Scholarship Application
APPLICATION FOR FINANCIAL ASSISTANCE FROM PREM ASHRAM CHARITABLE TRUST
PREM ASHRAM CHARITABLE TRUST
Address- PO: Amadalli, Karwar- 581 324, Karnataka State
e-mail- premashram2@gmail.com
Phone- 9483711922
NAME OF THE STUDENT: __________________________________________________________________
DATE OF BIRTH: _____/_____/___________
COMPLETE ADDRESS FOR COMMUNICATION: _____________________________________________________ ________________________________________________________________________________________
________________________________________________________________________________________
MOBILE NUMBER: ________________________________________________________________________
FATHER’s NAME AND OCCUPATION: ______________________________________________________
MOTHER’s NAME AND OCCUPATION: _____________________________________________________
HOW MANY MEMBERS IN THE FAMILY: ________
TOTAL ANNUAL INCOME OF THE HOUSEHOLD: Rs.______________
CURRENT STANDARD (Attach a copy of the recent Marks Card): _______________________________
NAME, ADDRESS, AND PHONE NUMBER OF SCHOOL/COLLEGE:
Name: _________________________________________________________________________
Address: _______________________________________________________________________ _______________________________________________________________________________
Phone No: ______________________________________________________________________
SB A/C DETAILS OF THE CANDIDATE: N
Name of the Bank: __________________________________________________________________
Branch: ___________________________________________________________________________
IFS Code: _________________________________________________________________________
A/C No. ___________________________________________________________________________
WHETHER YOU RECEIVED FINANCIAL ASSISTANCE FROM OUR TRUST IN THE PAST? YES [ ] / NO [ ]
EXPLAIN WHY YOU NEED FINANCIAL ASSISTANCE: ____________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________
DATE: _____/_____/___________
PLACE: _____________________________ Signature________________________________
PLEASE ATTACH COPY OF BPL CARD. FIRST PAGE OF BANK PASSBOOK, RECENT MARKS CARD, AND ANY OTHER DOCUMENT(S) THAT YOU WOULD LIKE TO ADD TO SUPPORT YOUR APPLICATION.
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