Annexure 5B-6M

APPLICATION FORM FOR FIITJEE REWARDS

(For 12th Pass studying in Engineering College)
(For the students who have been awarded with KVPY Fellowship)
Please note- Form should be submitted at your FIITJEE Centre during January-February and July-August
for the remaining instalments (if any).
Please tick [ ] the stream for which you are applying for KVPY Fellowship reward.
[ ] KVPY SA-(Class XI) [ ] KVPY SX-(Class XII)

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AIR in KVPY Fellowship Result = ____________________
Name of Student Santanu Kundu

FIITJEE Enrolment Number

FIITJEE Study Centre North Kolkata

Current University/College/Institute (Please specify the name ) IIT Kharagpur

Amount of award admissible per Instalment

Instalment Number 2nd 3rd 4th

Dated 28/02/2019 Signature of Student

Permanent Residential Address (in Capital letters ) :- Address(in Capital Letters) :-

Raja Rammohan Pally, Sreeniketan,Barasat, ,
……………………………………………………………………………... Do
……………………………………………………………………
North 24 Parganas, Kolkata-700124
…………………………………………………………………………….. …………………………………………………………………..
Santanuk.13@gmail.com
E-mail ID ………………………………………………………………. …………………………………………………………………..
9836773060 /
Phone ………………………………………………………………….. 8334963132 …………………………………………………………………..

FOR FIITJEE Centre (For approval of Centre Head)

Certified that Master/Ms …………………………………………………….. S/O or D/O …………………………………………was studying in FIITJEE

………………………………………… Centre bearing enrolment number……………………………………… I recommend to release his/her
reward amount as per policy. Please tick on instalment (2nd/3rd/4th) whichever is applicable.

Date:……………….. Signature of Centre Head with Centre’s Seal

Please note: To be eligible for reward, you must achieve a grade point average (GPA) of 8.5 (or equivalent grade
point applicable for the University / College you are studying at) or above in every semester.

FOR Attestation by University/Institute/College

Certified that Mr/Ms …………………………………………………….. S/O or D/O ……………………………was studying in……………..... year of
__________________ University/College/Institute and has passed the same. He/she has good moral character.

Date: …………………… Signature of Authorised Person

(With seal of the Institute)
FOR FIITJEE CORPORATE OFFICE ACCOUNTS

Passed for payment of Rs………………………………….. (Rupees……………………………………………………………………………………………………..)

Paid vide Cheque No:…………………………………. Dated …………..…………………..………….. for Rs…………………..………………………….. Drawn
on ……………………………………. Bank ………………………… New Delhi
Processed By Approved By

Name …………………………………….. Name ……………………………………..

Designation …………………………… Designation ……………………………
 Annexure 5B-6M

Documents required to be submitted by the Students at their FIITJEE Study Centre (Academic Operations
Department):

i. A written letter addressed to Centre Head of your FIITJEE Study Centre & duly signed by you
(student) to claim their FIITJEE Reward Amount applicable. This letter must contain name of
their FIITJEE Study Centre, their Enrolment No., details of the achievements.

ii. Filled up Application Form duly attested by concerned IIT or Engineering / Undergraduate
College.

iii. Copy of students Identity Card of IIT or Engineering / Undergraduate College where student is
studying in.

iv. Semester result copy duly attested by IIT or Engineering / Undergraduate College where
student is studying in.

Eligibility Clause: To be eligible to get the further instalments of the Reward, you must achieve a grade
point of 8.5 (or equivalent grade point applicable for the University / College you are studying at) or
above in every semester. However, if you contribute towards promoting brand FIITJEE continuously,
waiving off the condition of securing 8.5 or above grade point in every semester may be considered