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Forms can be downloaded from www.merck.co.in or can be collected from Merck Limited office.
Applications are invited from the students scoring above 80% in SSC examinations.
The application forms duly filled should be submitted to Merck Limited office within 10 days after the
declaration of the SSC Board Exam results.
Attach certified copy of your SSC examination mark sheet and a passport size photograph with the
application form.
Application form must be signed by the applying student and the parent / guardian of the applying student.
Incompletely filled and those without the required supporting documents will not be considered.
Only selected students will be informed by email or telephone for the first round of Interview.
The decision of the Board of Trustees is final and no disputes would be entertained.
FILL IN CAPITAL LETTERS
PERSONAL DETAILS
(First Name)
Date of Birth: ____ / _____ / _____
(DD)
(MM)
(Middle Name)
(Last Name)
(YY)
_____________________________________________________________________
Present Address
_____________________________________________________________________
_____________________________________________________________________
Permanent Address:
_____________________________________________________________________
_____________________________________________________________________
Contact Details:
(Mobile) __________________________
E-mail ID ____________________________________________________________
EDUCATION DETAILS
Examination
Passed
CLASS X
CLASS IX
CLASS VIII
Marks
Obtained /Out
of Total Marks
Percentage of
Marks (%)
Specify any academic / merit achievements or awards that you have received in the past
________________________________________________________________________________________
Mention your reasons for choosing the above field of study and how do you think it will benefit you?
________________________________________________________________________________________
Specify the educational course that you would like to pursue henceforth
________________________________________________________________________________________
Explain briefly your carrier plans
________________________________________________________________________________________
Which are the educational institution(s) you wish to apply?
________________________________________________________________________________________
Write in brief about your extra-curricular activities & interests
________________________________________________________________________________________
FINANCIAL DETAILS
Above 15000
_______________________________________________________________________________
Declaration by the Applicant and Parent/Guardian
I declare that the information given by me in this application for obtaining scholarship is true to the best of my
knowledge and that I have not withheld any relevant particulars. I have disclosed all the information correctly
as required to be given in this application. If any information provided is wrong or misleading, the scholarship
is understood as seized immediately.
Signature of Applicant
_______________________
Date _______________