RABARI ENGINEERS’ ASSOCIATION

Loan Scholarship/Renewal of loan scholarship (RESU V) 2019-20

Personal Details:
1. Student Name: ____________________________________
2. Residence & present Address: Photograph

________________________________________________________________________
______________________________________________
3. Contact No: _____________________(M)______________________
4. (a) Father Name:_______________________________________
(b) Occupation: ____________________ (M) ________________
5. (a) Mother Name:______________________________________
(b) Occupation: ____________________ (M) ________________
6. E-mail id:___________________________________________________
7. Age:_______________________________________________________
8. Birth Date:_______________________________________________________________
9. Native :__________________(Ta.)__________________(Dist.)_____________________
10. Student’s Bank Account Details:
(a) Student’s Bank A/C No: ____________________________ (b) IFSC code:_________
(c) Name of Bank: _________________ (d) Brach name: ________________________
(e) City/Village: ___________________ (f) Dist: ___________________

Educational Details:
1. DIPLOMA/DEGREE:___________________________________
2. Discipline : _____________ Semester/Year:______________
College Name: ______________________________________
: ______________________________________
3. Enrollment Roll No of GTU /Other University record(s):_________________
4. Student ID No as per GTU /Other University record(s): _________________

Source(s) of Income:

Father/Parents Combine Income [Annual] : Rs.

Brother/Sisters Income: (if any) Rs.
Details of any other Scholarship if received Rs.

Please provide two reference REA Engineers for recommendation

Name-1:___________________post____________________(M)_________________
Name-2:___________________ Post____________________(M)_________________
Examination Details:

EXAMINATION UNIVERSITY/ BOARD YEAR OF PASSING RESULT

( PERCENTAGE )
S.S.C G.S.H.E.B/CBSE
H.S.C G.S.E.B/CBSE
Diploma
GUJCET/IIT-JEE
Sem I
Sem II
Sem III
Sem IV
Sem V
Sem VI

Expenditure Details:total Scholarship Required per year Rs._________

College/University Tuition Fees:Rs

Examination Fees:Rs
Hostel Fees/Transportation Rs
Approximate Study material Cost:
[ Basically includes Textbooks and
Stationary needs / misc if any] Rs
Family Details

Sr Name Relation DOB/Age Education Occupation

1
2
3
4

Date Signature
Contact/Postal address for sending the filled form(s):
Mr. AMRITBHAI DESAI President REA (M) 9409285131, E-mail: amritdesai51@gmail.com
28, Vinayak bunglows, Nr. Crossing Sola Road, Ghatlodiya, Ahmedabad 380061
Mr. RAGHUBHAI DESAI (M) 9426415192 ,PROF. DIPAK RABARI (M) 8866667150, E-mail:
dipakrabari5403@gmail.com
NOTE: Please attach the photocopies of 1.SSC, HSC, Diploma/Degree last semester exam mark sheets , 2.College
Fees Receipt, other expenditure receipt, 3.Parents income certificate4. Xerox copy of Blank cheque or pass book
first page.5. College ID card, Application will be rejected, if the student is not eligible, based on the scrutiny of
documents by our reviewing committee. Preference will be to Govt college student ( Please attach 1-5
documents compulsory ,without these documents application will be rejected straightway )