fcgkj ljdkj

fiNM+k oxZ ,oa vfr fiNM+k oxZ dY;k.k foHkkx

o"kZ 2013&14 ds fy, vU; fiNM+k oxZ izosfkdkskj Nk=o`fk ;kstuk ds rgr vkosnu i= ls lacaf/kr fnkk&funsZk

fiNM+k oxZ ,oa vfr fiNM+k oxZ ds fy, izosf'kdkskj Nk=o`fk ;kstuk & bl ;kstuk ds vUrxZr fokh;
o"kZ 2013&14 esa jkT; ds vanj fuEukafdr laLFkku@dkslZ esa v/;;ujr fiNM+k oxZ ,oa vfr fiNM+k oxZ ds
Nk=@Nk=kvksa dks fuEu izdkj Nk=o`fk iznku fd;s tkus dk izko/kku gS%&
0

dkslZ dh fooj.kh

Nk=o`fk dh jkfk dh
vf/kdre okf"kZd lhek
ns; vfuok;Z 'kqYd ;k
fuEu fu/kkZfjr jkfk]
nksuksa esa tks U;wure gks

2
jkT; ds v/khu ljdkjh@vaxhHkwr@ekU;rk izkIr fofHkUu $2 fo|ky;ksa@
egkfo|ky;ksa esa baVjehfM;V d{kk ;Fkk&vkbZ0,0@vkbZ0,l0lh0@vkbZ0dkWe
,oa vU; led{k dkslZA
jkT; ds v/khu vaxhHkwr@ekU;rk izkIr egkfo|ky;ksa esa Lukrd Lrjh; d{kk
;Fkk&ch0,0@ch0,l0lh0@ch0dkWe ,oa vU; led{k dkslZA
jkT; ds v/khu Lukrdkskj d{kk ;Fkk&,e0,0@,e0,l0lh0@,e0dkWe@
,e0fQy0@ih0,p0Mh0 ,oa vU; led{k dkslZA
jkT; ds v/khu ljdkjh vkbZ0Vh0vkbZ0
jkT; ds v/khu ljdkjh laLFkku esa lapkfyr f=o"khZ; fMIyksek ikB~;e@
ikWfyVsDuhd ,ao vU; lEkd{k dkslZA
jkT; ds v/khu ljdkjh@vaxhHkwr O;kolkf;d ,oa rduhdh fk{k.k laLFkku
ds v/khu lapkfyr dkslZ] ;Fkk&bathfu;fjax@esfMdy@fof/k@izca/ku rFkk
vU; led{k dkslZ d`f"k dks NksM+djA

2
3
4
5
6

`2000@&
`5000@&
`5000@&
`5000@&
`10000@&
`15000@&

d mi;qZDr laLFkkuks@
a dkslksZa esa v/;;ujr fiNM+k oxZ ,oa vfr fiNM+k oxZ ds Nk=@Nk=kvksa dks
Nk=o`fk dh Lohd`fr esa uohuhdj.k vkosndksa dks izkFkfedrk nh tk;sxhA
[k mi;qZDr laLFkkuks@
a dkslksZa ds vfrfjDr vU; fdlh Hkh laLFkku] tks jkT; ds ckgj vofLFkr gSa] esa
v/;;ujr Nk=@Nk=kvksa dks Nk=o`fk ugha nh tk;sxhA
izosfkdkskj Nk=o`fk gsrq vkosndksa dh vgZrk%&
bl ;kstuk ds vUrxZr fiNM+k oxZ ,oa vfr fiNM+k oxZ ds fuEukafdr Nk=@Nk=k izosfkdkskj
Nk=o`fk gsrq vkosnu djus ds fy, l{ke gksaxs%&
1- vkosnd dks fcgkj jkT; dk LFkk;h fuoklh gksuk pkfg,A
2- vkosnd dks fcgkj jkT; ds v/khu vofLFkr mi;qZDr laLFkku esa gh v/;;ujr gksuk pkfg,A
3- bl ;kstuk ds vUrxZr ogh vkosnd vkosnu djus ds fy, l{ke gSa] ftUgsa foxr ijh{kk esa 60%
vad izFke Js.kh izkIr gSaA
4- vkosnd dh tkfr jkT; ljdkj }kjk fuxZr fiNM+k oxZ ,oa vfr fiNM+k oxZ dh lwph esa lfEefyr
gksAa
5- vkosnd ds ekrk&firk@vfHkHkkod dh lHkh lzksrksa ls dqy okf"kZd vk; vf/kdre `1-00 yk[k
:i;s ,d yk[k rd gksuk pkfg,A
6- ,d Lrj dk dkslZ mkh.kZ djus ds ckn nwljs led{k dkslZ esa v/;;u djus ij Nk=o`fk ds
gdnkj ugha gksx
a ]s ;Fkk&vkbZ0,l0lh0@vkbZ0dkWe dh ijh{kk mkh.kZ djus ds ckn vkbZ0,0]
ch0,0@ch0,l0lh0 dh ijh{kk mkh.kZ djus ds ckn ch0dkWe ,oa ,e0,l0lh0@,e0dkWe djus ds
ckn ,e0,0 d{kk esa v/;;u djus ij Nk=o`fk ugha nh tk;sxhA
6- ,d ekrk&firk ds ek= 02 nks iq=ksa dks gh izosfkdkskj Nk=o`fk iznku dh tk;sxhA ;g fu;e
iqf=;ksa ij ykxw ugha gksxkA

 vkosnu djus dh izf;k%&

12345i
ii
iii
iv
v
vi
vii

izosfkdkskj d{kk esa ukekafdr ,oa v/;;ujr Nk=@Nk=k foHkkxh; osclkbZV

www.bcebcwelfare.bih@nic.in esa miyC/k vkosnu i= dks MkmuyksM djsx
a As
vkosnu i= dkyk fjfQy@L;kgh esa lHkh dafMdk;sa ;FkkLFkku Hkjk gksuk pkfg,A [kkyh txg
ckWDl esa dk fu'kku yxk;saA mi tkfr dkWye esa tkfr dk Li"V uke fy[ksaA
vkosnd vkosnu i= ds lkFk vko;d izek.k i=ksa dks layXu dj vius laLFkku iz/kku dks lefiZr
djsx
a As
laLFkku iz/kku vkosnd ls izkIr vkosnu i=ksa dk lR;kiu ,oa viuh vuqkalk ds mijkUr lacfa /kr
ftyk ds ftyk dY;k.k inkf/kdkjh] ftl ftyk esa laLFkku vofLFkr gS] dks vkosnu i= izkIr djus
dh vafre frfFk ds vanj miyC/k djkuk lqfufpr djsx
a As
vkosnu i= ds lkFk LovfHkizekf.kr fuEufyf[kr izek.k i= dh izfr layXu djuk vfuok;Z gksxk%&
tkfr izek.k i= l{ke inkf/kdkjh }kjk fuxZr
vk; izek.k i= l{ke inkf/kdkjh }kjk fuxZr] tks vkosnu i= gsrq lwpuk izdkku dh frfFk ls 01
,d o"kZ ls vf/kd iqjkuk u gks
vkoklh; izek.k i= l{ke inkf/kdkjh }kjk fuxZr
foxr mkh.kZ ijh{kk dk vad i=
fk{k.k laLFkku }kjk fn;k x;k okf"kZd vfuok;Z 'kqYd fooj.khA
vfHkHkkod dk ?kks"k.kk i= vkosnu esa fn;s x;s izi= esa
vkosnu i= ij vkosnd dk LovfHkizekf.kr QksVksxzkQA

vkosnu i= lefiZr djus dh frfFk%&

1- vkosnd }kjk laLFkku iz/kku dks vkosnu i= lHkh vuqyXud lfgr lefiZr djus dh vafre
frfFk%&
30-03-2014
2- laLFkku iz/kku }kjk lacaf/kr ftyk dY;k.k inkf/kdkjh dk;kZy; esa vkosnu i= lefiZr djus dh
vafre frfFk%&10-04-2014
3- vafre frfFk ds mijkUr izkIr vkosnu i=ksa ij dksbZ fopkj ugha fd;k tk;sxkA

ljdkj ds mi lfpo]
fiNM+k oxZ ,oa vfr fiNM+k oxZ
dY;k.k foHkkx] fcgkj] iVukA

fcgkj ljdkj
Government of Bihar
fiNM+k oxZ ,oa vfr fiNM+k oxZ dY;k.k foHkkx
BC & EBC Welfare Department
izofs kdkskj Nk=o`fk gsrq vkosnu&i=
(Application form for Post Matric Scholarship)
(A)

uohu New@uohuhdj.k Renewal

LovfHkizekf.kr
ikliksVZ
lkbZt dk
QksVks fpidk;sa

(B) l= (Session)&

1- vkosnd dk uke fgUnh esa --------------------------------------------------------------------------------------------------------------------------------------------------------------Name of the Applicant In English In Capital Letters---------------------------------------------------------------------------------------------------2- firk@vfHkHkkod dk uke Name of father/Guardian ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------3- tUe & frfFk Date of Birth-------------------------------------------------------------------4- fyax Gender----------------------------------------5- okZeku@i=kpkj dk irk Present/Corresspondence Address ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------6- LFkk;h irk Permanent Address & xzke@eqgYyk Village/Mohallah)&-----------------------------------------------------------------------Mkd?kjPost Office --------------------------------------------------------------- vapyCircle ----------------------------------------------------------------------------ftyk District ------------------------------------------------------------------------- jkT; State ----------------------------------------------------------------------------fiu dksM Pin Code -----------------------------------------------------------------------------------------------------------------------------------------------------------------------7- jk"Vh;rk Nationality -------------------------------------------------------------------------------------------------------------------------------------------------------------------8- dksfV Category &
d fiNM+k oxZ B.C.
[k vR;ar fiNM+k oxZ EBC
x mitkfr Sub Caste
9- firk@vfHkHkkod dk okf"kZd vk; : esa Income of Father/Guardian in Rupees vad ,oa 'kCnksa esa fy[ksa
Write in figures & Words ---------------------------------------------------------------------------------------------------------------------------------------------------------10- foxr o"kZ esa mkh.kZ ijh{kk dh fooj.kh Description of the previous examination%&
ijh{kk dk uke cksMZ@fofo|ky;
mkh.kZ o"kZ
izkIrkad
Js.kh
izfrkr
dk uke
11- orZeku fk{k.k laLFkku dk uke ,oa iw.kZ fooj.k %&
Name and Description of the present Institution:-

id laLFkku dk uke ,oa iw.kZ irk] tgk vkosnd v/;;ujr gS Name of the Institution and full address%&

-------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------

[k laLFkku esa ukekadu dh frfFk Date of Admission in the Institution ----------------------------------------------------------------12- orZeku oxZ@d{kk@dkslZ dk uke@ftl dkslZ ds fy, Nk=o`fk dh ekx dh xbZ gS Name of the
class/Course for which the scholarship is demanded --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------d dkslZ dk uke Name of the course%& ---------------------------------------------------------------------------------------------------------------------[k dkslZ dh iw.kZ vof/k Period of the Course%& -----------------------------------------------------------------------------------------------------------x oxZ@dkslZ dk l= Session of class/Course%& -------------------------------------------------------------------------------------------------------13- i D;k vkosnd dks bl ;kstukUrxZr foxr o"kksZa esa Nk=o`fk dk ykHk feyk gS \ Has the applicant got
scholarship in previous years under this scheme ?
gk Yes
ugha No
ii ;fn gk] rks Nk=o`fk dh Lohd`fr dk o"kZ If yes, the year of sanction of the scholarship & ------------------------iii Nk=o`fk dh jkfk Amount of the scholarship & -------------------------------------------------------------------------------------------------------

&2&
iv Nk=o`fk Lohd`r djus okys inkf/kdkjh@dk;kZy; dk uke ,oa irk Name & Address of the
Officer/Office who sanctioned the scholarship ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------14- D;k vkosnd dksbZ vU; Nk=o`fk dk ykHk izkIr dj jgs gSa \ Is the applicant getting any other scholarship ?
gk Yes
ugha No
15- vkosnd ds laca/k esa lwpuk Detail information of the applicant%&
d fdrus HkkbZ dks Nk=o`fk izkIr gksrh gS How many brothers getting Scholarship \ -----------------------------------[k fdl laLFkku@foHkkx ls Nk=o`fk izkIr gksrh gS Name of the Institution who is providing
Scholarship \ --------------------------------------------------------------------------------------------------------------------------------------------------------------------Nk=@Nk=k ,oa vfHkHkkod dh ?kks"k.kk Declaration of the student & Guardian
eSa ,rn~ }kjk ?kks"k.kk djrk@djrh gw fd vkosnu i= esa nh xbZ mi;qZDr lwpuk esjs tkudkjh vuqlkj lR;
vkSj lgh gS vkSj eq>s ;g Hkh Kkr gS fd xyr lwpuk nsus ij esjs fo:) dh tkusokyh dkuwuh dkjZokbZ ds fy,
vkSj Nk=o`fk jkf'k dh olwyh ds fy, eSa gh ftEesokj gwxk@gwxhA
I do hereby declare that the information given in the application is true as per my knowledge and belief and
I also know that I shall be responsible for legal action against me and for the recovery of the scholarship, if the
given statements found false.

frfFk %&
Date :-

LFkku %&
Place :-

Nk=@Nk=k dk gLrk{kj

firk@vfHkHkkod dk gLrk{kj

Signature of the applicant

Signature of father/guardian

laLFkku dh flQkfj'k ,oa ?kks"k.kk

(Recommendation and declaration of the Institute)

laLFkk }kjk Hkjk tk,

To be filled by the institute
1- izekf.kr fd;k tkrk gS fd Jh@lqJh@Jherh ----------------------------------------------------------------------------------- bl laLFkku ds
oxZ@dkslZ ------------------------ dh Nk=@Nk=k gSA
This is Certify that Mr./Mrs./Miss ......................................................... is a bonafide student of the
course................................ in this Institution.

2- Nk=@Nk=k }kjk vkosnu i= esa nh xbZ lwpuk lgh vkSj laLFkku fjdkWMZ ds vuqlkj Bhd gSA
The statement given in the application is true and correct as per the record of the Institute.

3- laLFkku ds fjdkWMZ ds vuqlkj bl Nk=@Nk=k dks fdlh vU; laLFkku ls Nk=o`fk@fokh; lgk;rk@
othQk@vfuok;Z 'kqYd izkIr ugha gks jgk@jgh gSA
As Per record of the institute the applicant has not been getting scholarship/financial help/pocket
money/compulsury fees from any other sources/institute/agency.

4- bl laLFkku dks%
d dsUnz ljdkj--------------------------------------foofo|ky; uke dk mYys[k djsa ---------------------------------------cksMZ uke dk mYys[k djsa -------------------------------------------------------,e-lh-vkbZ- --------------------------------------------------------------------------------------

jkT; ljdkj uke --------------------------------------------fo- fo- vk;ksx -------------------------------------------------------,-vkbZ-lh-Vh-bZ- ----------------------------------------------------- --ls ekU;rk izkIr gSA

This Institute is affiliated and approved by Central Government.. State Government..

University (Write the Name) .
University grant commission
AICTE
.
Board (Write the Name) ...
M.C.I..

&3&

[k LFkk;h ekU;rk izkIr gSA

x vLFkk;h ekU;rk izkIr gSA

Permanentaly affiliation

Temporarily affiliation

5- vkosnd dk lkekU; vkpj.k larks"kizn@vlarks"kizn gSA

The General character of the applicant is satisfactory/ is not satisfactory.

6-

bls laLFkku iz/kku Hkjsaxs tgk vkosnd i<+ jgs gSa

To be filled by the head of the institution where the student is studying

(i) vkosnd ds dkslZ dh iw.kZ vof/k --------------------------------------------------------------------------------------------------------------------------------------------------Duration of the course of the applicant ..................................................................................................
(ii) dkslZ ds orZeku l= dk vfuok;Z 'kqYd rFkk vU; izklafxd [kpZ dk C;kSjk
Details of compulsory fees and other respective expences of the present session

ekad

C;kSjk

nj

vkosnd }kjk oLrqr% laLFkk dks ns; jde

vH;qfDr

S.N.

Particular

Rate

Actual paid amount by the applicant to the institute

Remarks

1
1

2
ukekadu 'kqYd

Admission fee

f'k{k.k 'kqYd

fofo/k 'kqYd

Tution Fee
Miscellaneous Fee

ijh{kk 'kqYd
Exam. Fee

5
6
7
;ksx Total
7- laLFkku ds cSad dk fooj.k Description of the Bank of the Institution
d cSad dk uke Name of the Bank & -----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------[kcSad dk IFSC dksM IFSC Code of the Bank& ---------------------------------------------------------------------------------------------------------------------x [kkrk la[;k Account Number% ----------------------------------------------------------------------------------------------------------------------------------------------?k [kkrk/kkjh dk uke Name of the Account Holder% ----------------------------------------------------------------------------------------------------------8- vkosnd ds cSad dk fooj.k Description of the Bank of the Institution
d cSad dk uke Name of the Bank & -----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------[kcSad dk IFSC dksM IFSC Code of the Bank& ---------------------------------------------------------------------------------------------------------------------x [kkrk la[;k Account Number% ----------------------------------------------------------------------------------------------------------------------------------------------?k [kkrk/kkjh dk uke Name of the Account Holder% ----------------------------------------------------------------------------------------------------------rkjh[k %
Date :

LFkku %
Place :

vkosnu i= ds lkFk layXu izek.k i= List of enclosers

1234-

tkfr izek.k i=
vk; izek.k i=
vkoklh; izek.k i=
foxr mkh.kZ ijh{kk dk vad i=

laLFkku ds izeq[k@izkpk;Z@jftLVkj@Mhu dk
gLrk{kj vkSj uke ,oa laLFkku dh eqgj
Sign. of the Head of the Institution principal/
Registrar/ Dean With Stamp