Beruflich Dokumente
Kultur Dokumente
ACKNOWLEDGEMENT SLIP
OFFICE COPY
application will be examined for eligibility. The dak receipt number ____________ is to be
ACKNOWLEDGEMENT SLIP
STUDENT COPY
application will be examined for eligibility. The dak receipt number ____________ is to be
Note: This copy duly stamped and signed by RSB / Coast Guard Headquarter is to be
given to the student by hand or by post. (Envelope enclosed alongwith the
application may be used.)
2
MINISTRY OF DEFENCE
Department of Ex-Servicemen Welfare
Brochure-Cum-Application Form
For Academic Year 2010-11
Application Form consists of Col No 1 to 19, Renewal Form and list of RSB / Coast
Guard Headquarter at state and UT level. (Brochure-Cum-Application form consists of
32 pages)
Note: This application form (page number 13 to 19 alongwith required documents only) is to be
deposited by individual to respective RSB / Directorate General of Coast Guard. Applications
duly recommended by RSB’s / Directorate General of Coast Guard shall only be considered by
3
KSB. Therefore, candidates are advised not to forward applications directly to KSB as the same
shall not be considered and will be returned unactioned to individual.
Prime Minister’s Scholarship Scheme has been introduced from the Academic year
2006-07. To encourage higher technical and professional education for the dependent
wards of Ex-Servicemen / Ex-Coast Guard and their widows (below officer rank only)
and dependent wards / widows of Ex-Servicemen / Ex-Coast Guard who died in
harness due to causes attributable to military service / Coast Guard Service,
irrespective of the rank.
2. Scholarships Available.
(a) Dependent wards of ex-servicemen / Ex-Coast Guard and their widows (below
officer rank only)
(b) Dependent Wards / widows of Ex-servicemen & Ex-Coast Guard who died in
harness due to causes attributable to military service / coast guard service,
irrespective of the rank.
Note: (i) The candidate irrespective of his marital status is eligible for PMSS. However,
an earning / serving candidate is not eligible.
One candidate to submit only one application form for one course, if any
candidate submit two application for more than one course, both the
applications will be rejected. Forms are to be downloaded from the website
www.mod.nic.in. Application forwarded on any other format will not be considered.
(d) Minimum Entry Qualification certificate duly attested. (10+2 Marksheet or full
Graduation Marksheet which ever is applicable)
(e) Bonafide studentship certificate from Collage in original as per specimen. (Refer
page number 21)
(f) Postal Order of Rs. 30/- not issued before 01st January 2011.
Note: Failure to attach above mentioned documents / certificate will lead to rejection.
5. Selection Procedure.
7. Eligible Courses.
First year professional degree programme in BE, B Tech, BDS, MBBS, B Ed, BBA,
BCA, B Pharma, etc. duly recognized by the respective government regulatory bodies,
such as All India Council for Technical Education, Medical Council of India, UGC etc
(master degree course are not eligible to apply for Prime Minister’s Scholarship
except MBA, MCA). The scheme is open for courses mentioned above in recognized
institutions (in India only). Students studying abroad are not eligible for this
scheme. Students getting stipend for the professional degree course are also not
entitled. The candidates may avail only scholarship for first degree course
(Professional) i.e. graduate level only under PMSS.
5
The facility under PMSS is restricted for professional courses only, such as B Ed but
not for BA+B Ed, also for LLB not for BA+LLB duly recognized by the respective
Government regulatory bodies such as All India Council for Technical Education,
Medical Council of India etc.
Two to five years as approved by the concerned regulatory body (Except one year for
B Ed).
(i) Rs. 1250/- per month for boys Paid after successful completion of each
academic year.
(ii) Rs. 1500/- per month for girls
Candidate shall submit new Renewal Form alongwith two acknowledgement slip, Bonafide
Certificate (as per Specimen) duly signed by the Principal / Dean / Registrar of the institution
/ college and Photocopy of Passbook to the respective RSBs / Coast Guard Headquarter
either in person or by post for renewal of scholarship for the subsequent academic year.
RSBs / Coast Guard Headquarter will scrutinize and check the application forms and
forward the same complete in all aspects to KSB immediately. RSBs / Coast Guard
Headquarter will issue acknowledgement slip to the candidates at the time of submission of
the application in person or by post. Candidate to attach a self addressed envelope, duly
stamped to receive the acknowledgement of renewal form by post. For easy
comprehension an illustration has been given below:-
* Dates given above are to illustrate an example for easy comprehension and the same
may not be quoted as authority.
7
(a) Checklist duly signed by student & parent is to be attached on the top of the
application form.
(c) The concerned RSBs / Coast Guard Headquarter to scrutinise / check the
application forms with regard to their eligibility criteria prior to forwarding the
same to KSB.
(d) Candidates and RSB’s / Coast Guard Headquarter to note that all
applications received after the due date will not be considered and returned
unactioned.
(f) Two stamped (Rs. 5 each) blank window envelopes of 27x12 cms are to be
attached with each application so as to facilitate correspondence with the candidate by
KSB / RSB / Coast Guard Headquater.
(g) The scholarship is admissible for only two children of ESM / Ex-Coast
Guard. Particulars of all children should be indicated in column 16 of application form.
This should be in uniformity with the Discharge Book / Certificate of the Ex-servicemen
/ Ex-Coast Guard.
(i) The payment of scholarship will be granted after the successful completion of
each academic year and on the submission of the renewal form (in original), as per the
percentages mentioned in ‘Criteria for eligibility’. In case, KSB ask a student to submit
the mark sheet for the full year, a student is liable to produce the same, failing which
the scholarship will be held up. On receipt of renewal for at KSB it may take
approximately two months for processing the form and completing the payment
procedure.
(k) The attached photocopies of the supporting documents should be duly attested
by gazetted officer (unattested documents will not be considered). In case of
legally adopted son / daughter or child born after retirement, the certificates are to be
attached with the application form duly attested by Secretary, RSB / ZSB / Coast
Guard Headquarter.
(m) The Ministry of Defence, Government of India can suitably modify these
instructions to remove anomalies, if any, for successful implementation of the
scheme, as may be necessary from time to time and will be applicable to all
students under the scheme.
(o) The application form should be downloaded from the official website of MOD,
i.e. www.mod.nic.in. The application form should be submitted to the respective
Rajya Sainik Board / Coast Guard Headquarter, (List of RSBs / COAST GUARD
HEADQUARTER is attached along with the brochure) duly completed, along with
a Postal Order (Repeat) Postal Order only for Rs.30/- in favour of Secretary,
Kendriya Sainik Board, payable at New Delhi. In case of any difficulty in obtaining
the form, the same can be obtained from the Secretary / Director Rajya Sainik Board /
Coast Guard Headquarter.
*Note: - The Postal Order should not be issued before 01st January 2011 (the
Postal Order is not refundable in any case).
(p) While filling the application form, leave 1 (one) box blank between 2 (Two)
words. Column wise guidelines are explained further for filling up the application form.
9
(a) A Bonafide certificate from the College/Institute indicating that the candidate
continues to study in the subject course and showing his / her percentage of marks for
which the Prime Minister’s Scholarship has been sought (As per the specimen attach).
(c) Candidate to attach a self addressed envelope, duly stamped to receive the
acknowledgement of renewal form by post.
10
1st Name A J A Y
Middle Name S I N G H
Surname R A N A
Male √ Female
D D M M Y Y Y Y
1 0 0 6 1 9 8 2
(iv) Column – 4. Mention your Rajya Sainik Board and Zila Sainik Board name,
from where your father / mother have registered and have obtained ex-servicemen /
widow identity card (Not for Ex-Coast Guard).
(vi) Column – 6. Write phone number along with STD code and email ID for any
query (email ID is must).
Category - 1 O N E
1 4 5 2 3 6 K
S E R G E A N T
A I R F O R C E
(ix) Column – 9. Details of 10+2 or MEQ. Leave blank space between words.
Marks to be shown in words and figures.
a. Total Marks O N E T H O U S A N D
11
(in words) T W O H U N D R E D
(in figure) 1 2 0 0
b. Marks obtained N I N E H U N D R E D
(in words) F O R T Y
(in figure) 9 4 0
c. % of marks scored S E V E N T Y E I G H T
(in words) P O I N T T H I R T Y
T H R E E
(in figure) 7 8 . 3 3
Yes √ No
(xi) Column – 11. The student is to specify the course which he / she is presently
studying. (Example:- B TECH)
B T E C H
(xii) Column – 12. Duration of the course both in numbers and figures to be
mentioned (without Internship). For example 4 years 6 months.
(In figure)
Y Y M M
0 4 0 6
(In word)
F O U R Y E A R S A N D S I X
M O N T H S
(xiii) Column – 13. Write date of commencement & completion of course as shown
below:
(xiv) Column - 14 Write the full name and address of the college with email ID and
phone number of principal.
Name of Student A J A Y S I N G H R A N A
Roll No. 0 8 E A T I T 0 4 3
Name of College A J M E R I N S T I T U T E
O F T E C H N O L O G Y
12
Full Address P U S H K A R B Y P A S S A
of college J M E R
State R A J A S T H A N
Pin Code 3 0 5 0 0 4
College Website w w w . a i t a j m e r . c o m
A I C T E
(xvi) Column – 16. Furnish the particulars of your all children as per specimen
given:-
(xvii) Column – 17. Given details of the scholarship availed by your brother /
sister in the past, if not availed write Not Applicable.
Sl. Selection Name of the Course of Academic year Amount
No. Serial No. brother/sister Study in which received so far
given by KSB applied
1. 6359 Satish Singh Rana B Tech 2007-09 15000
Issue D D M M Y Y Y Y
Amount (Rs.) in figure 3 0 Date 1 4 1 2 2 0 1 0
1. Candidates / ESM / Ex-Coast Guard are to ensure that the following documents
are attached (as applicable) along with the Application Form (non submission of these
certificate will lead to rejection and application will be returned unactioned).
(a) Attested copy of Ex-Serviceman / Ex-Coast Guard & Widow I-card issued by
RSB / ZSB / Coast Guard Headquarter.
This is an important document to be attached.
(c) If child born after discharge then affidavit is to be submitted by ESM / Ex-Coast
Guard, that child is dependent on him and he / she is a ward of ESM / Ex-Coast Guard.
(g) In case of MBA / MCA applicants, attested copy of minimum entry qualification
certificate. i.e Graduation
(i) Postal Order of Rs. 30/- (Rupees Thirty only) attached. (Application form without
Postal Order will not be processed and Postal Order should not be made before 01st
January 2011.)
Date: _____________________
_______________________________
Place: ____________________ Full Name & Signature of Candidate
14
_______________________________________
Checked / counter singed by ESM / Ex-Coast Guard / Widow
___________________________ _______________________________
_______________________________
_______________________________
_______________________________
____________________ ______________________________
__________________________________________________________________________
1. NAME:-
First Name
Middle Name
Surname
15
4. Your Rajya Sainik Board or Zila Sainik Board (Where ESM is registered and obtained Ex-
servicemen Identity card)
RSB
ZSB
5. Full Address:
a) Present Correspondence Address: - (Where you want your letter to be sent in case of
selection / rejection)
House No.
Tehsil
District
State
Pin Code
16
b) Permanent Address :-
House No.
District
State
Pin Code
6. Telephone Number.
STD Code
Mobile No.
E-Mail (mandatory)
7. Ex-servicemen / Ex-Coast Guard Category - (Mention category as per Para 6 of the brochure
and attach supporting documents duly attested).
a) Name of ex-serviceman /
Ex-Coast Guard
b) Service No.
c) Rank
d) Type of Service (Tick one) Army Air Force Navy Coast Guard
(in figure)
(in figure)
(in figure)
10. Whether the applicant is in receipt of any other financial assistance/scholarship/ fellowship
from any govt. / Private source for the course to which the scholarship applied for. If yes, then
state the amount and source
D D M M Y Y Y Y
a) Course commenced on
D D M M Y Y Y Y
b) Course completion date
approximately
Name of Student
Roll No.
Name of College
18
Full Address
of college
State
Pin Code
College Website
15. Regulatory bodies/ Council. (For example all engineering degrees and management
degree courses are recognized by AICTE & UGC and all medical degree are recognized
by Medical Council of India or Dental Council of India, specify as per case).
16. Furnish particulars of all children in order of age, as reflected in the discharge
book or attached a certificate in case child born after discharge, by the RSB / ZSB /
Record Office / Coast Guard Headquarter, as applicable.
17. Details of brother/sister availing the PM’s Scholarship, if any. (Including yourself if
granted earlier)
19. Declaration: “Certified that the particulars given by me in the application are correct
and any false statement made by us will disqualify me / my ward for award of PM’s
Scholarship Scheme, besides recovery of scholarship already paid. I also undertake to
abide by the conditions mentioned in the general instructions of the scheme.”
“It is certified that PM Scholarship application form for academic year 2010 - 11 in
checked, found correct as per check list provided by KSB and the applicant is eligible to apply
Place: ________________
Date : ________________
21
Date:- ______________
Place:-_____________
1. Type of :
_______________________________________
Service (Army, Navy, Air Force or Coast Guard)
2. Service No. :
_______________________________________
3. Rank :
_______________________________________
5. Trade :
_______________________________________
6. Date of enrolment :
_______________________________________
7. Date of Discharge :
_______________________________________
9. Duration/Length of Service :
_______________________________________
10. Regular :
_______________________________________
Reserve
It is certified that the above information is duly checked from the discharge book of Ex-
servicemen / Ex-Coast Guard and found to be correct.
Office Seal:
Date: ________________________
Place: ______________________
* Note:- If the marks in the qualifying examination are expressed in grades only,
then equivalent percentage (100 point scale) duly certified by the concerned college /
Board must be furnished (RSB, Coast Guard Headquarter & KSB will not be calculating
the percentage of marks).
2. Account Details.
All candidates to open individual bank accounts in the nearest State Bank of India branch
or Punjab National Bank which has “electronic clearance system” / Core Banking, to
facilitate transfer of the scholarship amount. Account number of the sister concern bank will
not be accepted. i.e State Bank of Travancore, State Bank of Bikaner & Jaipur, etc.
Candidate to attach a attested photocopy of passbook, showing name and account number
of the individual. A cancelled leaflet of a blank crossed cheque will duly authenticate the
account number. A joint account with parent will also fulfill the requirement.
24
DOCUMENTS TO BE ATTACHED WITH RENEWAL FORM:
(a) A Bonafide certificate from the College/Institute indicating that the candidate continues
to study in the subject course and showing his / her percentage of marks for which the
Prime Minister’s Scholarship has been sought (As per the specimen attach).
(c) Candidate to attach a self addressed envelope, duly stamped to receive the
acknowledgement of renewal form by post.
________________________________
Full Name & Signature of the Candidate
ACKNOWLEDGEMENT SLIP
OFFICE COPY
application will be examined for eligibility. The dak receipt number ____________ is to be
ACKNOWLEDGEMENT SLIP
25
STUDENT COPY
application will be examined for eligibility. The dak receipt number ____________ is to be
Note: This copy duly stamped and signed by RSB / Coast Guard Headquarter is to be
given to the student by hand or by post.
Name of ESM /
Ex-Coast Guard
Rank
Service Number
Distt
State
Pin Code
6. Details of Bank account of SBI or PNB for Electronic Clearing Services ( (PLEASE ATTACH A
PHOTOCOPY OF PASS BOOK, CROSSED BLANK CHEQUE SHOWING YOUR ACCOUNT NUMBER TO
BE FORWARDED, EVEN IT IS SUBMITTED EARLIER).
Bank Name
Branch Address
State
Branch Code
Account No.
REPEAT
Account No.
27
Place:_____________________ ________________________________
mahasainik@dataone.in
31
dsw@mahasainik.com
Secretary
Rajya Sainik Board Imphal-
19 MANIPUR Sainik Rest House
Opp. Lamphel Police Station, PO- 0385-2416228 (O)
Lamphel, Imphal-795004
Shillong-
Director
0364-2225613 (O)
Dte of Sainik Welfare
0364-2225613 (F)
20 MEGHALAYA Public Service Commission
Building Beyond DC Building
rsbmegha@rediff.com
Shillong - 793 001
Aizawl-
Director
0389-2322732 (O)
Deptt of Sainik Welfare & Res,
21 MIZORAM 0389-2322732 (F)
Tuikual ‘A’, PB No. 119
Aizawl - 796 001
rsbmizoram@yahoo.in
Kohima-
Secretary
0370-2270029 (O)
Rajya Sainik Board, Home Deptt,
22 NAGALAND 0370-2270029 (F)
Home Br, Nagaland Civil Sectt.,
Kohima - 797 001
secyrsb-ngl@nic.in
Bhubaneshwar
Secretary
0674-2432268 (O)
Rajya Sainik Board, Nageswar
23 ORISSA 0674-2435998 (F)
Tangi, Lewis Road,
Bhubaneshwar-751002
secyrsbors@rediffmail.com
secyrsbbbsr@gmail.com
Puducherry
Director
Deptt of Sainik Welfare 0413-2253107 (O)
PUDUCHERRY
24 Jawan Bhavan Complex, Lawspet 0413-2250575 (F)
(UT)
Main Road, Pakkamudayanpet,
Puducherry - 605 008
dswpuducherry@gmail.com
25 PUNJAB Director Chandigarh
Dte of Sainik Welfare, Punjab
Punjab Sainik Bhawan, Sector 0172-2701845 (O)
21-D, Chandigarh - 160 022 0172-2707345 (F)
0172-2706014 (F)
32
dswpb@rediffmail.com
ddhq@rediffmail.com
ddmpb@rediffmail.com
Jaipur-
Nideshak
Sainik Kalyan Vibhag 0141-2227897 (O)
26 RAJASTHAN
Secretariat Building, North Block, 0141-2227650 (F)
Jaipur - 302 005
rajasthansainik@yahoo.com
Gangtok-
rsbsikkim@ymail.com
Chennai-
Joint Director
044-26691747 (O)
Dte of Ex-Servicemen’s Welfare
28 TAMIL NADU 044-26691886 (O)
22, Raja Muthiah Salai, Choolai
044-26691886 (F)
Chennai - 600 003
exweldte@tn.gov.in
Agartala
Secretary
Rajya Sainik Board, Nehru Office 0381-2326507 (O)
29 TRIPURA Complex, Gorkhabasti, P.O. 0381-2326507 (F)
Kunjaban, Agartala - 799 006
West Tripura rsb_sainikboard@rediffmail.com
rsb.tripura@gmail.com
Lucknow-
Director
0522-2625354 (O)
UTTAR Dte of Sainik Kalyan Evam
30 0522-2625354 (F)
PRADESH Punarvas, Kariappa Bhawan,
0522-2305107 (F)
Kaiserbagh, Lucknow - 226 001
directorsainikkalyan@yahoo.com
Dehradun-
Director
0135-2744208 (O)
Sainik Kalyan Evam Punarvas
31 UTTARAKHAND 0135-2743773 (F)
Uttarakhand, 15C, Kalidaas Marg,
0135-2741481 (O)
PO-Haathibadkala,
Dehradun - 248121
dskddn@gmail.com
32 WEST BENGAL Secretary Kolkata-
Rajya Sainik Board, Block 'I'
(First Floor), Writers’ Building 033-22141347 (O)
Kolkata - 700 001 033-22144643 (F)
033-22143220 (O)
33
rsbkolkata@yahoo.com
rajyasainikboardwestbengal@gmail.c
om
Note:
Dadar Nagar Haveli: ESM of these states can submit their Prime Minister Application form to
Gujrat RSB.
Daman & Div
Lakshadweep: ESM of this state can submit their Prime Minister Application form to
Kerala RSB.