.

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

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