CENTRAL SECTOR SCHEME OF SCHOLARSHIP FOR

COLLEGE AND UNIVERSITY STUDENTS-2009

ELIGIBILITY
Application Form No. F-10
Form No.
Type: Central Sector Scheme of Scholarship for College and University
Students-2009
Eligibility*: (i) The applicant should be an Indian national and
(ii) The applicant should have passed in All India Senior School Certificate Examination
*(Detailed Scheme
(AISSCE) 2009 conducted by CBSE and secured a minimum of 80 % marks and
is available on the (iii) Pursuing regular course (not correspondence or distance mode) from recognized
website) educational Institutions and
(iv) Students should not be availing any other scholarship scheme and
(v) Income of parents from all sources should not exceed Rs 4.5 lakh per annum and
(vi) Should not belong to creamy layer as defined by DoP&T from time to time..
Value per Rs.1000/- for graduation level (10 months per academic year)
month:
Rs 2000/- for post graduate level (10 months per academic year)
Duration: 3 years for degree level and 2 years in the post graduation programme
(To be renewed on year to year basis subject to eligibility) For renewal
applicant has to apply on separate renewal form.

Note:

1. Those students who have done their Class –XII in year 2008 need not to apply using this Form
No F-10 form.

2. Mere submission of the application form shall not entitle the applicant for the award of
Scholarship.
 CHECKLIST
Signature:
All the applications must be signed by the applicant. Unsigned applications will be rejected.

Attestation:
All the applications must be certified alongwith signature / stamp of the Principal / Dean of the Institute
where the student has taken admission.

Bank Account Details:

Applicants should write their Bank Account number with detailed address of the Bank alongwith
Bank Code, MICR Code and RTGS/NEFT code of the Bank. Applicant should open Bank Account in their
name only. Scholarships will be sent by ECS mode directly to Bank Account of the selected candidates. In
case the Bank details as mentioned above are not complete and in prescribed format the application will be rejected.

Documents to be sent with the Application:

1. Annexure-I: Statement of particulars cum Joining report from HOD of Institute (Form No.F-10)
2. Annexure-II: Marksheet of AISSCE-2009 and Caste Certificate
3. Annexure-III: An Income affidavit from the parent in prescribed format on a non-judicial stamp paper of
Rs.10/- duly sworn in before Notary Public/First class Executive Magistrate/Revenue Officer should be
submitted alongwith the application. Applications without Affidavit as mentioned above will be rejected
summarily and no correspondence will be entertained in this regard. (Proof of Income of Parents i.e Income Tax
Returns of the parents should be attached alongwith the affidavit.)

Where to send Duly filled up Application Forms

i. For applicants who have done XII from CBSE Board in year 2009:-
The duly filled in proforma be sent in an envelope super scribing “Application for CSSS-2009”
should be sent to the “Deputy Secretary(A&V), CBSE, Shiksha Kendra, 2 Community
Centre, Preet Vihar, Delhi-110092”.
ii. For applicants who have done XII from Other Boards:-
Applicant who has done XII from Other Boards(like ICSE, UP, Uttranchal, Karnataka, Haryana
Board etc) are requested to their forms to his/her State Board only.

Change in Address And Bank Details

Any change in address and Bank Details must be immediately reported to “Deputy Secretary(A&V), CBSE,
Shiksha Kendra, 2 Community Centre, Preet Vihar, Delhi-110092” alongwith the Name and Roll No,. of the
applicant and copy of the form submitted.

Note: Those students who have done their Class- XII from CBSE prior to 2009 need not apply
under this scheme.

Last Date of Receipt of Application for the year 2009 : 30st Sept, 2009
 (Annexure-I) Form No. F-10
GOVERNMENT OF INDIA
MINISTRY OF HUMAN RESOURCE DEVELOPMENT
DEPARTMENT OF HIGHER EDUCATION
CENTRAL SECTOR SCHEME OF SCHOLARSHIP FOR COLLEGE AND UNIVERSITY STUDENTS
STATEMENT OF PARTICULARS CUM JOINING REPORT

Note: L A S T D A T E F O R S U B M I S S I O N : 30TH SEPTEMBER,

2009
Paste here
1. Please read checklist carefully before filling up the form. Each column should be Recent Color Photograph
carefully filled. No change in the information provided will be permitted subsequently. If of the Applicant attested
any entry is found to be incorrect, the scholarship, if awarded, is liable to be cancelled and stamped by
forthwith. Principal of Institution
2. It may be ensured that dully filled up form is sent after due attestation from Head of the where student is
Institution. presently studying
3. Incomplete statement or statement received after the prescribed date will not be
considered.
1. a Name of the Candidate (In block letters)
(As per Class XII Certificate)
b Nationality
2. Date of Birth (DD/MM/YY)
(As per Class X Certificate)
3. Sex : Male / Female
4. a Category: SC/ST/OBC/ General
(If Yes, Pl. attach proof thereof)
b Are you suffering from any of the disabilities
(PH/HH/OH) YES/NO
(If Yes, Pl. attach proof thereof)
Details of Class XII Examination passed by the Candidate:
5 a Name of the Examination passed
b Roll Number of AISSCE-2009 c Year of Passing 2009
d Name of the Board which conducted the
examination of the candidate(with headquarters.)
e State in which School ( from where done XII) was located
f Total aggregate marks obtained in the g Stream
examination (in First five subjects)
h Percentage of marks obtained in aggregate
6. Details of Father / Guardian/husband (as the case may be):
a Name
b Nationality c Occupation
d Permanent
Home
Address

Pin:
7. a Name of Mother b Nationality of
Mother
Details for Communication (Present Address for Postal Communication):
8. a Address for
Correspondence

Pin:
b Tel No. with STD c Mobile No.
Code
d E Mail ID
9. a Annual Income of Father (attach proof/ITR) Rs.
b Annual Income of Mother (attach proof/ITR) Rs.
10. Is the candidate in receipt of any other scholarship
from State Government or other institution or
person? Yes / No
If Yes, particulars should be given including the
monthly amount and date from which the
scholarship is being drawn.
11. a Name and Address of the Institution where
admitted for Graduate course
b Website address of the present Institute (if
available)
c Name of Duration …………… Yrs
the Course
Joined
Type of Institution Type of Programme Mode of Study Pattern of Examination
Central Govt. Degree Regular Classes Annual
State Govt. Diploma course Evening Classes Semester
Integrated Degree cum
AICTE Distance Mode Trim nester
Masters Degree
UGC approved Correspondence Bi-Annual
Private Non Collegiate
……………(Others) Pl specify Open Learning
12. It is further certified that (Please tick as applicable)
My father is directly recruited Class I/Group A officer. My Mother is directly recruited Class I/Group A officer.
My father is directly recruited Class II/Group B officer. My Mother is directly recruited Class II/Group B officer.
My father was promoted to Class I/Gp ‘A’ officer at age of 40. My Mother was promoted to Class I/Gp ‘A’ officer at age of 40.

One of my parent died/suffers permanent incapacitation. My father/mother retired from a Group A/Group B post.
I do not fall in definition of creamy layer as per DOPT OM No. 36033/5/2004-Estt(Res) dated 14.10.2004.
13. Particulars of Savings Bank Account (Mandatory; Application will be rejected if all the columns are not filled)
a Account Number
b Name and Address of the Bank

c Bank Code Number

d MICR Code
e RTGS:NEFT:IFSC Code (11 digit Code of the Bank)
14. Certified that the statement made by me in this form is correct.
I declare that in case I am selected for a scholarship, I shall devote my full time to the course of study,
and that I shall not receive any other stipend/scholarship from any other source.

Signature of candidate
JOINING REPORT

This is to certify that Shri/Smt./Kumari ………………………………………………………………………. S/o,W/o,D/o

Shri/Smt. …………………………………..………………………………………………………………… has been granted
admission as per above particulars in this institution on the …….…………….. day of …………………… for the ……
………………………………………………………………………………………… course. He/She has started attending the
First Year class with effect from ………………………...…., 2009.

Head of Institution ________________________________

Name & Designation ________________________________
Tel. & Mobile No. ________________________________
Email ID ________________________________
Seal ________________________________

Place …………………

Date: …………………
 ANNEXURE – III

INCOME AFFIDAVIT
Declaration of income of Parent/Guardian for the year (ending on 31 st March,2009) for purposes of
scholarships granted under the “Central Sector Scheme of Scholarship for College and University
Students”.
I, ____________________________________________ son/daughter of Shri/Smt __________________________
presently residing at _______________________________________________________________________________
__________________________________________________________________ solemnly affirm and say as follows:-
1. That my son/daughter/dependent Shri/Kumari
_____________________________________________________ who has been provisionally selected for
Scholarship under the “Central Sector Scheme of Scholarship For College and University
Students”, is studying in _________________________________________________
________________________________________________________________ (here give the name of
institution)
2. That my annual income in the preceding year ending the 31st March, 2009 is Rs.
___________________ as per details furnished in the Scheduled here under written, I also affirm that
particulars of property held by me is as shown in the Schedule and that I have correctly indicated
the amount on various taxes/cesses and land revenue paid by me. I make myself personally
responsible for the accuracy of the facts and figures furnished
3. That the statements made in the foregoing paragraphs are true to my knowledge.
4. That I further undertake that in the event of the particulars given in this declaration being found
false, I shall refund to the President of India DOUBLE the amount of the scholarship to the said
scholar(s) and the Government’s decision on whether the declaration of particulars is false shall be
final and binding on me.

Signature
Name in full

To be signed in the presence of Notary Public or a Magistrate/Ist Class Magistrate Executive/ Revenue
Officer/ who would also affix his signature and seal.
SCHEDULE
I Extent of Land held and Income
(a) Independently as owner (b) Jointly as (c) Independently as
owner tenant
(i) Area
(ii) Village
(iii) Survey No.
(iv) Land Revenue

Assessment
(v) Annual Income Rs. Rs. Rs.

II Property held and income (Houses, Shops, Buildings, House sites etc.)

(a) House No. ___________________________________________________

(b) Street/Road ___________________________________________________
(c) Village/Town/City ___________________________________________________
(d) Area of Site ___________________________________________________
(e) Rent derived if any ___________________________________________________
(f) House Tax Rs.___________________________________________
(a) Sanitary cess or otherRs.__________________________________________
(b) Net Annual Income Rs.__________________________________________

Whether the whole or part of land has been given out to tenants:. If ‘yes’ particulars.
III Income from Shops:
(i) Address of shop ____________________________________________
 (ii) Nature of trade ____________________________________________
(iii) Sales Tax, Income Tax paid Rs._________________________________________
(iv) License No. ____________________________________________
(v) Annual Income Rs. ________________________________________
IV Salaries Drawn, by father and mother:
(i) Name of the Employer ____________________________________________
(ii) Office/Unit in which working and designation
____________________________________________
(iii) Address of Office ____________________________________________
(iv)
(a) Annual Basic Pay for 2009 without deduction of Income Tax Rs
__________________________
(Certificate from the employee/Income Tax Authority/Revenue Authority may be attached)
(b) Special Pay/Bonus. Rs __________________________
(c) Deputation allowance and honoraria including NCC honoraria.Rs
__________________________
(d) Total of (a), (b) and (c) Rs __________________________
(e) Amount of contribution to Provident Fund Rs __________________________
(f) Payments towards LIC/CTD Rs __________________________
(g) Total of (e) and (f) Rs __________________________
(h) Whether belonging to non-creamy layer : YES / NO ________
If Yes, attach certificate from employer.
V Other benefits like house rent allowance, free house and other perquisites ______________
VI Other source of Income :
(i) Income from subsidiary industries part-time occupation Rs. _________________________
(ii) Amounts drawn as wages Rs. _________________________
(iii) Any other Income Rs. _________________________
VII Annual income of wife/husband and of the Scholar’s Income from any source Rs. _______________

(a) Annual Basic Pay for 2009 without deduction of Income Tax Rs
__________________________
(Certificate from the employee/Income Tax Authority/Revenue Authority may be attached)
(b) Special Pay/Bonus. Rs __________________________
(c) Deputation allowance and honoraria including NCC honoraria. Rs __________________________
(d) Total of (a), (b) and (c) Rs __________________________
(e) Amount of contribution to Provident Fund Rs __________________________
(f) Payments towards LIC/CTD Rs __________________________
(g) Total of (e) and (f) Rs __________________________

Signature of Parent/
Guardian of the Scholar
N.B.
1. Total income of the family should include income only of father & mother of the Scholar and of no other members though
they may be earning,
2. If father is dead, mother’s income will be shown alongwith the income, if any, in the Scholar own name from shares,
property etc.
3. If both father and mother of the scholar are deceased the income, if any, in the scholar’s name only will be shown, and not
the income of the guardian who may be supporting the scholar.
4. Income for the purpose of Means Test is defined as under:-
a. In the case of salaried class, basic pay plus income if any form other sources and would not include allowance like Dearness
Allowance, City Compensatory Allowance etc.
b. In the case of income from source liable to income tax, income computed (after deduction for rebate able items) for the
purpose of assessment of income tax, as per Income Tax Rules for the year.
c. In the case of income not liable to income tax, such as income from Agriculture, etc. the net income that is arrived at after
deduction expenditure incurred for earning that income.