11/19/13

Application for Stipend

GOVERNMENT OF ARUNACHAL PRADESH DIRECTORATE OF HIGHER & TECHNICAL EDUCATION ITANAGAR - 791111, ARUNACHAL PRADESH, Ph: 0360-2214416 (O), 2211717 (F) Email:dhearunachal@rediffmail.com, Website: www.apdhte.nic.in CONFIRMATION OF REGISTRATION FOR AWARD OF STIPEND FOR THE SESSION 2013-14 APPLICATION NUMBER 1 2 3 4 5 6 Name of Candidate Fathers Name Mothers Name Tribe Sub Tribe (If any) Address for Communication

: 8934 : : : : :
Jumma Ruti Larjum Ruti Yapek Ruti Adi(Galo)

7 8 9

Course of Study Undertaking Level of Course Year/Semester Studying in

10 Roll Number 11 Name of Institution 12 Address of Institution Date of Admission in the current Academic session

: Bluemount Lodge, Near Everfresh Hotel City: Kollam, State: Kerala, PIN: 691005 : B. Tech. : Technical : 7th Semester : 100655 : T.K.M College of Engineering : Kollam, Karikode City Kollam, State Kerala, PIN 691005 : 27/08/2010

Signature of the Student

13

14 Name of the last examination Passed

: 4th Semester B.tech Degree Examination Duration of course _____________________________________ Period of Academic Session _____________________________________ Date of joining of the Student in the Institution _____________________________________
Institution affiliated to (University/Board of council etc)

_____________________________________

Certified that all the details of the student as given above has been verified with the records available in the institution and found correct CERTIFICATE TO BE COMPLETED BY THE HEAD OF INSTITUTION WHERE THE APPLICANT IS STUDYING Do you recommend the award of Stipend? If No, give valid reasons %age of attendance in the class (to be filled during the month of November.) Name of designated officer to whom Bank Draft is to be prepared Name of nearest SBI Branch IFSC Code of SBI Branch

_____________________________________ _____________________________________

(In case of institutions located outside Arunachal Pradesh, the following details are to be given) _____________________________________ _____________________________________ _____________________________________
Name of Head of Institution
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11/19/13

Application for Stipend

Designation

: ___________________ : ___________________ : ___________________

Round Seal of Institution

Signature Date

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