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BHEL, TIRUCHIRAPPALLI, CSR, SCHOLARSHIP SCHEME 2012-13

APPLICATION FORMAT Name of the student: Phone Numbers: Name of the parent: Studying Std, group, year: Photo

If Physically challenged, give details (copy of certificates to be enclosed) Name & Address of the Institution studying at present:

Occupation of Father: Occupation of Mother: Full Address:

Community: Annual Income of Father: Annual Income of Mother: Whether parents are alive, If no give details: Are you getting any scholarship, If yes give details: If you are a Sports person, give details. Signature of the Student Date:

SC / ST / MBC / BC/ OC

Note: Attested copy of the Income Certificate signed by Thasildar to be enclosed Attested copy of the Mark sheets to be enclosed Attested copy of Community certificate to be enclosed Attested copy of Sports certificates to be enclosed

Recommendation of the head of Institution studying at present with seal

cWjp nkhopg; gbtk;

UNDERTAKING BY PARENT SEEKING SCHOLARSHIP FOR HIS/HER CHILD

I,

Smt/Shri

__________________________ ____________________

aged

____________Son/Daughter

of

Sri___________________________ residing at _______________________ and working as Corporate Social seeking scholarship under BHEL, Tiruchirappalli for my child Responsibility scheme,

Chi/Sow.______________________ studying in class ______________at _____________________________ School /Polytechnic / College solemnly state the following:

1. The particulars furnished by my son / daughter in the application form are true and factual.
2. I shall inculcate good habits and provide a healthy and wholesome atmosphere at my house to enable my child to pursue his /her study.

3.

If at any time the track record of my child or myself becomes questionable, the scholarship granted to my child may be withdrawn.

Signature of the Parent