Pkfas Application Format Renewal

CHECK LIST (RENEWAL APPLICATION)
1.
Name of the Student
2.
Name of the Institution
3.
Year of Admission
4.
Course of Present Study
5.
Category
6.
Phone/Cell No:
7.
Aadhar No
8.
Detail of Financial Assistance Already Availed
Financial Assistance
Availed
E.mail I.D
SC / ST / OBC / MBC / General
:
:
Amount
Sanction Order No. and

Date
Cheque No. and Date
I Year
II Year
III Year
(FOR DIRECTORATE OF HIGHER AND TECHNICAL EDUCATION OFFICE USE ONLY)

9.
Copy of CENTAC Selection Order
Enclosed / Not enclosed
10.
Self Affidavit
11.
Caste Certificate (In case of SC / ST / OBC / MBC)
12.
Attested copies of Mark List for Previous Year

Examination
13.
Application duly filled in
14.
Attested copy of 1st page of Bank Pass Book / Account

Statement
SIGNATURE OF DEALING ASSISTANT
SIGNATURE OF SECTION HEAD
APPLICATION FOR PERUNTHALAIVAR KAMARAJAR FINANCIAL ASSISTANCE

(RENEWAL APPLICATION) ANNEXURE II
[Rule VII (5)]
PERUNTHALAIVAR KAMARAJAR FINANCIAL ASSISTANCE TO THE STUDENTS
STUDYING _______________________________________________ COURSE
1.
Name of the Student (in BLOCK LETTERS)
2.
Institution
3.
CENTAC No. & Year of admission
4.
Students Bank Account Details

(a) Name of the Bank & Branch
(b) Bank Account No.

5.
Last Year Sanction Order No. & Date
6.
7.
Number and Date of Cheque received in the Previous

Year
Course of Present Study
8.
Whether promoted to next higher class?
9.
The date on which he / she joined the class in the current

academic year
The month in which his / her University Examination of
the current academic year will ordinarily be over
(a) Details of marks obtained in the Non-semester /

Semester Examination
(b) Total Number of maximum marks
(c) Marks obtained by the Scholar (Both semester)
(d) Percentage of marks obtained by the Scholar

(Aggregate of both semesters)
12.
Character and conduct of the Student
13.
Specific recommendation of the Principal / Head of the

Institution
10.
11.
Place
Date
Signature of the Head of the Institution

2
CERTIFICATE
(In case where the marks are indicated by Grades or Grade Point Average this Certificate furnished in
addition to the attested copies of the marks lists)
Certified that Thiru / Selvi ______________________________________________________

doing ____________________________________ in _____________________________________
(Name of the College) has secured not less 50% of marks in the aggregate of I and II Semester
Examination / I, II and III Trimester Examination / in the University examination during the Academic year
_____________.
Place
Date
:
CERTIFICATE
(In case the student was absent on Medical Grounds from either of the Semester / Trimester / University
Examination)
Certified that Thiru / Selvi ___________________________________________________ did

not appear for the following examination(s) during the course of the academic year ________________
on valid medical grounds. The Medical Certificate is enclosed.
EXAMINATION
DATE(S)
(i) I or II Semester
(ii) I or II or III Trimester
(iii) University Examination
Certified further that I am satisfied from the general academic performance of the student that
had he / she appeared for (each of) the above mentioned examination(s), he / she would have secured
not less than 50% of the total marks in the aggregate.
Place
Date
NOTE
1. Please not that if the particulars are not correctly furnished, the Annual Progress Report will
be rejected.
2. The Annual Progress Report of each Scholar should be forwarded to the Director of Higher
and Technical Education, Puducherry within one month from the date of publication of
results.
4
SELF AFFIDAVIT
(To be furnished in Stamped Paper worth Rs.5/-)
I, _________________________________ Son / Daughter of ___________________________ ,
Puducherry, under the Sponsored Quota of Government of Puducherry, hereby declare that the
information regarding Residence / Nativity furnished by me along with the applications for the Award of
Perunthalaivar Kamarajar Financial Assistance are true and correct.
Further, I declare that I shall devote my full time to the course of study for which I have applied /
received the Scholarship.
Further, I undertake in the event of particulars given in this declaration being found to be false or
become ineligible for receipt of the Financial Assistance I shall refund the double the amount of the
Financial Assistance received by me to the Government of Puducherry.
Place
Signature of the Student
Date
Name
Address
Witness 1.
Name
Address
Witness 2.
Name
Address

Pkfas Application Format Renewal

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CHECK LIST (RENEWAL APPLICATION)

Name of the Student

Name of the Institution

Course of Present Study

Detail of Financial Assistance Already Availed

SC / ST / OBC / MBC / General

Sanction Order No. and

Cheque No. and Date

(FOR DIRECTORATE OF HIGHER AND TECHNICAL EDUCATION OFFICE USE ONLY)

Copy of CENTAC Selection Order

Enclosed / Not enclosed

Enclosed / Not enclosed

Caste Certificate (In case of SC / ST / OBC / MBC)

Enclosed / Not enclosed

Attested copies of Mark List for Previous Year

Enclosed / Not enclosed

Application duly filled in

Enclosed / Not enclosed

Attested copy of 1st page of Bank Pass Book / Account

Enclosed / Not enclosed

SIGNATURE OF DEALING ASSISTANT

SIGNATURE OF SECTION HEAD

APPLICATION FOR PERUNTHALAIVAR KAMARAJAR FINANCIAL ASSISTANCE

Name of the Student (in BLOCK LETTERS)

CENTAC No. & Year of admission

Students Bank Account Details

(b) Bank Account No.

Last Year Sanction Order No. & Date

Number and Date of Cheque received in the Previous

Whether promoted to next higher class?

The date on which he / she joined the class in the current

(a) Details of marks obtained in the Non-semester /

(b) Total Number of maximum marks

(c) Marks obtained by the Scholar (Both semester)

(d) Percentage of marks obtained by the Scholar

Character and conduct of the Student

Specific recommendation of the Principal / Head of the

Signature of the Head of the Institution

Certified that Thiru / Selvi ______________________________________________________

Certified that Thiru / Selvi ___________________________________________________ did

(ii) I or II or III Trimester

(iii) University Examination

Signature of the Head of the Institution

Signature of the Student

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