Form for the Claim of Scholarship / Waiver / Concession

Name of the Student Father / Legal Guardians Name Registration No Program opted for

: : : : Study Centre Opted: Test Date: Enrollment No:

Scholarship based on Admission Test / FTRE / NSTSE:-

Claim for _____% scholarship awarded on the basis of Admission Test / FTRE / FTSE / NSTSE / F40 dated ______________ (First Attempt) I______________________________________(Fathers Name) hereby make a clear declaration that My Son /Daughter / Ward appeared on ________________(Test Date) for Admission Test / FTRE / FTSE / NSTSE / F40 and this was his / her first attempt for tests conducted by FIITJEE for AY_____________. I am fully aware of the fact that my ward is eligible for this scholarship only if this was his / her first attempt. I also understand that in future if it is found that this was not the first attempt by my ward for AY ___________, this scholarship will stand withdrawn and Ill be liable to pay the scholarship amount awarded with 24% interest p.a. and appropriate penalty as fixed by FIITJEE Management. Claim for ____% scholarship awarded on the basis of Admission Test / FTRE / FTSE / NSTSE / F40 dated ______________ (ReAttempt) I______________________________________(Fathers Name) hereby make a clear declaration that My Son /Daughter / Ward appeared on ________________(Test Date) for Admission Test / FTRE / FTSE / NSTSE / F40 and this was his / her reattempt for tests conducted by FIITJEE for AY_____________. My ward wrote the test first on _________vide Registration No______________________________________. I am fully aware of the fact that my wards scholarship has been made 1 scale down to _________% as per policy already known to me.

Scholarship based on NTSE:Claim for 50% scholarship on Tuition Fee awarded on the basis of NTSE Stage I Qualified Claim for 90% scholarship on Tuition Fee awarded on the basis of NTSE Stage I Qualified For State Topper Claim for 90% scholarship awarded on the basis of NTSE Stage II Qualified (90% Scholarship on Tuition Fee + Examination Fee + Books & Study Material price + (AITS + GMP + RTPF) Fee Documents to be attached This scholarship is applicable only for students above the general category cut off. The photocopy of the original award certificate. (Original to be produced for verification) Mark sheet of NTSE attested by the Principal of the school last attended / presently studying.

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Scholarship based on JSTSE (Delhi) / SSTSE (Rajasthan) / MTSE (Maharashtra) or similar kind of Talent Search exam conducted by State Government :Claim for 25% scholarship on Tuition Fee awarded on the basis of Stage I Qualified Claim for 50% scholarship on Tuition Fee awarded on the basis of Stage II Qualified Rank 1 Claim for 35% scholarship on Tuition Fee awarded on the basis of Stage II Qualified Rank 2 to 20 Documents to be attached o o o This scholarship is applicable only for students above the general category cut off. The photocopy of the original award certificate. (Original to be produced for verification) Mark sheet of JSTSE / SSTSE / MTSE attested by the Principal of the school last attended / presently studying.

Scholarships based on KVPY:Claim for 75% scholarship awarded on the basis of KVPY Stage I Qualified (Qualified Written Test & Called for Interview) (Scholarship on Tuition Fee + Examination Fee + Books & Study Material price + (AITS + GMP + RTPF) Fee Claim for 90% scholarship awarded on the basis of KVPY Stage II Qualified (Selected after Interview) (Scholarship on Tuition Fee+ Examination Fee + Books & Study Material price + (AITS + GMP + RTPF) Fee + 90% Scholarship on Infrastructure Fee

Documents to be attached o o o This scholarship is applicable only for students above the general category cut off. The photocopy of the original award certificate. (Original to be produced for verification) Mark sheet of KVPY attested by the Principal of the school last attended / presently studying.

Scholarships based on Olympiads:Claim for 75% scholarship awarded on the basis of National Olympiads (Organized by HBCSE) Stage I Qualified ((Qualified National Standard Examination in Physics /Chemistry / Astronomy or Regional Mathematical Olympiad for Stage-II Level) ( Scholarship on Tuition Fee + Examination Fee + Books & Study Material price + (AITS + GMP + RTPF) Fee Claim for 100% scholarship awarded on the basis of National Olympiads (Organized by HBCSE) Stage II Qualified (Qualified Indian National Olympiads in Mathematics / Physics / Chemistry / Astronomy for Stage-III Level) (Scholarship on Tuition Fee + Examination Fee + Books & Study Material price + (AITS + GMP + RTPF) Fee + 75% Scholarship on Infrastructure Fee Claim for 100% scholarship awarded on the basis of National Olympiads (Organized by HBCSE) Stage III Qualified (Selection in Stage-III i.e. Orientation Cum Selection Camp for Stage-IV Level i.e. Pre Departure Training Camp for International Physics / Chemistry /Mathematical /Astronomy & Astrophysics Olympiad) (100% Scholarship on Tuition Fee + Examination Fee + Books & Study Material price + (AITS + GMP + RTPF) Fee + 100% Scholarship on Infrastructure Fee + 50% Scholarship on Admission Fee Claim for 100% scholarship awarded on the basis of National Olympiads (Organized by HBCSE) Stage IV Qualified (Winning Medal for the Country in International Physics / Chemistry /Mathematical / Astronomy &Astrophysics Olympiad) (100% Scholarship on Tuition Fee + Examination Fee + Books & Study Material price + (AITS + GMP + RTPF) Fee + 100% Scholarship on Infrastructure Fee + 75% Scholarship on Admission Fee) Documents to be attached o o The photocopy of the original award certificate. (Original to be produced for verification) Mark sheet of Olympiads attested by the Principal of the school last attended / presently studying.

Scholarships based on Jr Olympiads:Claim for 75% scholarship awarded on the basis of Junior Science Olympiad (Organized by HBCSE) Stage I Qualified ((Qualified National Standard Examination in Junior Science for Stage II Level) (75% Scholarship on Tuition Fee + Examination Fee + Books & Study Material price + (AITS + GMP + RTPF) Fee Claim for 100% scholarship awarded on the basis of Junior Science Olympiads (Organized by HBCSE) Stage II Qualified ((Qualified Indian National Junior Science Olympiad for Stage III Level) (100% Scholarship on Tuition Fee + Examination Fee + Books & Study Material price + (AITS + GMP + RTPF) Fee + 75% Scholarship on Infrastructure Fee Claim for 100% scholarship awarded on the basis of Junior Science Olympiads (Organized by HBCSE) Stage III Qualified (Selection in Stage-III i.e. Orientation Cum Selection Camp in Jr. Science for Stage-IV Level i.e. Pre Departure Training Camp for International Jr. Science Olympiad) (100% Scholarship on Tuition Fee + Examination Fee + Books & Study Material price + (AITS + GMP + RTPF) Fee + 100% Scholarship on Infrastructure Fee + 50% Scholarship on Admission Fee Claim for 100% scholarship awarded on the basis of Junior Science Olympiads (Organized by HBCSE) Stage IV Qualified (Winning Medal for the Country in International Jr. Science Olympiad) (100% Scholarship on Tuition Fee + Examination Fee + Books & Study Material price + (AITS + GMP + RTPF) Fee + 100% Scholarship on Infrastructure Fee + 75% Scholarship on Admission Fee Documents to be attached o o The photocopy of the original award certificate. (Original to be produced for verification) Mark sheet of Olympiads attested by the Principal of the school last attended / presently studying.

Scholarships based on Board Exam marks:Claim for 25% scholarship on Tuition Fee awarded on the basis of Grades in Board ( X Board Result) (A1 in Science, Math and any 3 other subjects and overall CGPA is 10.00) Documents to be attached o o The photocopy of the X Mark sheet. (Original to be produced for verification) Mark sheet of X Mark sheet attested by the Principal of the school last attended / presently studying.

Claim for 25% scholarship on Tuition Fee awarded on the basis of Grades in Board ( XII Board Result) (A1 in Physics, Chemistry, Math and any 2 other subjects and overall CGPA is 10.00) Documents to be attached o The photocopy of the XII Mark sheet. (Original to be produced for verification)

Mark sheet of XII Mark sheet attested by the Principal of the school last attended / presently studying.

Other Category Waivers:-

Claim for 10% scholarship on Tuition Fee awarded on the basis of Siblings of Present / Ex-FIITJEEians Documents to be attached o o o Sibling Affidavit Form in Rs10/- Stamp paper. photocopy of Date Of Birth Certificate of both the children(Original to be produced for verification) photocopy of FIITJEE identity card / fee receipt / acknowledgement of the Present FIITJEEian or Ex FIITJEEian Claim for 25% scholarship on Tuition Fee for students with Physical Disability. Documents to be attached

Attested photocopy of the certificate issued by the Govt. General Hospital. Claim for 25% scholarship on Tuition Fee for Children of War Widows (Defense Personnel). Documents to be attached

Death Certificate issued by Army / Navy / AirForce Any other Scholarship / Waiver (If published in the Brochure) Documents to be attached

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Copy of the relevant page of the brochure. Relevant documents as published.

Refund Request (If the fee is already paid without the adjustment of the scholarship) 1. 2. Refund application will be accepted only after all the payment instruments are realized. Refund processing will take approx 100 days from the date application is received. Scholarships based on Admission Test / FTRE / FTSE / NSTSE / F40 etc are awarded only at the time of admission. No refund requests can be entertained towards such scholarships. Documents to be attached o o o Documents as specified in the scholarship column. The photocopy of the fee receipt / acknowledgement. The photocopy of the student ID card.

Declaration by the parent: 1. Scholarships mentioned here are having restrictions on the course / period of admission etc. Please refer to the course brochure for the detailed terms and conditions. 2. FIITJEE reserves the right to modify / cancel / add any scholarship any time without any prior notice. 3. Award of scholarship will be at the sole discretion of FIITJEE. 4. Signing this application form means you specifically agree that in case any of the information furnished here is found wrong / altered, the scholarship amount will be recovered with 24% interest pa and penalty as fixed by FIITJEE management. 5. This scholarship claim will be governed by the rules and regulations published in the brochure and the enrollment form. Date: Place:

Signature of the Parent / Guardian For Office Use only Declaration by the officer passing the scholarship:-

Signature of the Student

I have verified all the documents in original and verified the scholarship rules. I hereby declare that this scholarship is within the rules as published in FIITJEE Brochure. Scholarship / waiver under the category Any other Scholarship / Waiver (If published in the Brochure) has been approved by the centre head. Name and signature of the official passing the scholarship Date Signature of the Centre Head (If the Schol / Waiver is of Type Any Other)