Download Fresh Application for Financial Assistance to Post Graduate Students

GCPR 141-CT/5 (1) 3,000 Cps 30-10-2006. FORWARDING CERTIFICATE (This Certificate should not be filled in by the applicant. It should be filled In by the Head of the Institution in which the applicant Is a student for 200 -200 ) 1. Name of the student (in BLOCK : LETTERS) 2. Name of the examination passed : 3. Year of passing : 4. Mark secured by the student and : maximum marks 5. Percentage of marks : 6. Class to which admitted : 7. Whether the student is residing in : an approved Hostel? if so, Hostel Certificate should be attached. 8. The date on which the student joined : the Institution for the academic ................................ year 200 -200 Date 9. The month and year in which the : Annual University Examination will ordinarily be over for the present class. Certified that the above particulars furnished have been verified by me and found correct. The application form has also been scrutinized and found to be in order and the candidate deserves to avail scholarship. Place : Date : Signature of the Principal / Registrar (Office Seal) GOVERNMENT OF PUDUCHERRY DIRECTORATE OF HIGHER AND TECHNICAL EDUCATION GCPR 14C-T/5 (2) 3,000 Cps. 31-10-2006. CERTIFICATE I. Certified that Thiru / Tmt / Selvi...........................................................son/wife/daughter of Thiru................................................residing at ............................................................................ .............................................................................................is an Indian National. Date: EPUTY TAHSILDAR/TAHSILDAR CERTIFICATE II. Certified that Thiru/Tmt./Selvi...........................................................has his/her Parents have continuous residence in the Union territory of Puducherry for the last five years as on 1st June 200 Date : DEPUTY TAHSILDAR/TAHSILDAR CERTIFICATE III. (a) Certified that Thiru/Selvi......................................................has passed the S.S.L.C./ Metric/Brevet/Higher examination in the year........and has for that purpose had undergone academic studies continuously for three successive classes in the following recognized educational institution's) in Puducherry Union Territory. Name of the Institution Date(«) attended From To 1. 2. 3. Date : HEAD OF INSTITUTION -LAST ATTENDED (b) Certified that the said Thiru/Selvi............................................................................... has resided in the Union territory of Puducherry continuously for three years during the period of study mentioned in Certificate lll(a) above. Date: DEPUTY TAHSILDAR/TAHSILDAR CERTIFICATE V. Certified that Thiru/Tmt.....................................................................father/mother of Thiru/Selvi.........................................................is *a State Government employee / is an employee on deputation from Central/State Government in the Puducherry Administration. Date : HEAD OF OFFICE CERTIFICATE V. Certified that Thiru/Tmt....................................................................................father/mother of Thiru/Selvi.......................................................... ....................is *a Central Government servant / a Defense personnel / an employee of............................................................................................................................ (a public sector undertaking wholly or substantially run by the Central Government/Puducherry Administration) and that *he/she is presently posted in Puducherry Union Territory............................................................... ............that 'he/she has declared Union territory of Puducherry as 'his/her home town. Date : HEAD OF OFFICE CERTIFICATE VI. Certified that Thiru............................................................................................. father / of Thiru/Selvi........................................... was a Defence personnel and was killed/disabled in action during the year............................ Date: HEAD OF OFFICE/O.C. OF UNIT CERTIFICATE II. This is to certify that Thiru/Tmt......................father / mother of Thiru/Selvi .......................... was a Central Government employee of............................... which Is a public sector undertaking run wholly/substantially by the Central Government/Puducherry Administration and he/she died while in service in Puducherry Union territory on ............................... Date : HEAD OF OFFICE Strike out, if inapplicable. N.B.: An applicant claiming to be a Puducherry State resident must submit Certificate I (above) and any one of the Certificates II to VII (above). DEFINITION OP PUDUCHERRY STATE RESIDENCE An applicant is considered to be of Puducherry resident provided he/she is an Indian National and satisfies at least one of the following criteria : (I) Those candidates or whose parents are residing continuously in this Union Territory for at least the last five years as 1-6-200 (II) Those who tiave passed the Matrlc/S.S.L.C. or any higher public examination and has for that purpose had undergone academic studies continuously for three successive classes in a recognised educational institution located in this Union Territory having their residence in this Union Territory for for three years continuously during that period. (ill) Children of Puducherry State Government employees (including those on deputation from Central or State Government). (iv) Children of Central Government servants/Defence personnel/Employees Of public sector undertaking wholly or substantially run, either by the Central Government or by the Puducherry Administration posted in puducherry at the time of admission or who have declared Union territory of Puducherry as their home town and so certified by their respective Head of Office. (v) Children of Defence personnel who were killed or disabled In action and Children of the Central Government servants/ Defence personnel/Employees of public sector undertaking as referred to in category (iv) who died while In service In Puducherry. (vl) French Nationals residing in the Union territory of Puducherry and covered by the terms of the Treaty of Cession shall be treated on par with candidates who produce the prescribed Puducherry State Residence Certificate. Such French Nationals will not be required to produce Residence Certificate but Instead should produce a Certificate of Registration issued for this purpose from the French Consulate at Puducherry. These French Nationals shall not be considered for admission under the quota of non-residents. GCPP. 141-CT/5 (3) 3,000 Cps. 1-11-2006. GOVERNMENT OF PUDUCHERRY DIRECTORATE OF HIGHER AND TECHNICAL EDUCATION (Department of Education) This statement of particulars should be handed over to the Head of the Institution joined by the student. The Head of the Institution will forward it to the Director of Collegiate and Technical Education, Puducherry. APPLICATION FOR PUDUCHERRY STATE POST MATRIC SCHOLARSHIP/ FINANCIAL ASSISTANCE TO P.G STUDENTS I. Each item should be read carefully before the form is filled in. No change will be permitted after it has been submitted. If any entry is found to be incorrect, the scholarship, if awarded, will be liable to be cancelled forthwith. I. Incomplete statement or statements received after the prescribed date will not be considered. 1. Name in full stating whether Shri/Smt./Kum : (in BLOCK LETTERS) 2. (a) Exact date of birth (in Christian era) : (b) Place, District and State of birth : Nationality and Resident Certificate to be attached) 3. Father's name, or if father is not alive, the guardian's name (a) Name in full : (b) Present home address : Passport size photograph to be pasted here 2 (c) Permanent home address : (d) Profession, stating designation (if any) : and address 4. Whether father/guardian is a citizen of India? : 5. Total monthly income of both parents : (See Note 4 Income Affidavit pro forma). If, however, the applicant's father Is dead the income of the widowed mother should be mentioned. If the applicant's father and mother are both dead and he/she is looked after and supported by a guardian, then the income of the scholar alone from property, share or any other source should be mentioned. An Income Affidavit as in the form enclosed should be Produced in support of this column 6. Particulars of School/College/lnstitution last attended : Name of School/ Date of Date of Year Remarks, College/Institution entry leaving if any (1) (2) (3) (4) (5) 7. (a) Name of the last examination passed : (b) Year of passing : (c) Name of the Authority (Board or : University) which conducted the Examination taken by the applicant Together with the place where its headquarters 3 (d) Roll No. : e) Total number of marks for the examination As a whole including the marks in the optional paper/papers If these are counted by Board, University in awarding division (Attested copy of the marks sheet should be attached) f) Percentage of marks obtained in the : aggregates g) Rank secured in the examination : 8. (a) If the candidate is in receipt of any : scholarship or scholarships from a State Government or any other institution or persons, particulars should be given including the monthly rate and date from which the scholarship is being drawn. b) The candidate should indicate, the : Scholarship scheme out of those mentioned below under which he/ she wishes to be considered or which he / she wishes to continue to avail 1) Financial Assistance to P.G : Students (2) Puducherry State Post-Matric Scholarship Scheme : (3) National Scholarship for the : Children of School Teachers 9. (a) Name and address of the institution : where the scholar has been admitted b) Course of study : c) Duration of the course : (d) Whether hosteller? (if so, Hosteller : certificate should be attached) 4 10. List of enclosures sent with the statement (Please strike out that which is not applicable) (a) Income Affidavit and Schedule : (Calculation of income to be attached in case of salaried persons only) (b) Attested copy or mark sheet for the : last Board / University Examination (c) Certificate from Principal /Warden of : the Hostel regarding stay in Hostel (d) Nationality and Residence Certificate : Certified that the statements 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 another scholarship from any other source. Place : Date : Signature of the Student Countersigned Signature of the Head of Institution GCPP. 141-CT/5 (4) 3,000Cps. 31-10-2006. INCOME AFFIDAVIT Declaration of Income for the Year 200 200 ( Ending on 31st March of a Year) for Purposes of Scholarships Granted under the Scheme ................................................ I,............................... (Name of Father/Mother) Son/daughter of Thiru/Tmt..............................................................................at present residing at................................ ...................................................................................................................solemnly affirm and say as follows: 1. That my son/daughter/dependant Thiru/Selvi.................................................................................. (Name of student) who is applying for the grant of fresh scholarship under the scheme.......... .................................................................................................................................................................. is studying in..................................................................................................................................................... (Here give the name of the Institution) 2. That my annual income in the preceding year ending the 31" March 200 !s Rs.............. (Rupees...........................................................................................................)as per details furnished In the Schedule hereunder written. I also affirm that particulars of property held by me are 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 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 to be false, I shall refund to the President of India double the amount of the scholarship paid to the said scholar and Government's decision on whether the declaration of particulars is false shall be final and binding on me. SCHEDULE Signature Signature of Executive Magistrate Name in full (To be signed in the presence of Executive Magistrate who affixes his seal and signature) GCPR 141 CT/5 (5} 3,000 Cps. 31-10-2006. SCHEDULE (Alt the columns in the Schedule should be filled in properly by WORDS and not by DASHES or DOTS) I. EXTENT OF LAND HELD AND INCOME "(a) Independently as owner - (i) Area : (ii) Village : (iii) Survey No. : (iv) Land revenue assessment : (y) Annual income :...........Rs........... (b) Jointly as owner (i) Area : (ii) Village : (iii) Survey No. : (iv) Land revenue assessment : (y) Annual income :...........Rs........... (c) Independently as tenant (i) Area : (ii) Village : (iii) Survey No. : (iv) Land revenue assessment : (y) Annual income :...........Rs........... (d) Jointly as tenant (i) Area : (ii) Village : (iii) Survey No. : (iv) Land revenue assessment : (v) Annual income of the scholar's father / guardian :...........Rs.......... II. PROPERTY HELD AND INCOME (houses, shop buildings, house-sites, etc.) ...........Rs.......... (i) House No. : (ii) Street/Road : (iii) Village/Town/City : (iv) Area of site : (v) Rent derived, if any : (vi) House tax paid : (vii) Sanitary cess or other house taxes Paid : (viii) Net annual income after deduction of items (vi) and (vii) : Note : Whether the whole or part of the land has been given out to tenants? If" Yes" particulars. 2 III. INCOME FROM SHOPS (i) Address of shop : (ii) Nature of trade : (iii) Sales tax / Income tax paid : (iv) License No. : (v) Annual income :............Rs............. IV. SALARIES DRAWN (i) Name of the Employer : (ii) Office/Unit in which he/she is : working and designation (iii) Address of office : (iv) Annual emoluments for 200 : Rs........... Break-up for annual emoluments : Basic Pay Rs. D.A./A.D.A. Rs. H.R.A. etc. Rs. OTA/Bonus Rs. ......... Rs ........ (Anriexure has to be attached from the Pay Drawing Officer in respect of salaried person ) : V. OTHER SOURCE OF INCOME (i) Income from subsidiary industries / part-time occupation : Rs............... (ii) Amount drawn as wages : RS............... (iii) Any other income : Rs............... VI. ANNUAL INCOME OF WIFE AND THE SCHOLAR FROM ANY SOURCE : ............Rs............. VII.TOTAL INCOME OF THE FAMILY FOR THE WHOLE YEAR 200____ : ............Rs............. Average income of the family for one Month : ............Rs............. Signature of parent of scholar. M.S. : (1) Total Income of the family should include Income of father, mother and the scholar and of no other Members though they may be earning. (2) If father. Is dead then mother's income will be shown along with the income, if any in the scholar's own name from shares, property etc. (3) If both father and mother of the scholar are deceased, then the income, *f any, in the scholar's name only will be shown and not the income of any guardian who may be supporting the scholar. (4) A detailed break-up from the annual emolument shown under colum No. IV (Salaries drawn) as required against the column should Invariably be furnished. GCPP. 141-CT/5(6) 3,000 Cps. 31-10-2006 Check List for Scrutiny of Applications for the Award of Scholarship under Puducherry State Post Matric Scholarship Financial Assistance to P.G Students 1. Name of the student : 2. Class : 3. Name of the Institution where studying at : present. 4. (a) Qualifying examination : (b) Whether the individual has passed the : above examination prior to this year? (If so, his/her application should be rejected at the level of Institution) 5. Total aggregate marks : 6. Percentage obtained in the above examination: (Applications of those who have received less than 60% should be rejected at the level of Educational Institution). 7. Name of the scholarship applied for : 8. Whether the applicant is already in receipt of : any other scholarships, i.e. scholarship in Non-Hindi Speaking State/Financial Assistance to P.G. students and Perunthalaivar Kamarajar Financial Assistance to CENTAC Sponsored candidates? (If so, application should be rejected at the level of Institution). 9. Whether the following enclosures attached : to the applications? (i) Income Affidavit and Schedule of : Property / Source of Income. (ii) Attested copy of Marks Sheet for the last : Board/University Examination. (iii) Certificate from Principal/Warden of the : Hostel, regarding stay in Hostel. (iv) Nationality and Residence Certificate : 10. Whether all the columns of the application : duly filled or not? 11. Remarks : Signature of the Head of Institution. GCPR 141-CT / 5 (7) 3,000 Cps. l-U-2006. ANNEXURE I CALCULATION OF INCOME FOR THE YEAR 200 200 FOR SALARIED PERSONS ONLY (For the purpose of scholarship of Education Department) I. Total Annual Salary/Income [ Basic Pay, : Deputation Allowance, Honoraria, Special Pay and Bonus etc. (Excluding D.A., C.C.A., H.R.A., T.A., O.T.A., etc.) received in the year shall be taken into account for computing annual income II. Standard deduction @ 25% of Basic Pay : III. Rebate on contribution to (a) GPF : (b) LIC/CTO : (Limitedto30%of Basic Salary) IV Net Income[I (II + III)] : Place : Date : Signature of the Government Servant Name : Designation : Department : Place : Date : Countersignature of the Drawing Officer concerned with Office Seal.