DIYA PAKISTAN REGISTERED

1304/474, Hasan Street, Defence Road, New Lalazar, Rawalpindi

Tel: 051-5859582, Mobile: 0300-5322592
(Office Telephone Timings: 3:00pm to 5:00pm)
This Form must be submitted via email to apply@diyapak.org

APPLICANT'S DETAILS

Name:

CNIC No: Age:

Father's Name:

Gender: Male Female Domicile:

Email: Tel:

Present Address:

Permanent Address:

Applicant's Status: Orphan Disabled Poor & Deserving

Orphan's Only: Mention year of father's death:

Disabled Only: Indicate nature of disability:

COURSE DETAILS

Name of University / College:

Title of Programme / Course:

Roll No: Registration No:

Programme started on: will complete on:

Total Duration of your Programme / Course: Years: Semesters:

Currently Enrolled in Year / Semester:

Mode of Admission: Open Merit Reserved Seats Self Finance

Key person to be contacted in your department:

Name:

Designation: Tel:
ACADEMIC RECORD

Marks
Examination Year Roll No. Total Marks % Position
Obtained

Matriculation

Intermediate

Bachelors

Are you Hafiz-e-Quran? Yes No

Do you retain Hifz? Yes No

Current Academic Performance

Provide complete details of all examinations that have been administered by your university / college
so far, including examinations for which the result has not been declared yet.

Examination Level
Month / Year when Results Declaration Average Percentage or
(Mention Year, Prof or
exam was conducted Date / Status GPA obtained
Semester)

GUARDIAN DETAILS

Name:

CNIC No: Relationship with Applicant:

Guardian's Occupation: Yearly Income:

Exact Designation: Organization:

Telephone: Address:
EDUCATIONAL EXPENDITURE

Current Expenses on Education

Yearly Messing
Yearly Tuition Fee Yearly Hostel Fee Total Expenditure
Expenses

Sources of Educational Financing other than Guardian's Monthly Income

Loan from Relatives / Friends

Loan from some organization

Scholarship from another organization

Remission from College / University

Income from other sources

If you are receiving scholarship from another organization, then please provide the details of this
scholarship:

Name of the Donor / Organization:

Type of Scholarship: One-time Yearly Monthly

If you have stated any amount for 'Income from other sources', then provide complete details of all
such sources:

Tuition Fee of Institutes Previously Attended

Matriculation Intermediate

Name of the Institute

Location

Yearly Fee
Amount of any
Scholarship / Remission
Availed

Note: For matriculation you should state the yearly expenses you had to incur in class Xth only.
Similarly, for Intermediate you should state the yearly expenses of class XIIth only.
HOUSEHOLD DETAILS

Family Accommodation Details:

Note: Family includes father, mother, brothers and sisters.

Type: House Flat Quarter Mud House

Status: Rented Family Owned Provided by Govt. / Organization

If rented, annual rent:

Average monthly electricty bills during the months April to Sept.

Details of family members currently employed / retired

Yearly
Name Age Exact Designation Employer
Salary

Details of family members currently engaged in business / commercial activity

Yearly
Name Age Type of Business Location of Business
Earnings

Details of family members currently studying

Name Age Institute Yearly Fee

Does your family / guardian own a piece of land, property, car/motor cycle or any other asset.

Provide complete details.

Any other thing that you would like to add or say (related to this application):

Declaration by the Applicant and his/her Guardian:

We, the undersigned solemnly affirm that the details/information

provided are accurate and that we shall be responsible for
any inaccurate or false information.

Applicant's Signature Guardian's Signature

Verification by Tehsildar or Competent Authority:

I attest that the information contained in application form is accurate

and the applicant deserves the grant of scholarship award.

Signature Stamp / Seal

Note: Competent authority includes Area Magistrate, Tehsildar, Naib Tehsildar, Mukhtiarkar or
Area Nazim