pm scholarship form2010-11
TRANSCRIPT
PRIME MINISTER’S SCHOLARSHIP SCHEME
ACKNOWLEDGEMENT SLIP
OFFICE COPY
Your Application Form dated_________ has been received on__________. The
application will be examined for eligibility. The dak receipt number ____________ is to be
mentioned for further correspondence with this office.
Office Seal: (Signature of RSB / Coast Guard Headquarter)
Tear off Tear off
ACKNOWLEDGEMENT SLIP
STUDENT COPY
Your Application Form dated_________ has been received on__________. The
application will be examined for eligibility. The dak receipt number ____________ is to be
mentioned for further correspondence with this office.
Office Seal: (Signature of RSB / Coast Guard Headquarter)
Note: This copy duly stamped and signed by RSB / Coast Guard Headquarter is to be given to the student by hand or by post. (Envelope enclosed alongwith the application may be used.)
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MINISTRY OF DEFENCE Department of Ex-Servicemen Welfare
PM’S SCHOLARSHIP SCHEME FOR
DEPENDENT WARDS / WIDOWS OF EX-SERVICEMEN AND EX-INDIAN COAST GUARD
Brochure-Cum-Application Form
For Academic Year 2010-11
Application Form consists of Col No 1 to 19, Renewal Form and list of RSB / Coast Guard Headquarter at state and UT level. (Brochure-Cum-Application form consists of 32 pages)
KENDRIYA SAINIK BOARD West Block-IV, Wing-VII, 2nd Floor
R K Puram, New Delhi-110066 Website: www.mod.nic.in
E-Mail: [email protected]
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Note: This application form (page number 13 to 19 alongwith required documents only) is to be deposited by individual to respective RSB / Directorate General of Coast Guard. Applications duly recommended by RSB’s / Directorate General of Coast Guard shall only be considered by KSB. Therefore, candidates are advised not to forward applications directly to KSB as the same shall not be considered and will be returned unactioned to individual.
PRIME MINISTER’S SCHOLARSHIP SCHEME
1. Introduction.
Prime Minister’s Scholarship Scheme has been introduced from the Academic year 2006-07. To encourage higher technical and professional education for the dependent wards of Ex-Servicemen / Ex-Coast Guard and their widows (below officer rank only) and dependent wards / widows of Ex-Servicemen / Ex-Coast Guard who died in harness due to causes attributable to military service / Coast Guard Service, irrespective of the rank.
2. Scholarships Available.
A total number of 4000 scholarships will be allotted.
3. Students eligible for the scholarship.
(a) Dependent wards of ex-servicemen / Ex-Coast Guard and their widows (below officer rank only)
(b) Dependent Wards / widows of Ex-servicemen & Ex-Coast Guard who died in harness due to causes attributable to military service / coast guard service, irrespective of the rank.
Note: (i) The candidate irrespective of his marital status is eligible for PMSS. However, an earning / serving candidate is not eligible.
(ii) For dependent wards of widows and widows of personnel died in harness due to causes attributable as at (b), there will be no rank restriction.
4. How to Apply For Scholarship.
One candidate to submit only one application form for one course, if any candidate submit two application for more than one course, both the applications will be rejected. Forms are to be downloaded from the website www.mod.nic.in. Application forwarded on any other format will not be considered.
Application to be forwarded on plain A4 size paper (typed or handwritten) in the prescribed format duly completed in all respects with superscription on the envelope “Prime Minister’s Scholarship Scheme for the Academic Year 2010-11.”
Documents to be attached alongwith PMSS application form are as follows:-
(a) Photocopy of Ex-servicemen / Ex-Coast Guard valid I card duly certified by RSB / ZSB / Coast Guard Headquarter as applicable.
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(b) Extract of Ex-servicemen / Ex-Coast Guard discharge book as per specimen. (Refer page number 22)
(c) Matriculation certificate duly attested.
(d) Minimum Entry Qualification certificate duly attested. (10+2 Marksheet or full Graduation Marksheet which ever is applicable)
(e) Bonafide studentship certificate from Collage in original as per specimen. (Refer page number 21)
(f) Postal Order of Rs. 30/- not issued before 01st January 2011.
Note: Failure to attach above mentioned documents / certificate will lead to rejection.
5. Selection Procedure.
Applications will be short listed based on Ex-servicemen / Ex-Coast Guard category (as given in para 6) and percentage of marks obtained in minimum entry qualification (MEQ).
6. PRIORITY for Grant of Scholarship.
Order of preference for allotment of scholarships will be as under:-
Category 1 Wards/ widows of defence / Coast Guard personnel killed in action.
Category 2 Wards of Ex-servicemen / Ex-Coast Guard disabled in action and boarded out of service with disability attributable to Military / Coast Guard service.
Category 3 Wards / widows of defence / Coast Guard personnel who died while in service for causes attributable to Military / Coast Guard service.
Category 4 Wards / widows of ESM / Ex-Coast Guard personnel disabled in service with disability attributable to Military / Coast Guard service.
Category 5 Wards of ex-servicemen / Ex-Coast Guard in receipt of gallantry awards.
Category 6 Wards of ex-servicemen / Ex-Coast Guard (PBOR).
7. Eligible Courses.
First year professional degree programme in BE, B Tech, BDS, MBBS, B Ed, BBA, BCA, B Pharma, etc. duly recognized by the respective government regulatory bodies, such as All India Council for Technical Education, Medical Council of India, UGC etc (master degree course are not eligible to apply for Prime Minister’s Scholarship except MBA, MCA). The scheme is open for courses mentioned above in recognized institutions (in India only). Students studying abroad are not eligible for this
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scheme. Students getting stipend for the professional degree course are also not entitled. The candidates may avail only scholarship for first degree course (Professional) i.e. graduate level only under PMSS.
8. Scholarship for Integrated Courses.
The facility under PMSS is restricted for professional courses only, such as B Ed but not for BA+B Ed, also for LLB not for BA+LLB duly recognized by the respective Government regulatory bodies such as All India Council for Technical Education, Medical Council of India etc.
9. Minimum Eligible Marks in 10+2 or Graduation.(Minimum Educational Qualification for Entry) should be 60%.
Minimum educational qualification (MEQ) for entry to different professional course is different e.g. for MBBS and B E it is 10+2 where as it is graduation for B Ed and MBA. A candidate must have minimum 60% marks in MEQ to be considered for scholarship.
10. Duration of Scholarship.
Two to five years as approved by the concerned regulatory body (Except one year for B Ed).
11. Amount of Scholarship.
a) The amount of scholarship would be as follows:
(i) Rs. 1250/- per month for boys Paid after successful completion of each academic year.
(ii) Rs. 1500/- per month for girls
12. Renewal of Scholarship.
Candidate shall submit new Renewal Form alongwith two acknowledgement slip, Bonafide Certificate (as per Specimen) duly signed by the Principal / Dean / Registrar of the institution / college and Photocopy of Passbook to the respective RSBs / Coast Guard Headquarter either in person or by post for renewal of scholarship for the subsequent academic year. RSBs / Coast Guard Headquarter will scrutinize and check the application forms and forward the same complete in all aspects to KSB immediately. RSBs / Coast Guard Headquarter will issue acknowledgement slip to the candidates at the time of submission of the application in person or by post. Candidate to attach a self addressed envelope, duly stamped to receive the acknowledgement of renewal form by post. For easy comprehension an illustration has been given below:-
Student admitted in B Tech. September 2010
Marks in 10+2. 61%
Applied for PMSS. Before 31 December 2010
Finds his name in the list of 4000 successful candidates selected for grant of PMSS.
June 2011
Applied for first renewal of Scholarship by submitting first October 2011
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year / first two semester result.Granted first installment. December 2011
Applied for second renewal of Scholarship by submitting second year / second two semester result.
October 2011
Granted second installment. December 2011Applied for third renewal of Scholarship by submitting third year / third two semester result.
October 2012
Granted third installment. December 2012Applied for fourth renewal of Scholarship by submitting fourth year / fourth two semester result.
October 2013
Granted fourth installment. December 2013
* Dates given above are to illustrate an example for easy comprehension and the same may not be quoted as authority.
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Incomplete form / pages / column / documents will lead to rejection or returned to RSB / Coast Guard Headquarter unactioned.
IMPORTANT INSTRUCTIONS FOR PM’S SCHOLARSHIP SCHEME
(a) Checklist duly signed by student & parent is to be attached on the top of the application form.
(b) Applications alongwith relevant documents & certificates are to be deposited to respective Rajya Sainik Board / Coast Guard Headquarter “latest by 28th February 2011. Incomplete application form and non submission of required document is liable to be rejected and will be returned unactioned. The application will be received by the RSBs / Coast Guard Headquarter and will be acknowledged with a seal and date of receipt.
(c) The concerned RSBs / Coast Guard Headquarter to scrutinise / check the application forms with regard to their eligibility criteria prior to forwarding the same to KSB.
(d) Candidates and RSB’s / Coast Guard Headquarter to note that all applications received after the due date will not be considered and returned unactioned.
(e) List of selected candidates will be forwarded to RSBs / Coast Guard Headquarter after the merit list is finalized by the BOO at KSB.
(f) Two stamped (Rs. 5 each) blank window envelopes of 27x12 cms are to be attached with each application so as to facilitate correspondence with the candidate by KSB / RSB / Coast Guard Headquater.
(g) The scholarship is admissible for only two children of ESM / Ex-Coast Guard. Particulars of all children should be indicated in column 16 of application form. This should be in uniformity with the Discharge Book / Certificate of the Ex-servicemen / Ex-Coast Guard.
(h) The amount of scholarship, including any other scholarship or financial assistance from any other source will not exceed the total grant of assistance available under this scheme.
(i) The payment of scholarship will be granted after the successful completion of each academic year and on the submission of the renewal form (in original), as per the percentages mentioned in ‘Criteria for eligibility’. In case, KSB ask a student to submit the mark sheet for the full year, a student is liable to produce the same, failing which the scholarship will be held up. On receipt of renewal for at KSB it may take approximately two months for processing the form and completing the payment procedure.
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(j) Candidature of a student shall stand automatically rejected if, at any stage, it is discovered that he / she has secured scholarship fraudulently by
making false statement or misrepresentation of facts. Candidate shall have to refund the amount already given, if any.
(k) The attached photocopies of the supporting documents should be duly attested by gazetted officer (unattested documents will not be considered). In case of legally adopted son / daughter or child born after retirement, the certificates are to be attached with the application form duly attested by Secretary, RSB / ZSB / Coast Guard Headquarter.
(l) In case of change of any address, course, college, it is to be intimated immediately to Kendriya Sainik Board & Rajya Sainik Board / Coast Guard Headquarter in writing. Always mention selection serial number, name of applicant and ESM / Ex-Coast Guard particular for any correspondence with KSB & RSB / Coast Guard Headquarter after getting selected for the scholarship.
(m) The Ministry of Defence, Government of India can suitably modify these instructions to remove anomalies, if any, for successful implementation of the scheme, as may be necessary from time to time and will be applicable to all students under the scheme.
(n) Ex-servicemen entitlement will be governed as per the existing definition of ex-servicemen, as amended from time to time. The definition is available in the guide book available with the RSB / ZSB, also applicable to Ex-Indian Coast Guard personnel as per the rules of DGCG.
(o) The application form should be downloaded from the official website of MOD, i.e. www.mod.nic.in. The application form should be submitted to the respective Rajya Sainik Board / Coast Guard Headquarter, (List of RSBs / COAST GUARD HEADQUARTER is attached along with the brochure) duly completed, along with a Postal Order (Repeat) Postal Order only for Rs.30/- in favour of Secretary, Kendriya Sainik Board, payable at New Delhi. In case of any difficulty in obtaining the form, the same can be obtained from the Secretary / Director Rajya Sainik Board / Coast Guard Headquarter.
*Note: - The Postal Order should not be issued before 01st January 2011 (the Postal Order is not refundable in any case).
(p) While filling the application form, leave 1 (one) box blank between 2 (Two) words. Column wise guidelines are explained further for filling up the application form.
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IMPORTANT INSTRUCTIONS FOR RENEWAL FORM
(a) A Bonafide certificate from the College/Institute indicating that the candidate continues to study in the subject course and showing his / her percentage of marks for which the Prime Minister’s Scholarship has been sought (As per the specimen attach).
(b) Photocopy of passbook showing name, account number with photograph of individual and cancelled leaflet cheque. (Scholarship will not be sent in absence of photocopy of passbook)
(c) Candidate to attach a self addressed envelope, duly stamped to receive the acknowledgement of renewal form by post.
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COLUMN WISE GUIDE LINES FOR FILLING UP OF APPLICATION FORM
(i) Column -1. Fill your name as in matriculation certificate only:-(Not to be filled in any other format.)
1st Name A J A YMiddle Name S I N G HSurname R A N A
(ii) Column -2. Put a tick (√) mark as shown.
Male √ Female
(iii) Column – 3. Date of Birth as shown in matriculation certificate only. For Example:- (10 June 1982)
D D M M Y Y Y Y1 0 0 6 1 9 8 2
(iv) Column – 4. Mention your Rajya Sainik Board and Zila Sainik Board name, from where your father / mother have registered and have obtained ex-servicemen / widow identity card (Not for Ex-Coast Guard).
(v) Column – 5. Write your permanent address and correspondence address in block letters.
(vi) Column – 6. Write phone number along with STD code and email ID for any query (email ID is must).
(vii) Column – 7. Category as per para 6 to be written (attach the required document, if any). Category 1 (One).
Category - 1 O N E
(viii) Column – 8. Full Particulars of Father/ Ex-Serviceman / Ex-Coast Guard is to be mentioned as per the discharge book. A blank space to be provided between names. (Example: - KAMLESH CHANDRA CHOUDHURY)
K A M L E S H C H A N D R A C H O U D H U R Y
1 4 5 2 3 6 K
S E R G E A N T
A I R F O R C E
(ix) Column – 9. Details of 10+2 or MEQ. Leave blank space between words. Marks to be shown in words and figures.
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a. Total Marks O N E T H O U S A N D (in words) T W O H U N D R E D (in figure) 1 2 0 0
b. Marks obtained N I N E H U N D R E D
(in words) F O R T Y
(in figure) 9 4 0
c. % of marks scored S E V E N T Y E I G H T (in words) P O I N T T H I R T Y
T H R E E (in figure) 7 8 . 3 3
(x) Column – 10. Tick as applicale.
Yes √ No
(xi) Column – 11. The student is to specify the course which he / she is presently studying. (Example:- B TECH)
B T E C H
(xii) Column – 12. Duration of the course both in numbers and figures to be mentioned (without Internship). For example 4 years 6 months.
(In figure) Y Y M M
0 4 0 6
(In word)F O U R Y E A R S A N D S I XM O N T H S
(xiii) Column – 13. Write date of commencement & completion of course as shown below:
(Course Commencement / Date of Admission)D D M M Y Y Y Y0 1 0 7 2 0 0 7
(Course completion)D D M M Y Y Y Y3 1 1 2 2 0 1 2
(xiv) Column - 14 Write the full name and address of the college with email ID and phone number of principal. Name of Student A J A Y S I N G H R A N A
Roll No. 0 8 E A T I T 0 4 3
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Name of College A J M E R I N S T I T U T EO F T E C H N O L O G Y
Full Address P U S H K A R B Y P A S S A of college J M E R
State R A J A S T H A N
Pin Code 3 0 5 0 0 4
Tel No. (with STD Code) 0 1 4 5 - 2 3 0 0 6 2 8
E-Mail ID (if any) a i t _ a j m e r @ r e d i f f m a il . c o M
College Website w w w . a i t a j m e r . c o m
(xv) Column - 15 Write the regulatory body of your college.
A I C T E
(xvi) Column – 16. Furnish the particulars of your all children as per specimen given:-
Sl. No. Name of Child Gender Date of Birth Age1 Prakash Singh Rana M 10/10/1982 27 Years2. Satish Singh Rana M 12/05/1984 25 Years3. Ajay Singh Rana M 03/07/1987 22 Years4. Komal Rana F 14/02/1989 20 Years
(xvii) Column – 17. Given details of the scholarship availed by your brother / sister in the past, if not availed write Not Applicable.Sl. No.
Selection Serial No.
given by KSB
Name of the brother/sister
Course of Study
Academic year in which applied
Amount received so far
1. 6359 Satish Singh Rana B Tech 2007-09 15000
(xviii) Column – 18. Fill up attached Postal Order particulars.
Postal Order No. 0 2 3 1 5 0
Issue D D M M Y Y Y YAmount (Rs.) in figure 3 0 Date 1 4 1 2 2 0 1 0
Amount (Rs.) in word T H I R T Y
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Note: Application form from page number 13 to 19 alongwith required documents only to be forwarded.
CHECK LIST OF DOCUMENTS TO BE ATTACHED WITH
THE APPLICATION FORM
1. Candidates / ESM / Ex-Coast Guard are to ensure that the following documents are attached (as applicable) along with the Application Form (non submission of these certificate will lead to rejection and application will be returned unactioned).
(a) Attested copy of Ex-Serviceman / Ex-Coast Guard & Widow I-card issued by RSB / ZSB / Coast Guard Headquarter.This is an important document to be attached.
(b) Extract of ESM / Ex-Coast Guard discharge book as per specimen.
(c) If child born after discharge then affidavit is to be submitted by ESM / Ex-Coast Guard, that child is dependent on him and he / she is a ward of ESM / Ex-Coast Guard.
(d) Additional Certificates – Attested copy of following documents.
(i) Category 1: Part II Order Equivalent of other (ii) Category 2: Part II Order services i.e. Army /(iii) Category 3: Part II Order Navy / Air Force / Coast (iv) Category 4: Part II Order Guard(v) Category 5: Award Certificate
alongwith gazettenotification
(e) Attested photocopy of matriculation or equivalent examination certificate for verification of date of birth.
(f) Attested photocopy of mark sheet of MEQ as applicable (e.g. 10 plus 2, graduation / diploma etc). In case the MEQ is graduation / diploma, then complete mark sheet is required to be submitted.
(g) In case of MBA / MCA applicants, attested copy of minimum entry qualification certificate. i.e Graduation
(h) Bonafide studentship certificate to be issued by Registrar / Dean / Principal of College / Institution pertaining to course for which scholarship is claimed (As per specimen attach).
(i) Postal Order of Rs. 30/- (Rupees Thirty only) attached. (Application form without Postal Order will not be processed and Postal Order should not be made before 01st January 2011.)
Date: _____________________
_______________________________Place: ____________________ Full Name & Signature of Candidate
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RecentPhotographOf Student
(Write your name & ESM/Ex-Coast Guard/widow particular on
reverse)
_______________________________________ Checked / counter singed by ESM / Ex-Coast Guard / Widow
FOR OFFICIAL (KSB) USE ONLY
Signature of Supervisor/ IC PMSS Remarks of Supervisor
___________________________ _______________________________
_______________________________
_______________________________
RECOMMENDED / NOT RECOMMENDEDRemarks of JD PMSS
_______________________________
Signature of JD PMSS _______________________________
____________________ ______________________________
__________________________________________________________________________
Selection Serial Number(To be allotted by KSB) ......................
APPLICATION FOR PRIME MINISTER’S SCHOLARSHIP FOR THE YEAR 2010 - 11 ___.
Note: 1.) Please read column wise guide lines carefully before filing the application 2.) Application Form to be filled in Capital letters except email ID. 3.) Checklist must be attached on the top of application duly tick marked.4.) One candidate to submit only one application form for one course.
1. NAME:- First Name
Middle Name
Surname
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2. Put a tick mark (√)
LEAVE BLANK SPACE BETWEEN WORDS
3. Date of Birth (please attach proof of age) (i.e : Matriculation certificate) DD MM Y Y Y Y
4. Your Rajya Sainik Board or Zila Sainik Board (Where ESM is registered and obtained Ex-servicemen Identity card)
(Only for ESM)
RSB
ZSB
5. Full Address:
a) Present Correspondence Address: - (Where you want your letter to be sent in case of selection / rejection)
b)
Permanent Address :-
LEAVE BLANK SPACE BETWEEN WORDS
Male Female
House No.
Street No. & Name
Tehsil
District
State
Pin Code
House No.
Street No. & Name
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6. Telephone Number. STD Code
Land Line No.
Mobile No.
E-Mail (mandatory)
7. Ex-servicemen / Ex-Coast Guard Category - (Mention category as per Para 6 of the brochure and attach supporting documents duly attested).
8. Ex-serviceman’s / Ex-Coast Guard’s Particulars:-
a) Name of ex-serviceman / Ex-Coast Guard
b) Service No.
c) Rank
d) Type of Service (Tick one) Army Air Force Navy Coast Guard 9. Details of MEQ / course for qualifying examination for scholarship (10+2/equivalent or minimum entry qualification)
a. Name of Course/MEQ
b. Year in which exam passed
c. Total Marks (in words)
(in figure)
LEAVE BLANK SPACE BETWEEN WORDS
d. Marks obtained (in words)
(in figure)
e. % of marks scored (in words)
(in figure)
Tehsil
District
State
Pin Code
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10. Whether the applicant is in receipt of any other financial assistance/scholarship/ fellowship from any govt. / Private source for the course to which the scholarship applied for. If yes, then state the amount and source
Yes No Rs (per month / year)
11. Name of the Course (as per specimen)
12. Duration of Course in Years in figure and months
in words
13. Date of Commencement and Approximate Date of Completion.
D D M M Y Y Y Y a) Course commenced on
D D M M Y Y Y Y b) Course completion date approximately
14. Details of College / Institute.
Name of Student
Roll No.
Name of College
Full Address of college
LEAVE BLANK SPACE BETWEEN WORDS
State
Pin Code
Tel No. (with STD Code)
E-Mail ID (if any)
College Website
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15. Regulatory bodies/ Council. (For example all engineering degrees and management degree courses are recognized by AICTE & UGC and all medical degree are recognized by Medical Council of India or Dental Council of India, specify as per case).
16. Furnish particulars of all children in order of age, as reflected in the discharge book or attached a certificate in case child born after discharge, by the RSB / ZSB / Record Office / Coast Guard Headquarter, as applicable.
Sl. No. Name of Child Gender Date of Birth
17. Details of brother/sister availing the PM’s Scholarship, if any. (Including yourself if granted earlier)
Sl. No.
Selection Serial No.
given by KSB
Name of the brother/sister
Course of Study
Academic year in which applied
Amount received so far
18. Details of Postal Order.
Postal Order No. Issue D D M M Y Y Y Y
Amount (Rs.) in figure Date
Amount (Rs.) in word
LEAVE BLANK SPACE BETWEEN WORDS
19. Declaration: “Certified that the particulars given by me in the application are correct and any false statement made by us will disqualify me / my ward for award of PM’s Scholarship Scheme, besides recovery of scholarship already paid. I also undertake to abide by the conditions mentioned in the general instructions of the scheme.”
Place: (Signature of ward) _____________________________ Date: (Full Name of Ward) _____________________________
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Place: (Signature of Parent) ____________________________
Date: (Full Name of Parent) ___________________________
CERTIFICATE FROM RSB / ZSB /DIRECTORATE GENERAL OF COAST GUARD
“It is certified that PM Scholarship application form for academic year 2010 - 11 in
respect of Mr. / Ms. __________________________________________________________
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S/o / D/o Ex -____________________________________________________ has been
checked, found correct as per check list provided by KSB and the applicant is eligible to apply
as per rules of the scheme”.
Office seal: Secretary / Director
RSB / ZSB / Coast Guard Headquarter
Place: ________________
Date : ________________
CERTIFICATE FOR PM SCHOLARSHIP
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1. It is certified that Ms. / Mr._____________________ is Bonafide student
of __________________________________ college. His / Her roll
number is __________ and he / she is studying in the I / II / III / IV / V year
or ______ semester of the One / Two / Three / Four / five years
_______________ course in ____________________ branch (if any).
He / she has joined this college in the academic year 20___ - ___ and the
course will be completed in the month of ____________ 20___ -___.
2. This is also certified that _____________ course is a professional
degree course and this college is approved by
________________________________________________.
3. This is also certified that student is getting Rs._____________ per
month / year (If not getting write N/A) scholarship / stipend from this
Institute / College or any other sources.
Office Seal: Signature of Principal / Dean / Registrar
Date:- ______________
Place:-_____________
SPECIMEN COPY OF EX-SERVICEMEN / EX-COAST GUARD CERTIFICATE
EX-SERVICEMEN / EX-COAST GUARD CERTIFICATE
(In lieu of Discharge Book)
1. Type of : _______________________________________
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Service (Army, Navy, Air Force or Coast Guard)2. Service No. : _______________________________________
3. Rank : _______________________________________
4. Name & Initials : _______________________________________
5. Trade : _______________________________________
6. Date of enrolment : _______________________________________
7. Date of Discharge : _______________________________________
8. Reason for Discharge : _______________________________________
9. Duration/Length of Service : _______________________________________
10. Regular : _______________________________________Reserve
11. ESM / Ex-coast Guard died on (if applicable): _______________________________________
12. Cause of death & : _______________________________________Whether Attributable to military / coast guard service
13. Particulars of dependent children:-Sl. No.
Name Gender Date of Birth
1.2.3.4.5.6.
It is certified that the above information is duly checked from the discharge book of Ex-servicemen / Ex-Coast Guard and found to be correct.
Office Seal:
Dir RSB/ZSB/OI/C Record Office/ Coast Guard Headquarter
Date: ________________________
Place: ______________________
IMPORTANT INSTRUCTION FOR RENEWAL FORM
1. Minimum Marks for Renewal of Scholarship.
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The candidates should have secured a minimum of 50% marks, uninterrupted for continuation of scholarship in every year for the duration of course up to a maximum period of 5 years as prescribed for that programme of study. A person granted scholarship for one programme would not be entitled for scholarship for another programme.
* Note:- If the marks in the qualifying examination are expressed in grades only, then equivalent percentage (100 point scale) duly certified by the concerned college / Board must be furnished (RSB, Coast Guard Headquarter & KSB will not be calculating the percentage of marks).
2. Account Details.
All candidates to open individual bank accounts in the nearest State Bank of India branch or Punjab National Bank which has “electronic clearance system” / Core Banking, to facilitate transfer of the scholarship amount. Account number of the sister concern bank will not be accepted. i.e State Bank of Travancore, State Bank of Bikaner & Jaipur, etc. Candidate to attach a attested photocopy of passbook, showing name and account number of the individual. A cancelled leaflet of a blank crossed cheque will duly authenticate the account number. A joint account with parent will also fulfill the requirement.
DOCUMENTS TO BE ATTACHED WITH RENEWAL FORM:
(a) A Bonafide certificate from the College/Institute indicating that the candidate continues to study in the subject course and showing his / her percentage of marks for which the Prime Minister’s Scholarship has been sought (As per the specimen attach).
(b) Photocopy of passbook showing name, account number with photograph of individual and cancelled leaflet cheque. (Scholarship will not be sent in absence of photocopy of passbook)
(c) Candidate to attach a self addressed envelope, duly stamped to receive the acknowledgement of renewal form by post.
________________________________Full Name & Signature of the Candidate
PRIME MINISTER’S SCHOLARSHIP SCHEME
ACKNOWLEDGEMENT SLIP
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OFFICE COPY
Your Renewal form dated_________ has been received on__________. The
application will be examined for eligibility. The dak receipt number ____________ is to be
mentioned for further correspondence with this office.
Office Seal: (Signature of RSB / Coast Guard Headquarter)
Tear off Tear off
ACKNOWLEDGEMENT SLIP
STUDENT COPY
Your Renewal form dated_________ has been received on__________. The
application will be examined for eligibility. The dak receipt number ____________ is to be
mentioned for further correspondence with this office.
Office Seal: (Signature of RSB / Coast Guard Headquarter)
Note: This copy duly stamped and signed by RSB / Coast Guard Headquarter is to be given to the student by hand or by post.
Selection Serial Number......................
PROFORMA FOR RENEWAL OF SCHOLARSHIP UNDER PRIME MINISTER’S SCHOLARSHIP SCHEME
(To be send only if selected for scholarship)
1. Name of the applicant (Ward/widow):
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2. Put a tick mark (√)
3. Selection serial No. given by KSB:
4. Particular of ESM / Ex-Coast Guard:
5. Present address (where you want your letter is to be sent)(To be filled up only in case of change from previous address or write N / A)
6. Details of Bank account of SBI or PNB for Electronic Clearing Services ((PLEASE ATTACH A PHOTOCOPY OF PASS BOOK, CROSSED BLANK CHEQUE SHOWING YOUR ACCOUNT NUMBER TO BE FORWARDED, EVEN IT IS SUBMITTED EARLIER).
Name of account holder
Bank Name
LEAVE BLANK SPACE BETWEEN WORDSBranch Name
Branch Address
State
Bank Tel. No.
Male Female
Name of ESM /Ex-Coast GuardRankService Number
House No.
Street No. & Name
Tehsil & Post
DisttState
Pin Code
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Branch Code
MICR (9 digit) No.
(PLEASE ATTACH A PHOTOCOPY OF CHEQUE & PASS BOOK)
Account No.
REPEAT
Account No.
Place:_____________________ ________________________________
Date:______________________ Full Name & Signature of the ward / widow
It is certify that the information submitted by my child / self is correct.
Place :_____________________ _____________________________
Date :_____________________ Full Name & Signature of the Parent
LEAVE BLANK SPACE BETWEEN WORDS
Please Fill Properly Your Full Year (Both Semester’s) Marks
1. It is certified that Ms. / Mr._____________________ is a Bonafide
student of __________________________________ college. He / she is
studying in the I / II / III / IV / V year of the two / three / four / five years
_______________ course. He / she had joined this college in the
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academic year 20___ - ___ and the course will be completed in the month
of ____________ 20___ - ___.
2. This is also certified that Ms. / Mr. ___________________________
__________ has successfully completed his / her 1st / 2nd / 3rd / 4th / 5th year
and scored
Year Marks Obtained Out of Percentage
1st Year (1st & 2nd sem) ____________ ______ _________
2nd Year (3rd & 4th sem) ____________ ______ _________
3rd Year (5th & 6th sem) ____________ ______ _________
4th Year (7th & 8th sem) ____________ ______ _________
5th Year (9th and 10th sem) ____________ ______ _________
3. He / she is continuing the course in 2nd / 3rd / 4th / 5th year.
4. This is also certified that student is getting Rs _____ per month / year
(If not getting write N/A) scholarship / stipend from this Institute / College
or any other sources.
Office Seal:
Signature of Principal / Dean / RegistrarDate: ________________
Place: _______________
ADDRESS OF DEPTT OF SAINIK WALFARE / RAJYA SAINIK BOARDS &DIRECTORATE GENERAL OF COAST GUARD
Sl No Address of RSB For Detail, Pl contact RSB
1ANDAMAN & NICOBARISLANDS (UT)
SecretaryRajya Sainik BoardA & N Administration, Secretariat
Port Blair - 744 101
Port Blair-
03192-235621 (O)03192-235621(F)
27
2ANDHRA PRADESH
Director Deptt of Sainik WelfareBlock IV, II Floor, Gruhakalpa Premises, MJ Road, Nampally, Hyderabad - 500 001
Hyderabad
040-24736890 (F)040-24747991 (O)
3ARUNACHAL PRADESH
Director Dte of Relief, Rehabilitation & Settlement, Govt of Arunachal Pradesh, New Itanagar-791110
Itanagar-
0360-2212282 (O)0360-2212282 (F)0360-2213615 (F)
4 ASSAM
DirectorDte of Sainik Welfare, Sainik Bhavan, House No-74, Lachit Nagar, Guwahati - 781 007
Guwahati-
0361-2522229 (O)0361-2522229 (F)
5 BIHAR
Director
Sainik Kalyan NideshalayaHome Deptt, Old Secretariat Barrack No.10, Patna – 800015
Patna
0612-2217301 (O)0612-2217301 (F)
6CHANDIGARH (UT)
Zila Sainik Welfare Officer
Zila Sainik Welfare Office (UT) Opposite Aroma Hotel, Sector-21-D, Chandigarh - 160 022
Chandigarh
0172-2701947 (O)0172-2700317 (O)0172-2726325 (F)
7 CHHATTISGARH
Director Deptt of Sainik Welfare, CGNear Collectorate Parisar, Behind Home Guard OfficeRaipur - 492 001
Raipur
0771-2445165 (O)0771-2427449 (O)0771-2420084 (F)
8 DELHI
Secretary Rajya Sainik BoardOpp Tis Hazari CourtNo.1, Rajpur Road, Delhi-110 054
Delhi-
011-23991876 (F)011-23969260 (O)
[email protected] GOA Secretary
Deptt of Sainik WelfareCollectorate BuildingPanaji - 403 001
Panaji
0832-2227138 (O)0832-2227138 (F)
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10 GUJARAT
DirectorDirectorate Sainik Welfare & Resettlement, Gujrat State Gaurav Senani Bhavan, Shahibaug-Airport Road, Shahibag, Ahmedabad-380001
Gandhinagar
079-22868347 (O)079-22868348 (O)079-22868346 (F)
[email protected][email protected]
11 HARYANA
SecretaryRajya Sainik BoardSainik Bhawan, Sector 12, Shaheed Capt Rohit Kaushal Marg, Panchkula - 134 109
Panchkula
0172-2560462 (O)0172-2560462 (F))
12HIMACHAL PRADESH
Director Deptt of Sainik WelfareGovt of Himachal PradeshHamirpur - 177 001
Hamirpur-
01972-221854 (O)01972-224659 (O)01972-225643 (F)
13JAMMU AND KASHMIR
Director Deptt of Sainik WelfareAmbphalla, Jammu - 180005
Jammu
0191-2561547 (O)0191-2575362 (F)
14 JHARKHANDDirectorSainik Kalyan Nideshalaya Ranchi (Jharkhand)
Ranchi-
0651-2330178 (O)0651-2331434 (F)
15 KARNATAKA
Director Deptt of Sainik Welfare & Resettlement,Fd Mshl KM Cariappa, Bhavan, No 58, Fd Mshl KM Cariappa Road, Bangalore - 560 025
Bangalore-
080-25589459 (O)080-25589459 (F)
16 KERALA
DirectorDeptt of Sainik WelfareVikas Bhavan, Thiruvananthapuram - 695 033
Thiruvananthapuram
0471-2304980 (O)0471-2304980 (F)
17MADHYA PRADESH
Director Deptt of Sainik WelfareSouthern Shopping Centre
Guru Teg Bahadur Complex, TT
Bhopal-
0755-2553992 (O)0755-2577209 (F)
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Nagar, New Market,P.B.NO 364, Bhopal - 462 003
18 MAHARASHTRA
DirectorDeptt of Sainik WelfareMaharashtra State ‘Raigad’, Opp National War Memorial, Solapur Road, Ghorpadi, Pune-411 001
Pune-
020-26332763 (O)020-26332764 (O)020-26334427 (O)
[email protected]@mahasainik.com
19 MANIPUR
SecretaryRajya Sainik BoardSainik Rest HouseOpp. Lamphel Police Station, PO-Lamphel, Imphal-795004
Imphal-
0385-2416228 (O)
20 MEGHALAYA
DirectorDte of Sainik WelfarePublic Service Commission Building Beyond DC BuildingShillong - 793 001
Shillong-0364-2225613 (O)0364-2225613 (F)
21 MIZORAM
DirectorDeptt of Sainik Welfare & Res,Tuikual ‘A’, PB No. 119Aizawl - 796 001
Aizawl-
0389-2322732 (O)0389-2322732 (F)
22 NAGALAND
SecretaryRajya Sainik Board, Home Deptt, Home Br, Nagaland Civil Sectt., Kohima - 797 001
Kohima-
0370-2270029 (O)0370-2270029 (F)
23 ORISSA
Secretary Rajya Sainik Board, Nageswar Tangi, Lewis Road, Bhubaneshwar-751002
Bhubaneshwar
0674-2432268 (O)0674-2435998 (F)
[email protected]@gmail.com
24PUDUCHERRY (UT)
Director Deptt of Sainik WelfareJawan Bhavan Complex, Lawspet Main Road, Pakkamudayanpet, Puducherry - 605 008
Puducherry
0413-2253107 (O)0413-2250575 (F)
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25 PUNJAB
DirectorDte of Sainik Welfare, PunjabPunjab Sainik Bhawan, Sector 21-D, Chandigarh - 160 022
Chandigarh
0172-2701845 (O)0172-2707345 (F)0172-2706014 (F)
[email protected]@[email protected]
26 RAJASTHAN
NideshakSainik Kalyan VibhagSecretariat Building, North Block, Jaipur - 302 005
Jaipur-
0141-2227897 (O)0141-2227650 (F)
27 SIKKIMSecretary Rajya Sainik Board, Sikkim Paljor Stadium Road, Gangtok-737 101
Gangtok-
03592-202534 (O)03592-221456 (O)03592-221456 (F)
28 TAMIL NADU
Joint DirectorDte of Ex-Servicemen’s Welfare22, Raja Muthiah Salai, ChoolaiChennai - 600 003
Chennai-
044-26691747 (O)044-26691886 (O)044-26691886 (F)
29 TRIPURA
SecretaryRajya Sainik Board, Nehru Office Complex, Gorkhabasti, P.O. Kunjaban, Agartala - 799 006 West Tripura
Agartala
0381-2326507 (O)0381-2326507 (F)
[email protected]@gmail.com
30UTTAR PRADESH
DirectorDte of Sainik Kalyan Evam Punarvas, Kariappa Bhawan, Kaiserbagh, Lucknow - 226 001
Lucknow-
0522-2625354 (O)0522-2625354 (F)0522-2305107 (F)
31 UTTARAKHAND
DirectorSainik Kalyan Evam Punarvas Uttarakhand, 15C, Kalidaas Marg, PO-Haathibadkala, Dehradun - 248121
Dehradun-
0135-2744208 (O)0135-2743773 (F)0135-2741481 (O)
31
32 WEST BENGAL
SecretaryRajya Sainik Board, Block 'I'(First Floor), Writers’ BuildingKolkata - 700 001
Kolkata-
033-22141347 (O)033-22144643 (F)033-22143220 (O)
[email protected]@gmail.com
FOR EX-INDIAN COAST GUARDS ONLY
01 COAST GUARD
Directorate General of Coast Guard HeadquarterNational Stadium ComplexNew Delhi-110001
011-23074132 (O)011-23386766 (F)
Note:
Dadar Nagar Haveli: ESM of these states can submit their Prime Minister Application form to Gujrat RSB.
Daman & Div
Lakshadweep: ESM of this state can submit their Prime Minister Application form to Kerala RSB.
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