LAXMI CHARITIES

Regd. O f f : 21, Pa t ul l os R oa d , Ch en n a i - 6 0 0 0 0 2 .

APPLICATION FORM FOR AWARD OF SCHOLARSHIP 2019 - 20

CONDITIONS ALL CORRESPONDENCE TO
1. Attested copy of mark sheet to be enclosed along with Admin. Office
the application. Desabandhu Plaza
2. Incomplete application will not be considered. 47, Whites Road,
3. More than one application from the same family will not Chennai - 600 014.
be entertained.
The application form duly completed in all respects should
4. Parents Income Proof from the Employer is Must be sent on or before 31-Aug-2019.
5. Eligibility "+1" onwards
6. Marks >= 70%
7. Application will be considered subject to availability of
Funds
Application No. 017506
FOR OFFICE USE ONLY
NEW / RENEWAL REF NO CATEGORY DEGREE COURSE

NAME OF THE INSTITUTION QUAID E MILLATH GOVT COLLEGE FOR WOMAN MARKS 406 70 %
REFERRED BY ANNUAL INCOME 42000

AMOUNT

APPROVED BY Authorised Signatory

TO BE FILLED BY STUDENT
Details of the student's bank account to which the scholarship amount to be credited

Name of the Student V KAMATCHI

Name of the Bank BANK OF BARODA

Name of the Bank's Branch MANGADU

IFSC Code BARB0MANGAD

MICR Code 600012026

Account Number of the Student 05760100030487

* Please attach passbook front page
copy

1. Address for communication : 22,MARIYAMAN KOVIL STREET, MANGADU

Pincode: 600122

2. Date of Birth : 0 4 0 6 2 0 0 2

Mobile No. / Land Line No. 9 9 5 2 7 8 8 4 4 2

:

3. Parent's / Guardian's Particulars :

a. Name: V. GEETHA
Submission of Application Form
b. Occupation: RENT The completed Application Form may please be
c. Annual Income: 42000 deposited at the Administrative Office of the
(with Employer's Certificate) Charities before 31st August 2019
from 12:30 am to 02:00 pm on all working days.
 4. Name of the institution INSTITUTION'S NAME : QUAID E MILLATH GOVT COLLEGE FOR WOMAN
where the student is now
Course : B. COM GENERAL
studying
Year : 1st Year

Total Marks : 406 Percentage : 70 %

Male P Female
5. Particulars of Total Tution fees payable 2019 - 20 : 1800

6. Copy of the latest marks sheet (two semester Mark sheet of the Previous Academic Year) of the Annual
Examination should be enclosed along with the Application duly attested.

7. If the student is a recipient of scholarship from Laxmi Charities earlier, please furnish particulars: NO

Signature of the Parent / Guardian Signature of the Student

Place :
Date :

TO BE CERTIFIED BY THE INSTITUTION

Sri / Miss                                                          is a bonafide student of our institution studying
                                                                                                           course in this Academic Year 2019 - 20 and the particulars
furnished by him / her in the application form.

Place : Head of the Institution with Official Seal

Date :