Yashasvi (4)

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JSP Foundation
YASHASVI- Women Education & Skill Development Scheme:
(a) Candidate’s Name: (as on Aadhar Card)

Ms. Mrs.
First Name
Middle Name
Last Name
(b) Mobile no: _______________________________________________________
(c) Father’s Name & Occupation:
_______________________________________________________
(d) Mother’s Name & Occupation:
_______________________________________________________
(e) Husband’s Name & Occupation: (Applicable for married candidates only)
_______________________________________________________
(f) Date of Birth
1. Permanent Address:
Vill: P.O: Block:

Dist: State: Pin:
2. Email Address:
3. Aadhar Number :
Alternate ID Proof: (a) Voter Card No………………..……………… (b) Pan Card No…................................
4. Educational Qualification:
(a) General
Statement of Marks (Please attach the mark sheet)

Sl. Name of the course Institution Name Year of Total Obtained %
No completion Mark Mark
(b) Professional
5. Work Experience (if any) ……………………………………………………..
6. Current Monthly Income (In Rupees, if applicable)…………………………………………..
7. Bank details of the Candidate & Institutions:
Applicant Institution
Name
Bank A/C
Number
IFSC Code
Bank Name
Branch Address
8. Pre-existing health condition: No: _____Yes:_______________
If Yes, Details:____________________________________________________________________
9. Course Applied for: ………………………………………………………………….
a) Tenure of Course: ………………………………………………………………….
b) Present status of study (please specify which year of the course) ……………………………………………
10) Institutions imparting Courses in order of preference with correspondence address/ contact
details (pls. specify 2 options only):
Institute a)
……………………………………………………………………………………………………………...................................
…………………………………………………………………………………………………………………………………………………
Website:
…………………………………………………………………………………………………………………………………………………
Institute b)
………………………………………………………………………………………………………………………………………………
………………………………………………………………………………………………………………………………………………………
Website:
………………………………………………………………………………………………………………………………………………...
11. Course Fees as stipulated by the Institution (Monthly/ Quarterly/ Yearly/ One Time) (Eligible
applicants to submit Fee structure of admitted course duly signed by Principal / Head of the Institution)
.…………………………………………………………………………………………………………………………………………………
12. Amount of Financial support applied for (In Rupees Only):

……………………………………………………………………………………………………………………………………………………..
13. Income of Parents /Spouse (To be issued by a competent Revenue Authority and source of
such income:………………………………………………………………………………………………………………………………….
15. Reasons for applying for financial support from JSP Foundation for the vocational course/
higher studies:
………………………………………………………………………………………………………………………………………………….
Declaration
I declare that the entries made by me in this form are true to my knowledge and understand that
I am liable for action under the law for any false information or documents produce by me.
I also understand that the JSP Foundation shall be free to investigate on its own the correctness
of information furnished by me in this application and /or call for any further information in this
regard from me.
During such investigation or at any subsequent stage, JSP Foundation may refuse to issue the
certificate or if already issued, may cancel the same and I shall stand debarred from the scheme.
I also declare that I know and fully understand about the scheme offered by JSP Foundation.
My selection will entirely be based on the various criteria specified by JSP Foundation and the
Expert Committee. I also understand that this is an application form only which means selection
is not guaranteed by JSP Foundation
Place…………………………… Signature of Candidate:
Date…………………………….. Name:
Name, Contact Number and Signature of Mother along with identity proof:
Name, Contact Number and Signature of Father/ Spouse along with identity proof:
Name, Contact Number and Signature of Guardian/Witness along with identity proof:
Essential Documents to be attached with the filled in application
(Absence of any listed documents will result in the invalidation of the application)
 Complete filled in form in the prescribed format ( Incomplete forms will be treated as invalid)
 Self-attested photocopies of certificates of marks of Previous Exams passed :
 Residential proof certificate from the Block/ District :
 Bonafide certificate from the school/ college along with the fee structure :
 Annual family income certificate by appropriate authority :
 Self-declaration in the form of affidavit regarding non -receipt of scholarship from any :
other sources by the student duly endorsed by concerned authorities (sample copy attached) :
 Photocopy of Ration card. :
 Photo copy of Bank pass book of applicants & Institutions duly signed by Principal & Institution
Head with their Seal (Account No., IFSC, Branch name). :
 Pass port size photograph :
 Photocopy of Aadhar card of candidate and parents/spouse :
Filled in Application can be forwarded to: info.education@jsplfoundation.com

Sample form for AFFIDAVIT (above 18 years girl)
AFFIDAVIT
I, Ms. …………………………………………………………………………….…… a student of Institution
………………………………………………………..……………..……………………..……Department…………..………………...,
bearing Institute Roll No. ………………………. during the session ……………………….., do hereby solemnly
declare that I will strictly adhere to the rules and regulation for grant of “YASHASVI” which has been
published in JSP Foundation website and undertake that:
1. The income of my family is not more than 2 Lakh.

2. I am not in receipt and will not be receiving any other scholarship/stipend/ financial
assistance, etc. from any other sources. In case, I get any in future, I shall immediately
report to the authorities of JSP Foundation
3. I declare that I shall continue and complete my studies for which I have been supported by
JSPFoundation under this Special YASHASVI program.
4. The information which was given by me in prescribed format, the detail copy of documents
submitted/will be submitted with JSP Foundation for the said program are correct. In the
event of those being found to be forged or if I violate the terms and conditions of the Scheme,
the Financial Assistance sanctioned to me, may be cancelled and the entire amount will be
refunded by me and shall be subsequently transferred to JSP Foundation by me or the same
can be recovered from me by JSP Foundation along with interest as per the prevailing SBI
MCLR, apart from liability for such penal action as warranted by law.
5. In case, I dropout from the program before completion of the course, I shall be legally bound
to refund the money paid to the Institution/ self under the program to the JSP Foundation
with interest as stated in the above point.
6. I agree that my selection is based on the criteria specified by the Foundation, however, it is
solely at the discretion of the JSP Foundation whether or not to support me / my education
finances.
Signature of Guardian in full: Signature of Student in full:
Name (in Block letter): Name (in Block letter):
Witness 1: Name : Signature :

Date:
Sample form for AFFIDAVIT (Below 18 years girl)
AFFIDAVIT
I ………………………………………………………………. Father/ Mother, of Ms.…………………………………….… a

student of Institution ……………………………………………..……………………..…… Department
…………..………………..., bearing Institute Roll No. ………………………. during the session ……………………….., do
hereby solemnly declare that my daughter will strictly adhere to the rules and regulation for grant of
“YASHASVI” which has been published in JSP Foundation website and undertake that:
1. My family income is not more than 2 Lakh.

2. My daughter is not in receipt and will not be receiving any other scholarship/stipend/
financial assistance, etc. from any other sources. In case, she gets any in future, I shall
immediately report to the authorities of JSP Foundation
3. I declare that my daughter will continue and complete her studies for which she has been
supported by JSPFoundation under this Special YASHASVI program.
4. The information which was given by her in prescribed format, the detail copy of documents
submitted/will be submitted with JSP Foundation for the said program are correct. In the
event of those being found to be forged or if she violate the terms and conditions of the
Scheme, the Financial Assistance sanctioned to her/ institution, may be cancelled and the
entire amount will be refunded by me and shall be subsequently transferred to JSP
Foundation by me or the same can be recovered from her by JSP Foundation along with
interest as per the prevailing SBI MCLR, apart from liability for such penal action as warranted
by law.
5. In case, she dropouts from the program before completion of the course, I shall be legally
bound to refund the money paid to the Institution/ self under the program to the JSP
Foundation with interest as stated in the above point.
6. I agree that my daughter’s selection is based on the criteria specified by the Foundation,
however, it is solely at the discretion of the JSP Foundation whether or not to support my
daughter/ her education finances.
Signature of Father/Mother in full:
Name (in Block letter): Name of Student:

Date:

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(a) Candidate’s Name: (as on Aadhar Card)

(b) Mobile no: _______________________________________________________

(c) Father’s Name & Occupation:

(d) Mother’s Name & Occupation:

(f) Date of Birth

Vill: P.O: Block:

Statement of Marks (Please attach the mark sheet)

5. Work Experience (if any) ……………………………………………………..

6. Current Monthly Income (In Rupees, if applicable)…………………………………………..

7. Bank details of the Candidate & Institutions:

9. Course Applied for: ………………………………………………………………….

a) Tenure of Course: ………………………………………………………………….

12. Amount of Financial support applied for (In Rupees Only):

Place…………………………… Signature of Candidate:

Essential Documents to be attached with the filled in application

Filled in Application can be forwarded to: info.education@jsplfoundation.com

1. The income of my family is not more than 2 Lakh.

Signature of Guardian in full: Signature of Student in full:

Name (in Block letter): Name (in Block letter):

Witness 1: Name : Signature :

I ………………………………………………………………. Father/ Mother, of Ms.…………………………………….… a

1. My family income is not more than 2 Lakh.

Signature of Father/Mother in full:

Name (in Block letter): Name of Student:

Witness 1: Name : Signature :

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