K. C.

MAHINDRA EDUCATION TRUST

(Public Trust Act-Registration No. E 1245 - Bombay)
APPLICATION FORM FOR MAHINDRA ALL INDIA TALENT SCHOLARSHIP FOR 1ST YEAR DIPLOMA.

Application No. *
(Above entry to be left blank by the Applicant)

Affix
Passport size
Photograph with
your signature.

Read this Form carefully. Incomplete Application Form will NOT be considered.

Applicant’s Name in full: _____________________________________________________________

Age _________ Date of Birth _______________________________

(as recorded in your School Certificate - Encl. attested copy) (*)

Address for Correspondence:

Pin code

Name of the District: Name of the State:

Telephone/Mobile, if any : e-mail id: ________________________

Father’s Name in full : __________________________________________________________

Permanent address : __________________________________________________________

Pin code

Name of the District: Name of the State:

Has anyone else in your family (brother/sister) received the Mahindra All India Talent Scholarship:

Yes No Give Details: ______________________________________

Family Information:
Number of family members: ____________________________
Parents Name Level of Employment / Income per
Education occupation Year
Father

Mother

No. of Brothers ________

No. of Sisters ________

Any other source of income or scholarship? Please state amount and number of years: ___________

TOTAL FAMILY INCOME PER YEAR: _________________________

Details of Applicant’s Educational record :

Name of School/ Name of Examination Stream/ Year Percentage
College Board/University Passed Subjects of marks / CGPA
obtained

XTH (SSC)
(mandatory)

XII (HSC)
(If applicable)

Proposed Course of Study Course duration in Total College fees you have to pay
per year
(Give full details of your Diploma Course) years

Will you be living in a hostel? Yes/No

If yes, how much does it cost you every month?________________________________
Admission sought at:
Admission secured at:

(Name and full address of the Institute)

[Enclose copy of admission letter duly attested] *

Diploma Course Started from [Date]

No. of Years Course

CEEP (Common Entrance Exam) Rank (If applicable): _____________

Name and address of two referees (teacher/employer) - under at least one of whom the applicant has studied or worked.

1.

2.
Where did you hear about MAITS?
Ad in Newspaper ______________________ (Name of publication/newspaper)
College Notice Board Friends Others

Bank Details:

Name of the student as per bank account: ___________________________

Name of the bank: _________________________________________
Bank address: _____________________________________________
Account no. (Account no. for NEFT transfer): __________________________________________
IFSC Code (Mandatory): ___________________________________

Enclosures:

1. Testimonial (Recommendation letter) from any one of the two referees (teacher/employer) mentioned above.
2. A short statement as to your general aptitude and interest, the type of vocation you would like to pursue and your ambitions
and aspirations in life.
3. Attested copy of Certificate of Date of Birth as recorded in your School Certificate. *
4. Attested copy of Mark Sheets and Certificates of examinations passed. *
5. Attested copy of Letter from Institution where admission has been secured. *
* Candidates who have not secured admission will not be called for the final interview. Therefore candidates should
submit a copy of the admission letter as soon as they secure admission.
6. Family Income certificate copy.
7. Self-attested copy of first page of passbook or canceled cheque.
8. Aadhaar Copy. (Mandatory).

Please note that only students who have a bank account can apply for this scholarship.

I hereby declare that the entries in this form are true and if I am selected, I agree to abide by the terms and conditions of the K. C.
Mahindra Education Trust, Mumbai.

Date: Yours faithfully,

_______________________
[Name and Signature of
Applicant]

_______________________
Date: [Name and Signature of
Father/Guardian].

To the best of my knowledge, what is stated above is correct.

________________________
Date : [Name and Signature of the
Institution where you studied last/are studying)
 ELECTRONICS FUNDS TRANSFER – MANDATE FORM

To
K.C.MAHINDRA EDUCATION TRUST,
Mumbai.

Sub: Receipt of Scholarship payment through NEFT

I am giving below the details of my bank account for receiving the scholarship
Instalment payment through NEFT.

(1) NAME __________________________________

(2) Bank Name ______________________________

(3) Bank Br. Address : __________________________________________

__________________________________________

(4) Savings Account No. _________________________________________

(5) IFS Code No: ____________________________

(6) Students Contact No. ____________________

(7) E-Mail Id. ____________________

(8) Aadhar No.___________________

I have enclosed the following document to this effect.

(a) Cancelled Cheque leaf or Bank passbook containing details of Bank accounts number,
IFS Code

___________________
Signature of the Student
 Please submit the filled in form to the nearest centre in your area. Candidates must
submit their forms to ONLY ONE of the following addresses:

1 Ms Jayashree Payimpallai 7 The Coordinator

Mahindra & Mahindra Ltd Mahindra & Mahindra Ltd
34/1128 Balakrishna Menon Road Mahindra Tower, Automotive Sector
Edapally PO 1st Floor, 24,25,26 Durga Vihar Colony
Cochin 682024 Durga Pura, Tonk Road
Jaipur 302018

2 Mr V Suresh 8 The Coordinator

Mahindra & Mahindra Ltd Mahindra & Mahindra Ltd,
Mahindra Towers, 17/18 FES Swaraj Division
Pattulos Road Phase IV Industrial Area
Off Mount Road SAS Nagar
Chennai 600002 Punjab 160055

3 The Coordinator 9 The Coordinator

Mahindra & Mahindra Ltd Mahindra & Mahindra Ltd
Mahindra House, Auto Sector Mahindra Towers, 3rd Floor
T.S. Reddy Complex 2A Bhikaji Cama Place
1-7-1, Park Lane, SD Road New Delhi 110067
Secunderabad 500003

4 Mr. V Suresh 10 The Coordinator

Mahindra & Mahindra Ltd Mahindra & Mahindra Ltd
Raheja Chambers 3rd Floor, Mahindra Tower, Auto Sector
1st Floor, Museum Road Near HAL, Faizabad Road
Bangalore 560001 Lucknow 226016

5 The Coordinator 11 K.C. Mahindra Education Trust

Mahindra & Mahindra Ltd Cecil Court, 3rd Floor
Automotive Division Mahakavi Bhushan Marg
7 KYD Street Behind Regal Cinema, Colaba
3rd Floor Mumbai 400001
Kolkata 700016

6 The Coordinator
Mahindra & Mahindra Ltd.
Auto Sector
B/1, 701 to 707 & 712
7th Floor, Palladium, Corporate Road,
Near Divya Bhaskar Press, Makarba,
Ahmedabad 380051