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ACKNOWLEDGEMENT SLIP
OFFICE COPY
Tear off
Tear off
ACKNOWLEDGEMENT SLIP
STUDENT COPY
Note: This copy duly stamped and signed by RSB given to the student by hand
or by post. (Envelope enclosed along with the application may be used.)
MINISTRY OF DEFENCE
Department of Ex-Servicemen
Welfare
PM’S SCHOLARSHIP SCHEME
FOR
DEPENDENT WARDS OF EX-SERVICEMEN /
WIDOWS
Brochure-Cum-Application Form
For Academic Year 2009-10
Application Form consists of Col No 1 to 20, Renewal Form and list of RSB
at state and UT level. (Brochure-Cum-Application consists of 31 pages)
KENDRIYA SAINIK BOARD
West Block-IV, Wing-VII, 2nd Floor
R K Puram, New Delhi-110066
Website: www.mod.nic.in
Tele : 011- 26715250
E-Mail : jdpmscholarshipksb@gmail.com
2. Scholarships Available.
Note: (i) The candidate irrespective of his marital status is eligible for
PMSS. However, an earning / serving candidate is not eligible.
One candidate to submit only one application form for one course, if
any candidate submit two application for more than one course, both
the applications will be rejected. Forms are to be downloaded from the
website www.mod.nic.in. Application forwarded on any other format will
not be considered.
5. Selection Procedure.
7. Eligible Courses.
The facility under PMSS is restricted for professional courses only duly
recognized by the respective Government regulatory bodies such as All
India Council for Technical Education, Medical Council of India etc.
(i) Rs. 1250/- per month for boys Paid after successful
completion of each
academic year.
(ii) Rs. 1500/- per month for girls
(g) Three stamped (Rs. 5 each) blank envelopes of 27x12 cms and
one stamped (Rs. 35) blank envelope of 35x25 cms are to be attached
with each application so as to facilitate correspondence with the candidate
by KSB/RSB.
(t) While filling the application form, leave 1 (one) box blank between 2
(Two) words. Column wise guidelines are explained further for filling up
the application form.
1st Name A J A Y
Middle Name S I N G H
Surname R A N A
Male √ Female
D D M M Y Y Y Y
1 0 0 6 1 9 8 2
(iv) Column – 4. Mention your Rajya Sainik Board and Zila Sainik
Board name, from where your father / mother have registered and have
obtained ex-servicemen / widow identity card.
(vi) Column – 6. Write phone number along with STD code and email
ID for any query (email ID is must).
Category - 1 O N E
K A M L E S H C H A N D R A C H O U D H U R Y
1 4 5 2 3 6 K
S E R G E A N T
A I R F O R C E
b. Marks obtained N I N E H U N D R E D
(in words) F O R T Y
(in figure) 9 4 0
c. % of marks scored S E V E N T Y E I G H T
(in words) P O I N T T H I R T Y
T H R E E
(in figure) 7 8 . 3 3
Yes √ No
(xi) Column – 11. The student is to specify the course which he / she is
presently studying. (Example:- B TECH)
B T E C H
14. Column – 12. Duration of the course both in numbers and figures to be
mentioned. For example 5 years 6 months.
(In figure)
Y Y M M
0 5 0 6
(In word)
F I V E Y E A R S A N D S I X
M O N T H S
15. Column – 13. Write date of commencement & completion of course as
shown below:
(Course completion)
D D M M Y Y Y Y
3 1 1 2 2 0 1 2
(xiv) Column - 14 Write the full name and address of the college with
email ID and phone number of principal.
Name of Student A J A Y S I N G H R A N A
Roll No. 0 8 E A T I T 0 4 3
Name of College A J M E R I N S T I T U T E
O F T E C H N O L O G Y
Full Address P U S H K A R B Y P A S S A
of college J M E R
State R A J A S T H A N
Pin Code 3 0 5 0 0 4
College Website w w w . a i t a j m e r . c o m
(xv) Column - 15 Write the regulatory body of your college.
A I C T E
(xvi) Column – 16. Furnish the particulars of your all children as per
specimen given:-
(xviii) Column - 18 Please write the full details of bank account of the
student and attach the photocopy of passbook and cancelled cheque as
required to verify the correctness of the account number (individual
student account is preferred. However, a joint account with the father /
mother is also accepted).
Bank Name S T A T E B A N K O F I N D
I A
Branch Name A J M E R
Branch Address A J M E R I N S T I T U T E O F T
E C H N O L O G Y
State R A J A S T H A N
Branch Code 0 5 1 4
Account No. 3 0 2 0 0 1 5 2 4 6 8
REPEAT
Account No. 3 0 2 0 0 1 5 2 4 6 8
Date: _____________________
_______________________________
Place: ____________________ Full Name & Signature of
Candidate
_____________________________
__________
Checked / counter singed by
ESM / Widow
Note: 1.) Please read column wise guide lines carefully before filing the application
2.) Application Form to be filled in Capital letters except email ID.
3.) Checklist must be attached on the top of application duly tick marked.
4.) One candidate to submit only one application form for one course.
1. NAME:-
First Name
Middle Name
Surname
Male Female
2. Put a tick mark (√)
4. Your Rajya Sainik Board or Zila Sainik Board (Where ESM is registered and
obtained Ex-servicemen Identity card)
RSB
ZSB
5. Full Address:
a) Present Correspondence Address: - (Where you want your letter to be sent in
case of selection / rejection)
House No.
District
State
Pin Code
b) Permanent Address :-
House No.
Tehsil
District
State
Pin Code
17. Telephone Number.
STD Code
Mobile No.
E-Mail (mandatory)
8. Ex-serviceman’s Particulars:-
a) Name of ex-serviceman
b) Service No.
c) Rank
a. Name of Course/MEQ
(in figure)
(in figure)
e. % of marks scored (in words)
(in figure)
Amount
Source
D D M M Y Y Y
Y
Name of Student
Roll No.
Name of College
Full Address
of college
State
Pin Code
College Website
15. Regulatory bodies/ Council. (For example all engineering degrees and
management degree courses are recognized by AICTE & UGC and all
medical degree are recognized by Medical Council of India or Dental
Council of India, specify as per case).
Bank Name
Branch Name
Branch Address
State
Branch Code
Account No.
REPEAT
Account No.
Place : ________________
Date : ________________
Date:- ______________
Place:-_____________
2. Service No. :
_______________________________________
3. Rank :
_______________________________________
5. Trade :
_______________________________________
6. Date of enrolment :
_______________________________________
7. Date of Discharge :
_______________________________________
9. Duration/Length of Service :
_______________________________________
10. Regular :
_______________________________________
Reserve
Date: ________________________
Place: ______________________
ACKNOWLEDGEMENT SLIP
OFFICE COPY
Tear off
Tear off
ACKNOWLEDGEMENT SLIP
STUDENT COPY
Note: This copy duly stamped and signed by RSB given to the student by hand
or by post.
3. Particular of ESM:
Name of ESM
Rank
Service Number
Distt
RSB
Pin Code
Place:
________________________________
Place :
_____________________________
this college in the academic year 20___ - ___ and the course will
___________________________
and he / she is continuing the course in 2nd / 3rd / 4th / 5th year .
Office Seal:
Signature of Principal / Dean /
Registrar
Date: ________________
Place: _______________
________________________________
Full Name & Signature of the Candidate
Chandigarh
zswochd@gmail.com
7 CHHATTISGARH Col K L Yadav (Offg) (Retd) Raipur
Director
Deptt of Sainik Welfare, CG 0771-2445165 (O)
Near Collectorate Parisar, Behind 0771-2427449 (O)
Home Guard Office 0771-2352529 (R)
0771-2420084 (F)
09893164219 (M)
Raipur - 492 001
dsw.cg@nic.in
Delhi-
Gp Capt RK Sharma (Retd)
Secretary 011-23991876 (F)
8 DELHI Rajya Sainik Board 011-23969260 (O)
Opp Tis Hazari Court 09818953191 (M)
No.1, Rajpur Road, Delhi-110 054
rsbdelhi@nic.in
Panaji
Maj Venugopal Nair (Retd)
0832-2227138 (O)
Secretary
0832-2443236 (R)
9 GOA Deptt of Sainik Welfare
0832-2227138 (F)
Collectorate Building
09420686834 (M)
Panaji - 403 001
secyrsbgoa@gmail.com
Gandhinagar
rsb_guj@rediffmail.com
Panchkula
Brig KS Budhwar (Retd)
0172-2560462 (O)
Secretary
0172-2562102 (R)
Rajya Sainik Board
11 HARYANA 0172-2560462 (F)
Sainik Bhawan, Sector 12,
0172-2560321 (O)
Shaheed Capt Rohit Kaushal
09888527189 (M)
Marg, Panchkula - 134 109
sainikparivar@yahoo.com
Hamirpur-
Maj Jogi Dass Mankotia (Retd)
Director 01972-221854 (O)
HIMACHAL
12 Deptt of Sainik Welfare 01972-224659 (O)
PRADESH
Govt of Himachal Pradesh 01972-225961 (R)
Hamirpur - 177 001 01972-225643 (F)
09418090708 (M)
Jammu
Brig RS Langeh, VSM (Retd)
JAMMU AND Director 0191-2561547 (O)
13
KASHMIR Deptt of Sainik Welfare 0191-2465141 (R)
Ambphalla, Jammu - 180005 0191-2575362 (F)
09419180672 (M)
Ranchi-
jharkhand_skn@yahoo.in
Bangalore-
Col CM Uthaiah (Retd)
Director
080-25589459 (O)
Deptt of Sainik Welfare &
080-28445706 (R)
15 KARNATAKA Resettlement,
080-25589459 (F)
Fd Mshl KM Cariappa, Bhavan,
09886205130 (M)
No 58, Fd Mshl KM Cariappa
Road, Bangalore - 560 025
sainikblr@rediffmail.com
Thiruvananthapuram
govindan.nair@yahoo.com
Bhopal-
Brig Pramod Kumar (Retd)
Director
0755-2553992 (O)
Deptt of Sainik Welfare
0755-2666081 (R)
MADHYA Southern Shopping Centre
17 0755-2577209 (F)
PRADESH
09993030601 (M)
Guru Teg Bahadur Complex, TT
Nagar, New Market,
P.B.NO 364, Bhopal - 462 003
dirrsb@mp.gov.in
18 MAHARASHTRA Col Suhas S Jatkar (Retd) Pune-
Director
Deptt of Sainik Welfare 020-26332763 (O)
Maharashtra State ‘Raigad’, Opp 020-26332764 (O)
National War Memorial, Solapur 020-26850613 (F)
Road, Ghorpadi, Pune-411 001 09422314276 (M)
dsw@mahasainik.com
Shillong-
Brig WJB Sturgeon, YSM, SM
(Retd) 0364-2225613 (O)
Director 0364-2536574 (R)
20 MEGHALAYA Dte of Sainik Welfare 0364-2225613 (F)
Public Service Commission 09436101551 (M)
Building Beyond DC Building
Shillong - 793 001
rsbmegha@rediff.com
Aizawl-
Col John Zama, SM (Retd)
0389-2322732 (O)
Director
0389-2322732 (F)
21 MIZORAM Deptt of Sainik Welfare & Res,
0389-2325811 (R)
Tuikual ‘A’, PB No. 119
09436142593 (M)
Aizawl - 796 001
rsbmizoram@yahoo.in
Kohima-
secyrsb-ngl@nic.in
23 ORISSA Col (Dr) DK Das (Retd) Bhubaneshwar
Secretary
Rajya Sainik Board, Nageswar 0674-2432268 (O)
Tangi, Lewis Road, 0674-2435998 (F)
Bhubaneshwar-751002 0674-2721156 (R)
09937940807 (M)
rsbbbsr@gmail.com
Puducherry
Col Jacob Mathen Anand (Retd)
Director 0413-2253107 (O)
PUDUCHERRY Deptt of Sainik Welfare 0413-2250575 (F)
24
(UT) Jawan Bhavan Complex, Lawspet 09443228260 (M)
Main Road, Pakkamudayanpet,
Puducherry - 605 008
dswpuducherry@gmail.com
Chandigarh
dswpb@rediffmail.com
Jaipur-
rajasthansainik@yahoo.com
Gangtok-
Lt Col PB Gurung (Retd)
03592-202534 (O)
Secretary
27 SIKKIM 03592-221456 (O)
Rajya Sainik Board, Paljor
03592-202156 (R)
Stadium Road, Gangtok-737 101
03592-221456 (F)
09434448861 (M)
28 TAMIL NADU Capt S M Aslam, (Retd) Chennai-
Joint Director
Dte of Ex-Servicemen’s Welfare 044-26691747 (O)
22, Raja Muthiah Salai, Choolai 044-26691342 (O)
Chennai - 600 003 044-22331052 (R)
044-26691886 (F)
09444823182 (M)
mdossc@gmail.com
Agartala
Lt Col Mohit Ghosh (Retd)
Secretary 0381-2326507 (O)
Rajya Sainik Board, Nehru Office 0381-2323795 (F)
29 TRIPURA
Complex, Gorkhabasti, P.O. 0381-2319005 (R)
Kunjaban, Agartala - 799 006 09436510584 (M)
West Tripura
rsb.tripura@gmail.com
Lucknow-
Shri AK Chaturvedi, PCS
(Additional Charge)
0522-2625354 (O)
UTTAR Director
30 0522-2625354 (F)
PRADESH Dte of Sainik Kalyan Evam
0522-2305107 (F)
Punarvas, Kariappa Bhawan,
0522-2391701 (R)
Kaiserbagh, Lucknow - 226 001
09415404142 (M)
Dehradun-
Brig AN Bahuguna, KC, YSM,
VSM (Retd) 0135-2744208 (O)
Director 0135-2743773 (F)
31 UTTARAKHAND Nideshalaya Sainik Kalyan 0135-2741481 (O)
Uttarakhan, Kalidas marg 0135-2670813 (R)
P O- Haathi Badkala 09358254621 (M)
Dehradun - 248121
dskddn@gmail.com
Kolkata-
Note:
Dadar Nagar Haveli: ESM of these states can submit their Prime Minister
application form to
Gujrat RSB.
Daman & Div
Lakshadweep: ESM of this state can submit their Prime Minister application
form to Kerala RSB.