West Bengal Minorities' Development and Finance Corporation

A statutory Corporation under Minority Affairs & Madrasha Education Department, Government of West Bengal
"Amber", DD/27E,Salt Lake City Sector-I, Kolkata-700064, Toll free No:-18001202130

AIKYASHREE (FRESH)
APPLICATION FOR WB PRE MATRIC SCHOLARSHIP 2023-24
Application ID: SSP2023010606073288 Application Date: 09-10-2023
BASIC INFORMATION
Student's Name: PRIYA KHATUN Father's Name: ATAUR RAHMAN
Date of Birth: 13-12-2016 Mother's Name: NURBANU KHATUN
Gender: Female Annual Family Income: 60000
Marital Status: Unmarried Guardian's / Husband's Name: ATAUR RAHMAN
E-mail Id: Religion: Muslim
Mobile No: 8293315750 Aadhar No XXXXXXXX8818
Name as per Aadhaar: PRIYA KHATUN
Bangla shiksha ID: 01831622000355
ADDRESS INFORMATION
Permanent Address Present Address
Domicile State: WEST BENGAL State: WEST BENGAL
Domicile District: MURSHIDABAD District:MURSHIDABAD
Block/Municipality:Farakka(BLOCK) Block/ Municipality:Farakka(BLOCK)
Permanent Address: PACHULAGRAM Present Address: PACHULAGRAM
Post Office: BHABANIPUR Post Office: BHABANIPUR
Police Station: FARAKKa Police Station: FARAKKa
Pin: 742202 Pin: 742202
ACADEMIC INFORMATION
Previous Academic Information Present Academic Information
Institution District :MURSHIDABAD
Institution Name: PANCHULAGRAM PRY
Institution UDISE/AISHE/NCVT Code : 19072107201
Current Class / Course Name : I
Current year of Study :I
Are you a Hosteller: No
Name of the Board / Council / University : WEST BENGAL BOARD OF
PRIMARY EDUCATION
Course Duration : 1 Year
BANK ACCOUNT DETAILS
IFSC: CBIN0284548
Savings bank account no.: XXXXXXX2278
Name as per bank Account: ATAUR RAHMAN (Father)
Declaration:I hereby declare that the details furnished above are true and correct to the best of my knowledge and belief and I
have not applied for any other scholarship/stipend, etc. from any other government sources(one-student-one-
scholarship).NB:The application of student applying for more than one scholarship application/scheme is liable to be rejected.

___________________
Signature of Student
DECLARATION OF INCOME
(To be given by the parents/ guardians)

Certified that the gross annual income from all sources in respect of my family is Rs.60000 . I further undertake that in the
event of the particulars given in the declaration being found false, I shall refund the whole amount of the Scholarship paid to
the said Scholarship holder PRIYA KHATUN and the Government's decision in this regard shall be final and binding on me.

__________________________
Signature of the parents/ guardian
Instruction
Student is to submit this ***computer-generated filled-in application form (duly signed) to the educational
institution along with following supporting document within 7 days:

1. Photocopy of the bank-passbook where the details of bank a/c number,IFSC are mentioned clearly.

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