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 MERIT CUM-MEANS SCHOLARSHIP 2024-25
Application ID: SSP2024032000178360 Application Date: 28-10-2024
BASIC INFORMATION
Student's Name: MOHAMMAD CHAND Father's Name: MD ISLAM
Date of Birth: 22-10-2003 Mother's Name: ZARINA KHATOON
Gender: Male Annual Family Income: 120000
Marital Status: Unmarried Guardian's / Husband's Name: MD ISLAM
E-mail Id: mdislam7869434@gmail.com Religion: Islam
Mobile No: 6296068885 Aadhaar No XXXXXXXX0238
Class X Registration No: E061100320
ADDRESS INFORMATION
Permanent Address Present Address
Domicile State: WEST BENGAL State: WEST BENGAL
Domicile District: DARJEELING District:DARJEELING
Block/Municipality:Darjeeling(MUNICIPALITY) Block/ Municipality:Darjeeling(MUNICIPALITY)
Permanent Address: SILIGURI Present Address: SILIGURI
Post Office: SILIGURI Post Office: SILIGURI
Police Station: SILIGURI Police Station: SILIGURI
Pin: 734005 Sub Division: Sadar (Darjeeling)
Pin: 734005
ACADEMIC INFORMATION
Previous Academic Information Present Academic Information
Previous Institute Name: SHAMSIA HIGH MADARASAH Institution District :DARJEELING
Previous Class / Course Name: XII Institution Name: Indian Institute of Legal Studies
Previous Year of Study: XII Institution UDISE/AISHE/NCVT Code : C45785
Name of the Board of Current Class / Course Name : BBA. LLB
last Exam Passed: West Bengal council of Higher Secondary Current year of Study :2nd Year
Education Sub Division: Siliguri ( Matigara(BLOCK) )
Year of Passing Last Exam: 2023 Are you a Hosteller: No
% of Marks Obtained Name of the Board / Council / University : University of North Bengal
in Last Examination: 52.04 Course Duration : 5 Year
BANK ACCOUNT DETAILS
IFSC: SBIN0031744
Savings bank account no.: XXXXXXX3574
Name as per bank Account: MOHAMMAD CHAND (Self)
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.120000 . 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 MOHAMMAD CHAND 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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